Total Quality Management in Improving Health Services

This research aims to determine the implementation of Total Quality Management as an effective model for realizing quality health services at Ananda Hospital Makassar. This research method is of various types qualitative with a policy approach. The data source uses primary data via instrument observations and interviews as well as secondary data through reviewing various documents. The data analysis technique uses an interactive model, namely data collection, data condensation, data presentation, and verification/conclusion. The results of this research show that the implementation of the TQM model at Ananda Makassar Hospital was not implemented optimally due to the leadership aspect of manager Hospitals are less able to organize and organize all existing resources within the hospital and the inability of the head of the hospital to collaborate and communicate well with all Ananda Hospital staff to work together. set standard work procedures that are efficient and effective and the TQM implementation factors at Ananda Hospital can run well if the hospital can optimize the implementation of communication and collaboration factors where it is hoped that the Ananda Makassar Hospital will improve the quality of service by involving patient health organizations in provide education to patients as well as collaboration in exchanging necessary medical personnel resources done Ananda Makassar Hospital to develop the competency and work skills of doctors, nurses and staff administration hospitals in collaboration with other agencies and institutions that can provide training activities.


INTRODUCTION
Public service is an activity or series of activities in order to fulfill service needs in accordance with statutory regulations Law Number 25 of 2009 Concerning Public Servicess stating that the state is obliged to serve every citizen to fulfill the basic rights and needs of every citizen.The government is a bureaucratic organization that has duties related with public services to resolve various problems that have attracted a lot of criticism from the public both in terms of quality and quantity.One of approach Service-related theories depart from the New Public Service paradigm put forward by Denhardt and Denhardt (2016) stating why the government must serve (service) not directing (steer), why the government provides services to the community as citizens (citizens) not as a customer (customers), this was also stated by Aslinda & Ibrahim (2014) that the complexity of spatial problems in many developing countries, as well as society's demands for solutions, have a big impact on strong motives for the role of government to adopt and implement spatial planning policies effectively.Apart from that, Sinambela (2006) stated that theoretically the aim of public services is basically to satisfy the community.The implementation of public services itself, government officials are very important responsible in providing the best service to the community as a form of creating community welfare where the community has the right to receive effective and best services by the government (Parasuraman et al., 1988) One of the services that is often reaped There is a lot of criticism from the public regarding services in the health sector, where various hospitals have very important duties and roles in providing health services tailored to the needs of the community, (Elcock, 2005;68) suggests that public services in the health sector are the main agenda in every regional government, however The only difference is how it is implemented by public service actors.Health problems for the community have become a major need which is increasingly increasing where the public is increasingly aware of the quality or qualities of health services which are more oriented towards public satisfaction, meaning trying to provide the best service and evaluating it based on the public's point of view.Kurnia in Hidayat (2009) stated that the optimal level of health for every person, which is part of welfare, requires legal support for the implementation of the health sector, this is also in line with the 1945 Constitution Article 28-H and Law Number 36 of 2009 Concerning Health states that: "Everyone has the right to obtain safe, quality and affordable health services".Apart from that, the government needs to provide the community's need for quality health services in accordance with the rights of Indonesian citizens.
The problem with health services provided by hospitals is of course due to the absence of a management system that is implemented properly, therefore every health organization should be required to have quality management standards that can be implemented, namely the model Total Quality Management (TQM), known as this model, is an organizational approach that began in 1950 with a focus on quality, based on the participation of all its members for the purpose of longterm success through community satisfaction and can benefit all members of the organization.Weak integrated quality management is understood to have implications for limited human resources and patients in hospitals also continue to experience discomfort while receiving services provided by hospital staff, and this condition is caused by hospital staff who are incompetent and have low experience in providing services.to the patients.This is related to the implementation of Total Quality Management (TQM) which is inadequate and still not perfect.The problem is the lack of use of Total Quality Management (TQM) which is a challenge for hospital administrators and staff (Alawag, Alaloul, Liew, Baarimah, et al., 2023;Lepistö et al., 2022).According to the experience of researchers who carry out clinical practice in several hospitals, there are still complaints from patients or their families regarding the attention of hospital staff members, scarcity of service facilities, and shortage of medical staff, especially nurses.Besides that, To provide quality health services and provide satisfaction to the community is to provide a service that must have good service management.Good and high quality service management can be supported by high professionalism of employee performance where professionalism is the ability or expertise to carry out or carry out a job or task that is based on skills and knowledge as well as supported by the work attitudes required by the job (Goklas et al., 2021;Niswaty et al., 2021;Suprianto et al., 2024;Taliang et al., 2023) Ananda Hospital, Makassar City, which focuses on health services for mothers and children, is also expected to be able to implement its health services through a health service quality management model using a Total Quality Management.Ratminto & Winarsih (2015) states that service management practices have a number of weaknesses, including: a) The system in place still does not directly link the work performance of officers with career development, b) The system in place can overcome managerial matters but has not yet fixed things.-technical managerial matters, c) The management system has not been socialized to the public.Health service management at Ananda Makassar Hospital cannot run alone and cannot optimally provide quality services to patients when the model management TQM services are not implemented consistently by providing the availability of quality resources in hospitals starting from the competence of medical staff, patient room facilities, laboratory equipment, administrative staff, other support staff.

METHODS
This research uses a qualitative type with a policy approach to answer and describe facts explicitly, (Moleong, 2006).This method aims to understand and analyze the implementation of total quality service management at Ananda Hospital, Makassar City.Data collection in this research was carried out by means of interviews (Interview), Observation and document reviewers by testing the validity of data in qualitative research including tests, credibility, transferability, dependability, and confirmability (Patton, 2005).The data analysis technique used is an interactive model by Miles, Hubarman, and Saldana (2014).There are four flows, namely, data collection, data condensation, data presentation, and verification/conclusion.

RESULTS AND DISCUSSION
Efforts to overcome problems with services at Ananda Makassar Hospital through mistakes One Total Quality Management model where the TQM model is implemented implemented The Ananda Makassar Muda Hospital is considered to have not implemented it well, this is indicated by the three dimensions of the TQM model (leader, SOP and collaboration) to create services that are quality where the leader (leadership) dimension of the hospital management does not work to make a plan that suits the hospital's needs, there is a lack of ability to organize all human resources to move the managers and medical personnel to be able to innovate in developing good cooperation with patients and to parties outside the hospital who can support a quality service management system.
The application of TQM to services at Ananda Makassar Hospital seeks to create an environment that involves all elements of the hospital, from medical to non-medical staff, in achieving common goals.Along with this, receiving feedback from patients through the suggestion box and call center is a real form of openness and commitment at Ananda Makassar Hospital for continuous improvement.Implementation of total quality management (TQM) at Ananda Makassar Hospital for create health services needs to implement system management oriented towards patient satisfaction which is prepared and planned by implementing an integrated quality management approach strategy or total quality management.This is supported by one of the main principles in total quality management, Hensler and Brunell (in Tjiptono and Diana, 2003) namely that the concept of service user satisfaction regarding quality and customers has been expanded.Where quality does not only mean conformity to certain specifications, but this quality is determined by the service user.Implementation of TQM was identified as an important step to instill a sense of ownership and responsibility among staff (Alawag, Alaloul, Liew, Musarat, et al., 2023;Jong et al., 2019;Lim et al., 2022).This shows that the application of TQM is not only a concept, but as an organizational culture that involves every individual in 120 Jurnal Ilmiah Ilmu Administrasi Publik: Jurnal Pemikiran dan Penelitian Administrasi Publik Volume 14 Number 1, January -June 2024.Page 117-124 achieving optimal service quality.Thus, the application of TQM at Ananda Makassar Hospital is not only a strategy , but rather a fundamental change in the health care paradigm.
Based on research findings, the implementation of quality management standards for the services provided by Ananda Makassar Hospital to the community is still very minimal, with facilities and infrastructure that are still inadequate, such as several problems that arise including a lack of health facilities and equipment, operating equipment, administrative equipment in the form of high specification computers., and some laboratory equipment which really slows down the administration and treatment process, of course this can result in delays in providing health services at Ananda Makassar Hospital, even though from the theory of Parasuraman, et.al (1984) it is very important for a company to demonstrate its existence to the public.proven to exist Tangible or physical evidence of the availability of adequate equipment and facilities so that every health service process provided to patients can be as expected by the patient, this is also emphasized by Juharni et al., (2023) tangible or physical evidence in a service, namely: ( 1) Upto-date equipment and technology, (2) Condition of facilities, (3) Condition of company human resources, (4) Alignment of physical facilities with the type of service provided to service users.
As a health provider, health human resources require sufficient quantity, type and quality, and must be distributed fairly and evenly in accordance with health development needs.The findings of this research also show that the availability of medical personnel at Ananda Makassar Hospital is still quite low, especially doctors.This causes sometimes some patients to not be served satisfactorily, even though the appearance of hospital staff has become standard procedure in Ananda Hospital for every officer in serving patients and patient caretakers must prioritize a cheerful facial attitude and give a smile, and the hospital officers have implemented this attitude in every service they provide to anyone they serve, but this is not enough to fulfill quality services.If it cannot be proven by the availability of adequate medical infrastructure, as well as the attractive appearance of the hospital staff tasked with providing services to the community, The equipment is new, the facilities are attractive, the appearance professional, and materials related to services (Arhas et al., 2021;Saleh et al., 2024;Tunggul, 2021).
The implementation of Total Quality Management at Ananda Makassar Hospital has a big impact on the quality of service felt by patients, and to realize quality service, this aspect is very important.leadership from the management of Ananda Hospital to organize, manage and organize all supplies that are very important for the hospital and the Ananda hospital leadership is also required to consistently carry out the process of monitoring and evaluating all the performance of hospital staff.Implementation of TQM from the leader's perspective is the main objective.You must be more thorough and even better in reviewing business performance and results, so that determining what will be implemented in the future can be better and more successful.in accordance with the achievement targets expected by the business.in accordance with applicable policies and regulations and have become appropriate provisions.Top management responsibility is observed to be the most significant factor influencing the implementation of Total Quality Management.A leader must create a vision and grow organizational enthusiasm to realize this vision (Niswaty et al., 2019;Rifdan et al., 2022).Besides that, a quality leader is also the leader who can involve all members of the organization together to design programs and establish clear standard work procedures.
The quality of health services does not only depend on physical facilities, but is also influenced by various complex determinants such as communication and collaboration factors in health services at Ananda Makassar Hospital which can be the key to success in providing holistic and effective care for patients.A program planned by Ananda Hospital cannot be implemented with high quality standards if each program is not communicated well to all members of the organization, as stated by Aslinda, et al (2024) that so that every For program policies to run effectively, the government must be able to do so communicate policy the well to all institutional actors involved as well as to the parties involved other stakeholders.From the view of Aslinda, et al (2018), focus on the importance of communication and collaboration between one party and another.Collaboration is a form of working relationship between health workers in providing services to patients in discussing diagnosis, collaborating in health care, mutual consultation or communication and each is responsible for their work.Whatever the form and place, collaboration includes an exchange of views or ideas that provides perspectives to all stakeholders.Collaboration was carried out by Ananda Makassar Hospital to improve the quality of service by involving patient health organizations in providing education to patients as well as collaborating in exchanging medical staff resources that must be provided.done Ananda Makassar Hospital to develop the competency and work skills of doctors, nurses and staff administration hospitals in collaboration with other agencies and institutions that can provide training activities.Siraj, et al. (2023) also stated that Human resource development is an activity that must be carried out by organizations so that their knowledge, abilities and skills are in line with the demands of the work they do.Apart from that, collaboration between health teams is also very important increase professional work, collaboration between nurses and doctors is also seen as an important factor in providing quality nursing care (Nelson et al., 2008) which should be demonstrated by all hospital medical personnel to provide information to each other and collaborate in every process of service provided to each patient, as well as through effective collaboration with external parties and other health institutions, it can expand its positive impact on patient health and improve the quality of health services provided by hospitals.

CONCLUSION
Based on the research findings, it was concluded that the implementation of the TQM model at Ananda Makassar Hospital was not implemented optimally due to the leadership aspect of manager Hospitals are less able to organize and organize all existing resources within the hospital and the inability of the head of the hospital to collaborate and communicate well with all Ananda Hospital staff to work together.set standard efficient and effective work procedures.The results of this research also contain several recommendations for the Ananda Makassar Hospital to evaluate human resources by developing human resources by providing consistent and periodic training and improving source facilities and infrastructure that can be collaborated with partners, apart from that, it is necessary to increase leadership for Ananda Hospital managers by establishing work processes and service methods that are oriented towards patient needs and increasing partnerships with stakeholders.