Medical Service Management Analysis in the Specialist Medical Centre

Healthcare services, as frontline services, have an essential role in creating a healthy society. Indeed, the community will choose qualified health services for treatment. Hence, the services need to improve the existing management to provide the best quality. The regulation concerning medical service standards is under the Republic of Indonesia's Minister of Health No. 1438 of 2011. The type of research in this article is normative research, using a statutory and conceptual approach analyzed and presented descriptively. As a health service provider facility, the specialist medical center must provide standarized services and have good management. The problem is in the service system's poor management. The specialist medical center must provide effective, safe, quality, and non-discriminatory services by prioritizing patients' interests under professional standards, services, and operational procedures to accelerate service and provide service satisfaction.


Introduction
Healthcare services is a technical procedure in handling patient, medical treatment costs, and patients' convenience in getting exact, fast, precise, and prime health information and services. Healthcare services include preventing disease, promoting/improving health, cure disease, and recovering. Health effort is a series of integrated and continuous activities to maintain and enhance the public health status in disease prevention and health improvement, disease treatment, and health recovery by the government and the community (M. Nursalim, 2020).
From a sociological perspective, the legal relationship between doctors and patients has changed recently. Previously, their position was not equal; doctors knew better than patients so that patients were more passive and dependent on what the doctor said. On the other hand, along with the development of technology and science in medical law today, doctors and patients' position are considered equal. All doctor's medical actions must be based on the patient's consent after receiving a complete explanation of the doctor's treatment and therapy. The regulation is under Law No.36 of 2009 on Health, Article 8, which stated: "Every person has the right to obtain information about his/her health data, including actions and medications from health workers." As also stated in Law No.36 of 2014 on Health Workers Article 68, Paragraph 1, "Every act of individual health service performed by Health Workers must obtain approval." Therefore, patients also have the right to choose existing health facilities and get good health services (I Ketut Agus Prasetyo, 2020).
Healthcare services in Indonesia are currently facing severe challenges. They are required to provide low-cost services with high-quality services. Healthcare services are about medical (technical medical), health issues, legal (policy), social and economic issues. Healthcare providers must understand applicable policies such as regulations, guidelines, and technical instructions for health services. Moreover, an understanding of economic concepts and principles, including financial management, accounting, and taxation, is needed. Health service providers must understand the surrounding community's conditions and social characteristics so that the surrounding community's norms, values, and culture will not be separated (Tito Yustiawan., 2013: 208).
Based on the regulation of the Minister of Health of the Republic of Indonesia Number 9 of 2014 as the amendment of the Regulation of the Minister of Health Number 028/MENKES/PER/I/2011, the definition of a clinic is a health service facility that organizes individual health services. It provides basic and specialized medical services, organized by more than one type of health worker, and led by medical staff (Minister of Health Regulation No. 9, 2014). The health worker can be a nurse or a midwife, and the medical staff is a doctor, specialist doctor, dentist, and dentist specialist. Thus, a clinic must decide the type of health service provided, whether it is basic medical services, specialized medical services, or even both. The decision on this type of clinic will determine the stratum of a clinic (Tito Yustiawan., 2013: 210).

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Based on the type of service, there are two types of the clinic: 1. The primary health center provides basic medical services, both general and special. 2. The specialist medical center offers specialized medical services or basic.
The government, local government, or the public can organize these healthcare centers. The following are the difference between the primary health center and the specialist medical center: 1. The medical services at the primary health center are basic medical services, while the specialist medical center includes basic and specialist medical services. 2. The primary health center leader is a doctor or dentist, while the specialist medical center is a specialist doctor or dentist. 3. Services in the primary health center include inpatient services, whereas inpatient services are only for business entity healthcare in the specialist medical center. 4. The minimum number of medical personnel in the primary health center is two doctors or dentists. On the other hand, each type of service in the specialist medical center requires one specialist.
The condition of the health service industry is growing and full of emotional problems. Indonesia's health problems currently range from service quality and human resources to service providers and service management. Management of health services in the future faces a formidable challenge, including in Indonesia. The provision of health services must be carried out with full calculations and correct economic principles so that the efforts made by health service providers are efficient. Healthcare service providers must continuously improve the quality of service in terms of satisfaction, comfort, and patient safety so that health services become effective. The management process needs planning. Planning is an organizational reference for achieving goals. Moreover, it can also help to have periodic evaluations to achieve goals.
Assessment of service quality, service efficiency and clinical success rate in providing services to consumers are seen in various indicators related to hospital or clinic service facilities utilization. The excellence of hospital and clinic services depends on the uniqueness and quality provided. Specific services must be under the patients' needs and desires. What is felt and enjoyed directly by them will immediately be assessed according to customer expectations. Quality must start with the needs of the customer and end with the patient's perception .
Patients will always try to find the best service by choosing the hospital/clinic with good service quality. Patients assume that a good-service hospital/clinic can provide satisfaction and an effort to manifest loyalty to patients (Indra, Ari P dan Hari S, 2013: 1-12).
Loyalty comes from perceived satisfaction. Satisfied patients will be encouraged to reuse hospital/clinic healthcare services, making patients loyal. Loyal patients will enable a 4 long-term relationship with the hospital/clinic. The relationship between patients and hospitals/clinics as healthcare service providers will provide many advantages for the hospital/clinic .

Research Methods
The author uses the type of normative legal research, namely legal research by tracing in order to explore significant legal materials on the legal issues faced by looking for laws and regulations as well as legal theories and principles related to these issues. In this legal research, the author uses a statutory approach and a conceptual approach.

Doctors
Doctors know to cure diseases. Being able to heal people does not mean a doctor. A doctor requires special education and training as well as a degree in medicine. Doctors' role is vital to improve the community's health status. Moreover, doctors are a significant component of the public health care system (Lumenta, 1989).
Healthcare services will involve hospitals, health workers, and patients. The direct relationship that will occur is between the doctor and the patient. The medical profession is a noble profession related to human welfare interests so that the medical field profession always carries out moral and intellectual orders. Being a doctor means willing to provide services to people who suffer from illnesses to recover and provide services to healthy people to (Yussi A. Mannas, 2018: 166). Thus, a doctor must always have a spirit of service. This attitude is essential in the formation of the most basic ethical attitudes (Astuti, EK, 2009).
The profession of doctors is implemented with high morality. A doctor has the authority and permission to perform health services, such as examining and treating diseases based on the law on health services. The medical profession is concerned with human well-being. In other words, the job in a medical field always carries out moral and intellectual orders. Being a doctor means willing to serve patients to recover and help people stay healthy by preventing and improving their health status. Thus, a spirit of service must exist (Komalawati, Veronica, 2002).
On the other hand, Doctor's Reflection of Indonesian Medical Codes of Ethics (KODEKI) does not find the word patient. Patients in the code of ethics are replaced with the word "sufferer." Indonesian dictionary defines a patient as a person with a disease (who is treated by a doctor); sufferer (sick). Article 1 point 10 of the Medical Practice Law stated: "A patient is a person who conducts a consultation on his / her health problem to obtain the necessary health services, either directly or indirectly to a doctor or dentist." Indeed, a relationship between doctor and patient is known as a medical service contract relationship, a legal relationship (M. Zamroni, 2022).

Rights and Duties of Doctors and Patients
According to Bahder Johan Nasution (Nasution, BJ, 2005), a relationship between doctor and patient is a therapeutic transaction. Legally, the agreement between doctors and patients has created rights and obligations and should be implemented as agreed. In contrast to the transactions commonly carried out by society, therapeutic transactions have different characteristics, and their specificity lies in their object. The object is to make efforts or therapy to cure the patient. A therapeutic transaction is a transaction to determine or attempt to find the most appropriate treatment for patients implemented by doctors. Based on patients' rights and obligations, doctors' and patients' legal relationships in this health service will have a legal impact (Atmanti. H. D. and Naylah. M., 2019: 44-651). The legal impact that occurs is a doctor's legal responsibility to the patient due to law violations, ethics, and discipline (Mannas.Y.A, 2018: 163-182).
Article 52 of the Medical Practice Law stated that the Patient's Right is to get a complete explanation of medical procedures. Including diagnosis and procedures for medical treatment, the purpose of medical treatment, other alternative measures and risks, risks and complications that may occur, as well as prognosis for action taken. Patients also have the right to ask another doctor or dentist's opinion, get services according to medical needs, refuse medical action, and get medical records.
In Article 53 of the Medical Practice Law, the patient's obligations rules stated that patients must provide complete and honest information about their health problems. Comply with the advice and instructions of a doctor or dentist. Comply with the applicable provisions in health care facilities and provide compensation for services received. Therapeutic transactions carried out by patients and doctors oblige both parties to fulfil their respective rights and obligations.
Article 50 of the Medical Practice Law stated that doctors or dentists implementing medical practice have the following rights; 1). Obtain legal protection in implementing tasks under professional standards and standard operating procedures, 2). Provide medical services according to professional standards and standard operating procedures, 3). Obtain complete and honest information from patients or their families, and 4). Receive fees for services.
There are several obligations of doctors in the Medical Practice Law. First, doctors must attend continuous medical education and training organized by professional organizations and institutions accredited by professional organizations to absorb medical science and technology development. Second, have a Registration Certificate (STR) and Permit/ License to Practice a Profession (SIP). Third, provide medical services under professional standards, standard operating procedures, and patient medical needs. Next, refer patients to other doctors or dentists who have better skills or abilities when they cannot implement an examination or treatment. In that case, they keep everything about the patient secret, even after the patient dies. Then, perform emergency aid on a human basis, unless he is sure that someone else is on duty and can do so.
Finally, provide quality control and cost control.

The Specialist Medical Centre
The implementation of clinics in Indonesia has been regulated in the Minister of Health Regulation (PMK) No. 28 of 2011. A clinic is a health service facility that provides basic and specialized medical services by more than one type of health worker and is led by medical staff. Thus, a clinic must determine the services because they can be limited to basic medical services, specialist services, or both. This decision will affect the stratum of a healthcare center.
The specialist medical center provides specialized medical services or basic medical services. The implementation must pay attention to several requirements such as location, building, room, facilities, infrastructure, equipment, and personnel.
Buildings and rooms for clinics must be permanent and separate from living quarters or other work units. The building should also meet the requirements of a healthy environment, provide easy access, security, and safety for all people, including persons with disabilities, children, and the elderly. Moreover, clinics should have at least several rooms such as admission room, waiting room, consultation room, action room, pharmacy room, and administration room to provide service.
Besides, facilities and infrastructure must include water, electricity, and air circulation installations. Then, waste treatment plants (solid and liquid), fire prevention, and control installations. These facilities must function properly, including periodic inspections and calibrations.
Furthermore, the workforce requirements adjust to the level and type of service provided by a clinic. The specialist medical center workforce consists of medical personnel (doctors, dentists, specialist doctors, specialist dentists), health workers (nurses and midwives), and non-health personnel. The specialist medical center leader is a specialist doctor or dentist specialist. All medical and health personnel must complete themselves with a Registration Certificate. Medical personnel must have a Permit/ License to Practice a Profession (SIP), and other health workers must have a Work Permit (SIK). A clinic is not allowed to employ foreign health workers.
The specialist medical center as a health service provider facility must provide standardized services and have good management. Medical service is one of the services offered by the specialist medical center.

Management of Medical Services at the Specialist Medical Center
In the management process, planning is crucial for every organization in implementing its activities. Planning is an organizational reference for achieving organizational goals. Moreover, it gives standardized services which can also help to conduct regular evaluations to ensure management's purposes.
It must be supported by the Minimum Service Standard (MSS) and Standard Operating Procedure (SOP). Clinics must have service indicators as a tool to control the quality of services provided to patients. To achieve the predetermined indicators (MSS), an operationalization of service providers' steps and activities needs SOP. In general, SOP documents can include Service, Administration, Technical, Safety, and Security (Tito Yustiawan., 2013: 214).
The goal of healthcare services is to achieve a degree of public health which satisfies expectations (consumer satisfaction), excellent service by providers which satisfy expectations (provider satisfaction) and organized service institutions (Institutional satisfaction).
Managing the specialist medical center will undoubtedly face many challenges and obstacles, one of which is the service system's poor management. Problems that often arise include long queues, missing patient data, complicated registration processes, and incomplete drug stock management.
The first problem that often experiences is missing patient data. There will be many patient data in the patient medical record database. Medical records are vital in a clinic or hospital management system. In addition to recording patient visits, medical records also function to track a patient's medical history through previous visits. Medical records are about identity, anamnesis, physical determination, laboratory, diagnosis of all medical services and actions given to patients and treatment, whether inpatient, outpatient, or receiving emergency services (Department of Health, 2006).
Medical records are facts about the patient's condition, medical history, past and current medications (Yanuar Wisnu Triaji,dkk, 2017: 15-22). According to Yuliartanto, patient's medical record contains some actions to provide treatment to support health services. This medical record data includes the patient's history, examination results, and medicines given to heal (Purnaresa Yuliartanto, dkk, 2014: 203-207).
Poor management can cause data loss or tuck away. It will disrupt the clinic's performance. Moreover, frequent patients will fill out the same form every time they visit. The result is that it will be troublesome for those who have made the clinic their first choice when they are sick or need medication.
When patients' data is lost, it will be complicated. The patients need fast service in the clinic, and they want to see a doctor immediately for consultation and examination. Clinic will need general and medical data from the patients, especially new patients, to enter the clinic's medical record database. The process often takes time, and it distresses the patients. For example, new patients must fill in the form manually. Sometimes they will ask questions about unclear points in the form. Imbar and Kurniawan have stated that the amount of data from patients in manual format or hardcopy is very ineffective (Radiant Victor Imbar, Yulius Kurniawan, 2012: 53-67).
Besides, the problem that arises is in pharmacy installations. Incomplete and manual recording of drug stock often distresses the officers. The clinic requires sufficient drug stock for the patients. This mismanagement will be a problem for patients. They usually want a one-way service. After they get health services and a prescription, they can immediately redeem the medicine at the clinic without redeeming it.

Conclusion
The specialist medical center must provide effective, safe, quality, and nondiscriminatory services by prioritizing the patient's interests under the professional standards, service standards, and standard operating procedures to make patients feel comfortable and safe. Using digital media helps to simplify the search for patient medical records and speed up the registration process. By using digital media, the risk of losing medical records is smaller. Besides, digital media also functions as data storage for tools, materials, and medicines to know the specific and definite amount.