Accesed on: http://jkb.ub.ac.id/index.

php/jkb/article/view/2958
Jurnal Kedokteran Brawijaya Vol. 31, No. 5, xxxx 2021, pp. xxxx
Article History: Received 30 April 2020, Accepted 5 August 2021

Supplement

Development of Caesarean Section Clinical Pathway: A Lesson Learned

Pengembangan Clinical Pathway Sectio Caesarea: Pelajaran yang Didapat

I Gede Sastrawan 1,2, Viera Wardani3

1
Technical Implementation Unit of Kintamani III Public Health Center Kintamani Bangli Bali
2 Postgraduate Program in Hospital Management Faculty of Medicine Universitas Brawijaya Malang
3
Department of Public Health Faculty of Medicine Universitas Brawijaya Malang

ABSTRACT
When the development of a clinical pathway at hospitals is primarily for accreditation purposes, it will hinder the
intended outcomes that is to ensure quality and cost. This study aimed to develop a clinical pathway for caesarean
section and explore the problem during the process. Using participatory action research, the researcher started the
program by performing an implementation evaluation, literature review, and regulation to propose the first clinical
pathway draft. The evaluation identified implementation discrepancies and prolonged length of stay. Based on the
evaluation and literature review results, the Professional Care Provider in the hospital conducted discussions and
suggest the revised clinical pathway by considering available resources, current practices, and behavior. In the revised
clinical pathway, notification, explanation, inclusion and exclusion criteria, and references were added. Before the
simulation, the hospital also develops a standard operational procedure for the implementation, resources, and
monitoring and evaluation. The simulation on the two cases found differences in the type of medication and
documentation method, which then further discussed with all Professional Care Providers involved in defining the
agreed solutions. Professional engagement and openness culture that embraces along the process are the main key
lesson learned in addition to the understanding that clinical pathway development and implementation is a continuous
learning process. Therefore, continuous monitoring and evaluation are paramount to reach quality and efficiency, the
ultimate goals of the clinical pathway.

Keywords: Caesarean section, clinical pathway development, organizational learning

ABSTRAK
Ketika pengembangan clinical pathway di rumah sakit hanya untuk tujuan akreditasi, hal tersebut akan menghambat
hasil yang diinginkan, yaitu pengendalian mutu dan biaya. Penelitian ini bertujuan untuk mengembangkan clinical
pathway untuk sectio caesarea dan mengeksplorasi masalah selama proses tersebut. Menggunakan participatory
action research, peneliti memulai program dengan melakukan evaluasi implementasi, kajian literatur, dan regulasi
untuk mengusulkan konsep clinical pathway perdana. Evaluasi tersebut mengidentifikasi perbedaan implementasi dan
lama perawatan yang berkepanjangan. Berdasarkan hasil evaluasi dan kajian literatur, Profesional Pemberi Asuhan di
rumah sakit melakukan diskusi dengan mempertimbangkan sumber daya yang tersedia, praktik terkini , dan perilaku
dalam penerapan clinical pathway yang telah direvisi. Dalam clinical pathway yang telah direvisi terdapat
penambahan notifikasi, penjelasan, kriteria inklusi dan eksklusi, serta referensi. Sebelum simulasi, rumah sakit juga
mengembangkan Standar Prosedur Operasional untuk implementasi, logistik, serta monitoring dan evaluasi. Terdapat
dua variasi dalam simulasi, yaitu perbedaan jenis pengobatan dan metode dokumentasi, yang kemudian di lakukan
diskusi lebih lanjut dengan semua Profesional Pemberi Asuhan yang terlibat dalam menentukan solusi yang disepakati.
Keterlibatan profesional dan budaya keterbukaan sepanjang proses pengembangan menjadi kunci utama
pembelajaran ini. Selain itu, perlu ditekankan bahwa pengembangan dan implementasi clinical pathway adalah proses
pembelajaran yang berkelanjutan. Oleh karena itu, monitoring dan evaluasi berkelanjutan sangat penti ng untuk
mencapai tujuan akhir dari clinical pathway, yaitu mutu dan efisiensi.

Kata Kunci: Pengembangan clinical pathway, pembelajaran organisasi, sectio caesarea

Correspondence: I Gede Sastrawan. Technical Implementation Unit of Kintamani III Public Health Center Kintamani Bangli Bali ,
alamat???????? Tel. 08179717195 Email: ajik_4@student.ub.ac.id

DOI: http://dx.doi.org/10.21776/ub.jkb.2021.031.05.X