The forgotten moment of truth in the hospital industry (a humanist approach that bears sweet fruit)

Recently, there has been a lot of news on social media, some from conglomerates starting to acquire hospitals in many places, such as

The EMTEK Group or PT Elang Mahkota Teknologi Tbk (EMTK) led by Eddy Kusnadi Sariaatmadja already has SAME which manages Omni Hospitals., plans to annex 66% of the shares managing the hospital, Grha Kedoya Hospital, PT Kedoya Adyaraya Tbk (RSGK). Last August, the Emtek Group also consolidated its business sector with the SAME mechanism by acquiring its affiliated entity, namely PT Elang Medika Corpora (EMC) with a transaction value of Rp 1.35 trillion.

Riady's family owns the Lippo Business Group with Siloam Hospital, namely PT Siloam Internasional hospital Tbk (SILO). And until now it has more than 43 hospitals throughout Indonesia.

Dato' Sri Tahir, owner of the listed company managing Mayapada Hospital, PT Sejahteraraya Anugrahjaya Tbk (SRAJ).

There is also an issuer managing the Mitra Keluarga Hospital owned by the founder of PT Kalbe Farma Tbk (KLBF) Boenjamin Setiawan, PT Mitra Keluarga Karyasehat Tbk (MIKA). And until now it has more than 26 hospitals throughout Indonesia

Edwin Soeryadjaya and Minister of Tourism and Creative Economy (Menparekraf) Sandiaga Uno, PT Saratoga Investama Sedaya Tbk (SRTG) also have a hospital portfolio, namely the Primaya Hospital network. And until now it has more than 13 hospitals throughout Indonesia.

Bunda Hospital, namely PT Bundamedik Tbk (BMHS). BMHS shares are also owned by a strategic investor, namely Northstar Group. Akasya Investments Limited (AIL), an investment company belonging to the Northstar Group founded by Patrick Sugito Walujo and Glenn Sugita, also holds a 4.90% stake in BMHS.

And also the Ramsay Sime Derby group which is famous for Premier Hospital, which until now has 3 hospitals.

and many other private hospitals such as Eka hospital, Buddha Tsuci hospital and others

Why did these conglomerates enter the hospital business?, of course not for a social mission, which is clear that this business is very profitable, such as the following data

First, the 2022 State Revenue and Expenditure Budget Draft (RAPBN) budgets Rp 255.3 trillion for the health sector. However, with the COVID-19 pandemic that has not ended, that number may still rise again. This year, Minister of Finance Sri Mulyani estimates that the realization of the health budget will reach Rp 326.4 trillion, up from the initial ceiling of Rp 169.7 trillion.

Second, in addition to the health budget, demographics of the Indonesian population are also one of the main considerations that are important. Based on data from the Central Statistics Agency, Indonesia's population is projected to continue to increase, from 271 million people in 2020 to 294 million people in 2030.

Third, another interesting aspect to observe is the potential increase in Indonesia's per capita health spending in line with the government's JKN (National Health Insurance) program.

Fourth, another potential that has not been fully exploited is related to the availability of health infrastructure in Indonesia, which is still concentrated on the island of Java.

Fifth, Covid-19 cases that have not been fully controlled and

sixth, related to the growth potential of the telemedicine sector in Indonesia

From the data above it is clear that this business is growing rapidly, and will require a lot of human resources and proper, as in Siloam Group which has 42 hospitals requiring more than 2700 doctors and 10,000 nurses, or Mitra Keluarga Group requires more than 1600 doctors and nurses. 3800 nurses, a very large number. From the phenomena above, approximately 50 to 70 doctors and 140 to 250 nurses are needed in each hospital.

To support the development of the hospital business, the Lippo Group (Siloam) has long prepared its human resources by establishing the Faculty of Medicine and the Faculty of Nursing from Pelita Harapan University which is under the auspices of the Lippo Group. While other conglomerates seem not ready for this surge

?

Incidentally, I am one of the examiners at the Management of Administration Hospital (MARS), and from the several studies we conducted with students at various hospital locations in Indonesia, the biggest problem in this business is the nurse. If you visit the hospital (visit) or you need treatment or are lying in the hospital, the nurse is the person who is almost always with us 24 hours, if the doctor only comes to visit once.

The moment of truth from the hospital industry is in the nurses, because apart from a lot of time interacting with patients, nurses are there. (the moment of truth is the point of service interaction between the customer and your business), from a survey of several research locations for my students, I can draw a common thread that always in terms of income and benefits for nurses, the level of satisfaction is always low and even reaches the “burnout” stage.

In Indonesia in general, nurses always complain; It's been a small salary, big responsibilities and long working hours that make many of these nurses stress and burnout. For comparison, in Australia the income of new nurses can reach 7000 AUD (about 77 million rupiah every month and almost double the regional minimum wage (UMR) of around 3200 AUD (about 36 million rupiah). While in Indonesia the income from nurses is only limited to the UMR .

Even though the doctor has a big responsibility, he gets enough or even excess income, so that his stress can be compensated for with a large income.

The fast way The conglomerates who acquire hospitals to get big profits will have problems if the Moment of Truth problem for the nurse is not resolved immediately.

Every symptom has a cure, every problem has a solution

The quickest solution is to directly increase the wages of the nurse, but of course it will have an impact on profits. For example Mitra Keluarga Group with 26 hospitals, has 3800 nurses, if the income is increased by 2 times like nurses in Australia, it will have an impact of around 16.7 billion rupiah per month (= 3800x4.400.000 "UMR jakarta") or like Siloam Group will have an impact of around 44 billion rupiah per month (=10,000x4,400,0000). With such a large impact, the conglomerates will certainly not agree.

The second alternative is to use the job satisfaction component

Investigations on how to retain employees have been started since 1967, Weiss et al (1967) with the MSQ index (Minneshota Satisfaction questionnaire) which divides employee satisfaction in intrinsic and extrinsic values, followed by research by Smith, Kendall, & Hulin (1969) with the Job Descriptive Index (JDI) and Spector (1997) with the Job Satisfaction Survey (JSS). Several retail companies have started to do ways to retain employees from this research.

If we explore further from the research of Spector (1997) with the Job Satisfaction Survey (JSS), it concludes that job satisfaction consists of 9 important dimensions related to one's job satisfaction, namely pay, promotion, supervision, fringe benefit, contingent reward, operating conditions, coworker. , nature of work and communication.

Pay, employees want a pay system and promotion policy that they perceive as fair, unambiguous, and in line with their expectations. When a pay system is seen as fair based on job demands, individual skill levels, and community pay standards, satisfaction is likely to result. Many people are willing to accept less money to work in a more desirable location, a less demanding job or to have greater flexibility in the work they do and the hours they work. So that the key to the relationship between salary and satisfaction is not the absolute amount paid but more importantly the perception of fairness.

Fringe Benefit, is an important part of compensation that will play a role and job satisfaction, the greater the fringe benefit received, the better job satisfaction will be.

Contingent Reward, is the value of the award made by superiors to employees and not in the form of material, but recognition that is done. If the contingent reward is done well by acknowledging, appreciating the results of the employee's efforts will lead to increased job satisfaction of the employee.

?Promotion, is a factor related to the presence or absence of opportunities to obtain career advancement during work. Employees seek more promotion policies and practices, and improved social status. Therefore, individuals who perceive that promotion decisions are made in a fair and just manner are more likely to experience satisfaction from their jobs.

Supervision, is a factor related to superiors who are able to appreciate the work of their subordinates. Studies generally find that employee satisfaction is enhanced when the immediate supervisor is friendly and understanding, gives praise for good performance, listens to employees' opinions, and shows a personal interest in them. The behavior of superiors is also a major determinant of satisfaction.

Communication, defined as the ability to interact well with others with the accuracy of communication, clarity of communication, effectiveness of communication, and suitability of communication. If in a company the communication is good, it will increase employee job satisfaction. Communication here is not only verbal but also non-verbal, such as a clear procedural system and the right way of delivery.

Operating Condition, greatly affects job satisfaction. Operating Conditions must be in accordance with each individual's ability by creating comfortable working conditions by making fair regulations, appropriate work for each employee, giving freedom to work.

Coworkers, people get more than just money or tangible achievements from work. For most employees, work also fills the need for social interaction. Therefore, it is not surprising that having friendly coworkers will increase job satisfaction.

In the nature of work, employees tend to like jobs that give them the opportunity to use their skills and abilities and offer assignments, freedom and feedback on how well they are doing. These characteristics make work psychologically challenging. Less challenging work creates boredom, but too challenging creates frustration and feelings of failure. Under moderately challenging conditions, most employees will experience pleasure and satisfaction.

?example of a Strategy Canvas Model

The canvas strategy model can be used for this analysis, of the 9 dimensions that are related to money, only 2 component are Pay and Fringe Benefit are talk about money while the 7 dimensions are not. From there we can answer the basic question "How much should management increase the nurse's income?" is to increase sufficiently and balanced with increases in other satisfaction factors (promotion, supervision, contingent reward, operating conditions, coworkers, nature of work and communication.) So by doing other ways we can achieve our goals.

So play all the component/dimensions, so that nurse satisfaction increases, and of course the moment of truth??becomes more positive, and leads to increased income.

When blessings are hidden in the folds of time

Tangerang, September 2021

DR. Martinus T, MM