Health service innovation in City of Makassar
Muhammad Yunus
, Saenab, Andi Ahmad Yani, Sangkala, Suryadi Lambali, Lutfi Atmansyah, Muhammad Tang Abdullah, Amril Hans, Andi Rahmat Hidayat
Corresponding author
Department of Administrative Science, Hasanuddin University, Indonesia
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On the other hand, the public sector with all its inflexibility is also experiencing demands for change, to be more flexible, better ability to respond to challenges, changes and dynamics that occur in society. Increasing citizens’ awareness of their rights, as well as the level of education, literacy, health, welfare and other socio-economic aspects have forced the public sector to compensate the policy and quality of services equal to the capacity of its citizens.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Innovation has become a real practice that makes governments everywhere have a much better performance. That is, innovation becomes an option most rational to avoid a country from various forms of failure. Innovation is no longer an option, but rather a duty and a necessity for the government in all lines and all levels. It is no exaggeration to say that innovation is the answer to every problem faced by public sector.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In general, understanding innovation is doing the process of renewal, utilization, development by creating new things different from before. Damanpour explained that innovation could be a new product or service, a new production process technology, a new structure and administration system, or a new plan for members of the organization.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In line with that, Rogers points out that an innovation is an idea, practice, or object that is perceived as new by individual or another unit of adopter.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It can be said that innovation is an idea, practice, or object that is considered new by the individual of another adoption unit. The concept of innovation which addressed by Damanpour and Rogers shows that innovation can be tangible or intangible. So, the dimension of innovation is vast. Understanding innovation as appropriate that only synonymous with technology alone will be narrowing the context of actual innovation.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the current global era where changes are so rapidly happening, it is too late and harming society without innovated service. Innovative Health services provide better opportunities and speed to the community. Therefore, innovation must be done by adjusting the demands and needs of the community.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In order that innovation of health services will reach the public health, it needs to be more effective and efficient to serve every need of society appropriately and without wasting energy and budget.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The innovation of health services is necessary because it influences productivity of society and also can contribute to poverty, particularly in low levels of community welfare.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Therefore, the local government should make breakthroughs and innovations in improving services to public health, particularly the Government of Makassar City.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Makassar is a gateway position of Eastern part of Indonesia and has 1,408,072 inhabitants.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Makassar has 14 sub-districts and 143 villages. With this area, the people of Makassar were exceedingly burdened when they get sick. Before the home care Program was launched in May 2014, the citizens of Makassar should strive to reach a health care center in the city. Even in urban areas, with a hectic condition, health care centers cannot reach all citizens of Makassar.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The home care program was created to break the isolation of health services Makassar actually located in urban areas. Homecare Program in Makassar was initially developed by Danny Pamanto, Major of the City of Makassar, and implemented by the Health Agency and the Health Community Center. The program is considered auspicious in its implementation as a reference which can be emulated by local governments. The home care health service innovation was implemented for all citizens of City of Makassar and promoted by using a brand as “<span class="elsevierStyleItalic">Dottorotta” –</span> a local dialect which literally means “our doctor.” The home care <span class="elsevierStyleItalic">Dottorotta</span> program is a health service undertaken by door- to door visit in 24<span class="elsevierStyleHsp" style=""></span>h services based on call phone in all sub-districts of the City of Makassar. This study aims to explore in what extent <span class="elsevierStyleItalic">Dottorotta</span> homecare as health service innovation contributes to City of Makassar Government's quality of health service improvement.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Research location</span><p id="par0035" class="elsevierStylePara elsevierViewall">This research was conducted at the Health Agency of Makassar City and four health community centers in Makassar City in two different areas. The first two health community centers are located in the urban areas of Makassar, namely the Batua Health Center and the Kassi-Kassi Health Center.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Data collection techniques</span><p id="par0040" class="elsevierStylePara elsevierViewall">The field study was carried out to collect primary and secondary data. Primary data is collected through interview and observation methods. Secondary data is collected from documents to clarify primary data. The interview method was conducted using the in-depth interview method with the snowball system to get informants involved in the <span class="elsevierStyleItalic">Dottorotta</span> Homa care program</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results and discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">The initiative of the Makassar City Government to create the <span class="elsevierStyleItalic">Dottorotta</span> Home Care program to respond to complicated problems in health services in Makassar City, particularly in marginal and urban slum areas. The word of <span class="elsevierStyleItalic">Dottorotta</span> means our doctor, which represents the city government provides health service directly to the community. The <span class="elsevierStyleItalic">Dottorotta</span> Home Care Program approach was conducting with proactive care system that aims to improve the quality of health services and maximize function of health community centers.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Dottorotta</span> teams are in charge of all forty six health center community in each sub-district of Makassar city and supported by a non-ambulance operational car. Each team consists of a doctor, two nurses, and a driver. Doctors and nurses who are employees in each health center. The commitment of the Makassar City Government to improve health services with the <span class="elsevierStyleItalic">Dottorotta</span> Home Care Program is carried out by making a legal basis through the Makassar Mayor Regulation Number 63 of 2015 concerning 24-h home visit services. This policy emphasizes the maximization of the functions of the community health center at the sub-district level as a type of first-level health service facility that has an important and strategic role in providing health services to the community.</p><p id="par0055" class="elsevierStylePara elsevierViewall">People of Makassar support the <span class="elsevierStyleItalic">Dottorotta</span> home care program as a program that enhance their access to health services, especially for elderly and vulnerable groups. In order to get health assistance from the team, a citizen can call emergency number 112, which later connected with the <span class="elsevierStyleItalic">Dottorotta</span> Team at the nearest health center to provide help. As a citizen said:<span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Now it is easier to get health services with the Homecare Dottorotta Program. If there are neighbors who need help, we call 112, and officers will come to the house to provide health assistance (Informant 10, 05 May 2017).</span></p></span></p><p id="par0060" class="elsevierStylePara elsevierViewall">This study analyzed the application of Dottorotta home care programs in two community health centers. The first case is the Batua health center in Panakukang sub-district. This area is inhabited by 147,783 residents with an area of 117.01<span class="elsevierStyleHsp" style=""></span>km<span class="elsevierStyleSup">2</span>.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Based on data from the Batua health center, the Dottorotta Team has served 433 patients and none have been referred to the hospital. This data shows that the Dottorotta Program succeeded in providing patient care through a visit program and reduced treatment visits to hospitals. Comparing data of the <span class="elsevierStyleItalic">Dottorotta</span> team's patients with other health centers, the Batua Health Center has served most significant number of patients in 2015, namely 433 patients. In 2016, patients number decreased to 212 patients and only 33 patients at the beginning of 2017 (January to March).</p><p id="par0065" class="elsevierStylePara elsevierViewall">The second case is the Kassi-kassi community health center. The <span class="elsevierStyleItalic">Dottorotta</span> home care Team Services are supported by four teams, each consisting of three staff from the health center. Each team consisted of a doctor, a nurse, and a health worker serving six villages with 83,000 residents. In 2016 the Kassi-Kassi community health center managed to serve 71 patients treated and seven patients referred that were total visit of 78 patients. In 2017 from January to March, the Kassi-Kassi community health center visited 34 times, with 30 patients treated while four other patients were referred to the hospital.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Based on the two cases above, this study identifies that the innovation of health services of the <span class="elsevierStyleItalic">Dottorotta</span> home care program contributes to improving the quality of health services in Makassar City. Nevertheless, this study indicates three main obstacles to this innovation program. The first obstacle is excessive dependence on the mayor as the initiator of the health service innovative program. The <span class="elsevierStyleItalic">Dottorotta</span> Home Care Program was initiated by the Mayor of Makassar – Danny Pomanto – which aims to change the mindset and culture of the bureaucratic apparatus, especially in the Health Office. Danny wants the old bureaucracy's slow mindset to change to a more responsive mindset. Thus, the health service innovation program is dominated by the initiative of Mayor Danny, which means that process of change was initiated from the top. The dominance of Mayor Danny's initiative in this health service innovation program will actually become a boomerang because the bureaucratic apparatus tends to depend on a dominant leader. This condition will make the bureaucracy officials will only carry out their duties properly only if monitored by the leader.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The second obstacle is the limited number and capacity of human resources. 24-hour home care services require the number of health workers who are available when they receive reports from the public to be served. Doctors and nurses on duty at the health center on a regular schedule also work on the <span class="elsevierStyleItalic">Dottorotta</span> home care team. This condition makes the workforce of health workers excessive because they have to serve the community at the health center and also serve residents at home through the <span class="elsevierStyleItalic">Dottorotta</span> home care program. Excessive work hours become an obstacle when the number of workers is still limited but not proportional to the number of residents who must be served. This condition makes Dottorotta services often slow in responding to requests for citizens’ health assistance. As informant 5 states that:<span class="elsevierStyleDisplayedQuote" id="dsq0010"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">“<span class="elsevierStyleItalic">I once called the Dottorotta team to come home to provide medical assistance because my family needed treatment. The health team is plodding because they have to wait for doctors to finish working hours of service at the primary health center”</span> (Informant 6, 17 May 2017).</p></span></p><p id="par0080" class="elsevierStylePara elsevierViewall">The third obstacle is the amount of reward given to <span class="elsevierStyleItalic">Dottorotta</span>'s Home Care Team service personnel is relatively small, and sometimes the staff is late in receiving a fee for their additional service duties. One official of the Dottorotta Team said that:<span class="elsevierStyleDisplayedQuote" id="dsq0015"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">”<span class="elsevierStyleItalic">I have not received any incentive from Home Care for several months. There is usually an additional fee of 500 thousand rupiahs per month</span>” (Informant 15, 19 June 2017).</p></span></p><p id="par0085" class="elsevierStylePara elsevierViewall">The low honorarium and the late payment of honorariums to the Dottorotta health team will have an impact on the low quality of the home care team's services. As net result, it can reduce the quality of public health services.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="par0090" class="elsevierStylePara elsevierViewall">This study shows that the <span class="elsevierStyleItalic">Dottorotta</span> Home Care program is a health service innovation which contributes to improves the quality of health service in Makassar. However, the <span class="elsevierStyleItalic">Dottorotta</span> program faces three main barriers that may negatively affect health services. First, excessive dependence on the mayor as the initiator of the health service innovation program. Second, the limited number and capacity of human resources. Lastly, inappropriate reward to members of the <span class="elsevierStyleItalic">Dottorotta</span> team.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres1898967" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1642780" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Method" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Research location" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Data collection techniques" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Results and discussion" ] ] ] 4 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusion" ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-05-29" "fechaAceptado" => "2019-07-15" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1642780" "palabras" => array:3 [ 0 => "Health service" 1 => "Service innovation" 2 => "Homecare" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aims to describe home care program as a health service innovation to improve quality of health service.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study employs a descriptive qualitative approach and collected data by interview and field observation. The research was conducted in two health community centers during March–May 2017. Result data is analyzed with qualitative descriptive method.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The study identified home care services carried out in each community health center in Makassar City to improve the quality of public health services, especially in the community in the slum area. Nevertheless, this home care program still has obstacles, including overdependence on top leaders, limited number and capacity of health workers, and inappropriate rewards.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Home care program is health service innovation, which is initiated by the Health Service Agency of City of Makassar and it contributes to quality improvement of health service, particularly to vulnerable urban communities.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the International Conference on Women and Societal Perspective on Quality of Life (WOSQUAL-2019). Full-text and the content of it is under responsibility of authors of the article.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Innovation in the public sector" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Mulgan" 1 => "D. 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