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INA
Doctor of Medical Sciences Develops Clinical Supervision Model to Improve Patient Safety Implementation in Private Hospitals
Located in the Postgraduate Hall room, Lt. III Postgraduate Building, Udayana University, Doctor of Medical Sciences Study Program, Faculty of Medicine, Udayana University held an open examination for Doctoral Promotion with promovenda candidate, Ns. I Gusti Agung Ayu Sherlyna Prihandhani, S.Kep., M.Kes., with the dissertation title "The Effect of the Reflective and Proctor Combination Clinical Supervision Model (RE-PRO) on the Implementation of Patient Safety Goals in Private Hospitals in Bali." (21/3/2025)
Patient safety is a top priority in health care, but the implementation of Patient Safety Goals (PST) in hospitals still faces various challenges, such as the lack of effective supervision, limited training of health workers, and an unoptimal safety culture. The current clinical supervision model tends to be administrative and lacks support for skill development and reflection on clinical practice by health workers.
This study aims to develop and test the effectiveness of the Reflective-Proctor (RE-PRO) combination clinical supervision model in improving the implementation of SKP in private hospitals. The RE-PRO model combines a reflective approach, which encourages health workers to critically evaluate their clinical practice, with supervision based on Proctor's three functions, namely normative (compliance with standards), formative (competency development), and restorative (psychological support).
This study was conducted with an explanatory sequential mixed methods design in two type C private hospitals in Bali. The first phase used a quantitative approach with a pre-test and post-test design on two groups of nurses: an intervention group that received RE-PRO supervision and a control group that continued to use conventional supervision. HCS implementation was measured based on six patient safety indicators and analyzed using Wilcoxon and Mann-Whitney tests. The second phase involved in-depth interviews with nurses, supervisors, and nursing managers to explore their perceptions of the effectiveness of the RE-PRO model in improving patient safety and quality of care.
The results showed that the RE-PRO supervision model significantly improved compliance with the SCP (p < 0.05), especially in the aspects of patient identification, effective communication, and fall risk prevention. However, it did not significantly improve drug safety and infection prevention, indicating the need for more comprehensive multidisciplinary supervision. Qualitatively, the model also improved team coordination, nurse confidence, and job satisfaction.
Thus, the RE-PRO supervision model offers a more systematic and supportive approach for health workers to improve SKP implementation. This model has the potential to be adopted in various health facilities with adjustments to their respective policies and organizational structures. Further evaluation with a wider scope of hospitals and adjustments for government hospitals can strengthen the effectiveness of this model on a larger scale.
The examination was chaired by the Vice Dean for General Affairs and Finance of the Faculty of Medicine, Udayana University, Prof. Dr. I Made Sudarmaja, M.Kes., with a team of examiners:
1. Prof. dr. Pande Putu Januraga, M.Kes.Dr,PH (Promoter)
2. Dr. Ni Made Swasti Wulanyani, S.Psi., M.Erg., Psychologist (Copromoter I)
3. Dr. dr. A.A. Ngurah Jaya Kusuma, Sp.OG, Subsp.K.Fm, MARS (Kopromotor II)
4. Prof. Dr. dr. I Made Jawi, M.Kes
5. Prof. dr. I Made Ady Wirawan, S.Ked, MPH., Ph.D., Sp.KKLP
6. Prof. Dr.dr.I Made Sudarmaja, M.Kes
7. Prof. Dr. dr. I Wayan Putu Sutirta Yasa, M.Si
8. Dr. Luh Seri Ani, SKM, M.Kes
9. Dr. Ni Ketut Sutiari, SKM, M.Si
10. Dr. dr. Ketut Suarjana, S.Ked., MPH
By academic invitation:
1. Dr. Komang Ayu Mustriwati, S.Kep., M.Kep
2. Dr. Ns. I Made Udayana, SST., S.Kep., M.Kes.
3. Dr. Luh Putu Widiastini, S.Si.T., M.Kes
4. Dr. Ns. Ni Made Dian Sulistiowati, M.Kep., Sp.Kep.J
5. Dr. Ns. Kadek Cahya Utami, S.Kep., M.Kep
In this exam, Dr. Ns. I Gusti Agung Ayu Sherlyna Prihandhani, S.Kep., M.Kes., was declared to have graduated as the 452nd Doctoral Graduate of the Medical Science Doctoral Study Program, Faculty of Medicine, Udayana University with the title of CUMLAUDE.
UDAYANA UNIVERSITY