Role and Impact of National Health System in

Implementing Patient Safety Management and

Service Excellence at Public Hospital in Thailand
Imelda Fitria, Fida Rahmayanti, Fahmy Rezkiah,
Vidria Handayani, Andreas Wahyudi

Abstract
Aim - National health system is one of a country's effort to improve the
standard of living for its citizen with universal coverage. But with a
health

assurance

service

quality.

sometimes
World

Health

hospital

give

Organization

less

attention

(WHO)

to

declared

the
how

important patient safety became critical component in hospital quality

management. This article will explain how King Chulalongkorn Memorial
Hospital (KCMH) as one of public hospital maintain, even impproving the
service quality with patient-centered care in the application

of national

health system in Thailand.

Method

Data

collected

from

national

and

international

literature

study, observation while doing comparative study, interviewing with the

structural

officer, expert discussion, and with descriptive approach.

Collecting data was held at KCMH on march 9th 2015

Result

In

applying

the

national

health

system,

KCMH

remain

improving the service quality with patient-centered care with building the
principal "Patient-care Excellence". The policy that KCMH had is 5S which
are : safety, standard, selfcare, service-mind, and simplify process. With
the

policy,

KCMH

improving

it

service

quality

by

accreditation,

by

based

on

the

Total

International Society

Quality

Management

(TQM), accredited by the

for Quality (ISQua), and begin to

apply

the

Joint

Commision International 5 th edition for strengthening clinical process.

Conclusion

- Thailands national health system is one of Thailand

goverments

effort to improve their country. This national health system

needs more than 10

years to reach 99% Universal Health Coverage.

Thailands national health system may became reference for improving

tne

national

health

system

in

Indonesia.

Hospital can

maintain and

improving the service quality if it has strong pillar in management.

Keyword - National health system, Patient safety, Service excellence,
Quality management.

Preliminary
Health is a very important thing for all citizens. Each country has diverse policy in fulfilling
system health. Health insurance is necessary for each country to ensure overall health for its
citizens. All security systems designed a national health should be able to be applied to serve all
citizens. In the planning and implementation of programs national health insurance, the
government should make observations. Observations can be done in the nearest community, to
Hospital Visit: Thailand - March 2015 3 environment extends even to the neighboring countries.
The results of observations can be used as a reference in planning and implementing security
systems Most health in accordance with the conditions of each country. Implementation of health
insurance should remain guided on patient safety and with regard to quality of service. Although
health insurance program is cheap or even free for all citizens state, hospitals must continue to
serve with quality and procedures best. WHO confirms the importance of safety in service to
patient, and has launched the World Alliace for Patient Safety states that: "The safety of patients
is a fundamental principle of services once a critical component in quality management "(Bieber
et al, 2014). Thailand including States that have achieved Universal Health Coverage (Universal
Health Insurance). In Southeast Asia, only Thailand and Malaysia achieved it. Moreover, the
health insurance coverage they diverse. Thailand effort to ensure the health of its citizens began
mid 1970 by targeting specific populations. Residents vulnerable and poor health guaranteed by

the state, private sector health costs secured by contributions of workers, employers, and
government. The informal sector paid by the government and informal workers. (Bieber et al
2014). In this article, the author would like to illustrate how the role and the impact of the
national health system in Thailand, particularly in King Chulalongkorn Memorial Hospital
(KCMH).

Method
The research method in this article uses a descriptive approach .Data
collected included primary and secondary data . Primary dataobtained from
observations , interviews , and discussions . Observations made onone
government hospital in Thailand that King Chulalongkorn Memorial Hospital.
Interviews and discussions were conducted in a forum attendedby structural
officials

KCMH

Secondary

data

were

obtained

from

review

of

literatureprofiles obtained from the hospital visited, national journals and

international, as well as textbooks. The data collection was conducted in
KCMH on dated March 9, 2015.Expert discussion include how the national
health system in Thailandparticularly in KCMH in ensuring the health of its
citizens bycentered on the patient (Patient-centered care) so as to providea
quality service.

Result
Quality and universal security for all citizens of Thailand is the main goal of
the National Development Plan (Development Plan National) all 11 years
from 2012 to 2016. The health system in Thailand using the rules of the
Universal Health Care (UHC) in 2002 and has produced
99% protection universal (Universal Coverage) for citizens with using three
schemes. The first scheme is the Civil Servant Medical Benefit Scheme
(CSMSC) for government workers with a range of three generations of
protection, which means protection also applies to the birth parents, and a
maximum of three biological children aged under 20 years, which is entirely
paid by government. The second scheme is the Social Security Scheme (SSS)

which guarantees health to private sector workers. Here, the head of the
company are encouraged to health insurance pay a maximum of 35,000 baht
(15 million). On certain conditions, can be paid up to 200,000 baht (90
million). For excess charges are the responsibility of the workers themselves.
Scheme The third is The Universal Coverage Scheme (UCS), which protects
the entire Thai citizen outside of the two forms of protection on top. The
subsidy provided by the government entirely. Society just enough pay 30
baht (13 thousand rupiah) per visit to a hospital with resident identity cards.
Payment of health promotion activities in Thailand supported by state taxes
derived from beverage tax alcohol and cigarettes. Sriratanaban (2010)
describes the difference scheme The National Health Insurance in Thailand
as follows:
In the table above, the form of the fourth is the private insurance sector not
included in the national health insurance system in Thailand. Pattern KCMH
health care in a patient-centered (patient-centered care) that give priority to
quality and service excellence using the principles Patient-care excellence as
pillars. Departing from seeing the needs patients and their families, KCMH
has become a key policy 5S in improving the quality of services; safety,
standards, self-care, servicemind, and simplified process.
Safety here means all forms of service focuses on safety patient, family, and
all employees of the hospital. service standards given a reference of Thailand
Hospital Accreditation (THA) the which has been Achieved by KCMH for 14
years. Quality management principles use is Total Quality Management
(TQM),

the

International

Society

for

Quality

(ISQua),

and

the

Joint

Commission International standards were Adopted. Self-care question is how

to educate the patient and or the patient's family to Participate in the selfhealing process or supportive services so that health services can be
implemented holistic. Service-mind means that all services provided by the
employees hospitals based on the principle of serving. Simplified process

intended as one way to Overcome KCMH administrative bottlenecks. Process

in form of the simplification of the digitization of medical records, and the
use of ID cards as the number of health insurance.
Thailand Hospital Accreditation (THA) is an independent institution which was
adopted by the Institute of Hospital Quality Improvement and Accreditation
of Thailand in charge to evaluate public and private hospitals government.
Four THA assessment is an important part; 1. Scope organizational
management, 2. Key hospital system, 3. The process centered on patient,
and 4. Results. Service quality development methods KCMH using Quality
Control Improvement (CQI) / Kaizen aims to boosts the quality of each unit,
became the basic requirements of nursing throughout unit, and integrated
with the "Lean Method" and research.
Philosophy of "Lean Method" of Kaizen here is how a small changes are made
continuously and sustainably can bring a great impact to an organization
(Conrad, 2002). This philosophy is reflected in the concept of quality that has
KCMH 3P principles, that purpose (goal), process (process), and performance
(appearance). Through vision and mission, KCMH established a goal to
become a hospital modern ones that have a standard of hospital services as
in developed countries. After that, the process includes planning and
execution of the strategic plan, accreditation standards, and 5S. The quality
which can be proved by the KCMH is through 85 indicators of quality, quality
round, internal surveys, and accreditation hospital. With the policy of "Policy
of No Blame", is expected across KCMH employee has the responsibility and
the courage to report events that are not in accordance with the standard so
that it can be evaluated for diagnose and solve the problem.
By relentlessly improving service quality, KCMH is the only hospital that won
the Thai government one quality product awards event in Thailand in 2014. It
This is the first time a government institution that awarded national. Here is
a picture that shows the framework Thailand Hospital Accreditation:

Discussion
In 1995, Thailand's health ministry began to form a neutral agent to find a
way out of the conflict on the quality and cost between health services with
consumers. This initiative evolved into a research project on hospital
accreditation which aims to develop and implement a standard hospital
Comprehensive and serves as the basis for assessing the quality of hospital
(Sriratanaban 2010).
Hospital accreditation program in Thailand started to become a project
research supported by WHO, The Thailand Research Fund, and the Institute
Health Systems Research. In 1996, discovered a standard for assess the
quality of the health system functioning hospital for determine the
accreditation standards. The system was tested in 35 hospitals Public and
private voluntary basis in 1997. During this phase the committee counsel
advised to work with the involvement of various sectors between other
professional organizations, health care providers, owners of capital, and
consumer. Furthermore, it can form a collaboration for the development of
quality and hospital accreditation (Sriratanaban 2010). Some of the partners
of the program These include:
Funding agencies: Thailand Research Fund, Health Systems Research
Institute, and the World Health Organization (WHO).

Professional bodies: Thai Medical Council, Thai nursing council, Thai

Dental

council,

Thai

Association of Thailand,
Private

Hospital

PharmaceuticalCouncil,
Medical

Technologist

Hospital

Pharmaceutical

Association

of

Thailand,

Association of Thailand and Medical Section of Christ

Church of Thailand.
Educational institutions: Consortium of Royal Colleges of Thailand,
Consortium of Medication Education, Mahidol University, Chulalongkorn
University and Prince Songkhla University.

 Social Security Office.

international collaboration: Canadian Executive Service Organization,
and Liverpool School of Tropical Medicine.
After research and development project ended in 1999, The collaboration
turned into "Institute of Hospital Quality Improvement and Accreditation ".
The Institute is an independent agency that moves in under the supervision
of a health systems research institute. The program was developed from
which began only 35 hospitals to become a national scale. On In 2009, more
than 350 hospitals have been accredited, and hundreds of hospitals others
voluntarily join the program and the application process systems such
management. Currently the institute has turned into an organization public
called "Healthcare Accreditation Institute" (Sriratanaban 2010).
Thailand hospital accreditation program is not just a certification or an
accreditation program, but rather the mechanisms to encourage improving
the quality of hospitals in total, systematic, and standards compliant. The
program emphasizes the principle of self-assessment, quality assurance,
continuous quality improvement that focuses on the customer (Customer
Countinous Focused Improvement / CQI) and total quality management (Total
Quality Management / TQM). Accreditation is meant to encourage home pain
increases and confirm how well hospitals implement activities according to
the standard rather than as an external quality audit or inspection
capabilities hospitals run a minimum standard. With terakreditasinya the
hospital, means that have demonstrated a commitment improving the
quality of patient-based, and suggests that hospitals have a good quality
system to minimize risks and ensure quality. Akteditasi system that oversees
ethics and professional services remains appropriate, and demonstrated the
ability to improve on an ongoing basis (Sriratanaban 2010).
In general, a hospital accreditation system is seen as a mechanism which
helps limit the behavior of providers in the healthcare system. Hospitals need

to meet the standards of accreditation, where it is including the structural

requirements and the need for the main process. they also are guidelines for
the assessment and surveys done periodically. Accreditation status is
required hospitals to enable them to join the program and activities in the
community. The need for the law, such as the operational license is not
needed (Sriratanaban 2010).
According Sriratanaban (2010), some of the activity in implementing hospital
accreditation program in Thailand, among others:
1. Form a team of research and development.
2. Establish a special team of accreditation and development of hospital
quality.
3. Involve professional organizations and hospitals to form professional
standards and applying them.
4. The process of survey was developed and tested with a pilot hospital.
5. Periodically conduct publicity through newspapers, articles, books, and
forums national.
6. Do qualitative research on organizational behavior and evaluation of the
accreditation program.
7. Once the pilot program is complete, the Thai Hospital Accreditation be
used as an independent organization.
A health insurance system in Thailand can be used as a reference for
enhance the health insurance system in Indonesia. Thailand did research
over to the national health system. And In Indonesia implement a national
health insurance system, but the implementation is still encounter various
obstacles. Various attempts should be made by Indonesian government in
order to create a national health system able to cover all of its citizens with

regard to patient safety and quality of care. Here is a table that describes the
differences in the national health insurance system in Thailand and
Indonesia.
National health insurance system in Thailand and Indonesia have some
differences. If seen from the types of health insurance in Indonesia already
concentrated in the health insurance program Nasioanal (JKN) and managed
by Social Security Organizing Body Kesesehatan (BPJS Health) while in
Thailand This type of insurance is divided into three, namely Social Security
Scheme, Civil Servant's Medical Benefit Scheme and Medical Welfare
Scheme. Kepersertaanya, the health insurance system in Indonesia is
compulsory, while in Thailand automatically every citizen both working or not
work has the same right to get service healthcare in government hospitals.
The composition of participants in Indonesia divided into two: Recipient
Contribution (PBI) which is funded by the Government of through the state,
and Non-Recipients contribution is financed by contributions individuals and
business entities, while in Thailand Composition of participants in accordance
the type of insurance that is followed by the financing system is divided into
two ie Tax (SSS insurance types, CSMBS, and MWS) and Premium (types
Insurance VHI).
Payment Model of Health Services in Indonesia is divided into two: Capitation
for Primary Level Health Facilities (FKTP) and CBG'Sm Facility secondary and
tertiary level of health. Thailand has two health palayanan payment model
that capitation and DRG in accordance with the type of insurance that
followed.
Type of Health Services in Indonesia are Comprehensive (Promotive,
Preventive, curative and Rehabilitative) held at all facilities health (health
centers, clinics pratama, government hospitals, private hospitals and doctors
families that have taken in cooperation with the BPJS) whereas in Thailand

The type of health care and health facilities is limited in accordance with the
type of insurance that followed.

Conclusion
Most countries - developing countries to developed countries, has implement
the national health system. But discretion is different different one country
to another. Necessary their indicators and comparators the national health
system in a country so that we can find the lack or excess of a system in a
country. With overview of the national health system in Thailand we can see
how The national health system run on one instance hospitals government.
From the results of the visit hospitals in Thailand can be deduced that the
implementation of the national health system in Thailand is one results of
operations of the Thai government to promote the country. The health
system This national take more than 10 years to reach 99% Universal Health
Coverage. During that time one of the reinforced is an information system to
collect data accurately and right, so that this data then becomes the basis
for deciding the size capitation for primary health care in health centers and
hospitals, as well as perlayanan the cost per case in the RS.
In Indonesia, health information systems is still not running good. Service
charge, applicable in Indonesia is the tariff regulation set of unit cost, not the
real cost as in Thailand. It is also requires the support of a strong information
technology so that someday Indonesia also has a national health systembased data.

Bibliography
Conrad, S., Waldrip, G, 2002. "Using Kaizen to reduce waste and Prevent
pollution ", Environmental Quality Management. 23-37. Accessible from:
http://www.epa.gov/lean/environment/methods/kaizen.htm

on

the

stairs

March 15 2015
Ministry of Health, 2013, Handbook of Health BPJS Lestari, N. P., Sunjaya, D.
K., Syaefullah, A. 2014. Management Concepts Based Patient Safety Program
in

Kalimantan

Kapuas

District

Hospital

Central.

Accessed

from:

http://pustaka.unpad.ac.id/wpcontent/uploads/2014/01/KONSEP-MANAJEMEN
KESELAMATAN-PASIENBERBASIS-PROGRAM.pdf\ on March 16, 2015
Hospital Management, 2010. Learn from Thailand: Implementation of
Universal

Coverage

Hospital.

Accessed

from:

http://manajemenrumahsakit.net/2012/10/belajar-dari-thailand-implementasi
universal-coverage-at-rs / on March 18, 2015
Sriratanaban, J. 2010. A Case Study on Hospital Accreditation in Thailand and
Quality Improvement at King Chulalongkorn Memorial Hospital: Part 1.
Chulalongkorn

University.

Thailand.

Accessed

from:

http://www.ps4h.org/docs13_qual/Background%20Case%20study
%20Singapore% 20 2004_1.pdf on March 15, 2015.
Sriratanaban, J. 2010. Hospital Accreditation as a Mechanism Regulatory
System: A case of Thailand. Chulalongkorn University. Thailand. Accessed
from:

http://ps4h.org/baliday3r/Jiruth%20Sriratanaban_Case

%20(BARU)_Session%204 .pdf on March 15, 2015