FORM 4 PENILAIAN KINERJA STAF MEDIS

NAMA LENGKAP
(dengan gelar)

DIAJUKAN UNTUK
Proses Pengangkatan Kembali Staf Medis Proses Penambahan Kewenangan Klinis Rekredensial

baik sekali
1. Patient Care
(praktisi menyediakan perawatan pasien yang tepat dan efektif untuk promosi kesehatan, pencegahan penyakit,pengobatan penyakit, dan perawatan di akhir hidup)

baik

cukup

kurang

2. Medical/Clinical Knowledge *
(menerapkan dan mengembangkan ilmu medis, ilmu klinis dan sosial, dan penerapan pengetahuan untuk perawatan pasien dan pendidikan)

3. Technical Skills & Application *

(demonstrated knowledge and application of the skills required, Includes knowledge and understanding of appropriate equipment, policies and procedures)

4. Practice-Based Learning & Improvement

(using scientific evidence and methods to investigate, evaluate, and improve patient care practices)

5. Interpersonal & Communication Skills

(enable them to establish and maintain professional relationships with patients, families, and other members of health care teams)

6. Professionalism
(reflected in a commitment t continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward patients, their profession, and society)

7. Personal & Professional Development

(demonstrated experience and understanding of the need for continuation of both personal and professional development)

8. Teamwork
(demonstrated ability to participate as an active member of the team, consistent with the philosophy and policies of the organization)

9. System-Based Practices
(the understanding of the contexts and systems in which health care is provided)

10. Administration & Documentation

(through the use of organizational processes ensure that all Administration and documentation requirements are initiated and Completed in a professional and timely manner)

*) Dilakukan oleh Komite Medik

11. Number of Services (see attachment) 12. Clinical Outcomes Review (see attachment)

HASIL PENILAIAN
DIREKOMENDASI (UNTUK DILAKUKAN PENGANGKATAN KEMBALI) TIDAK DIREKOMENDASI

KOMENTAR

TIM PENILAI
Tanda tangan

Dr. Mulyadi Muchtiar MARS

Dr. Juniwati Gunawan

Medical & Ancillaries Manager

Chief Executive Officer

FORM 4 (lampiran) PENILAIAN KINERJA STAF MEDIS

NAMA LENGKAP
(dengan gelar)

NUMBER OF SERVICES
Previous Year 1. Number of Out-Patient 2. Number of In-Patient 3. Number of Surgery Complex Major Minor Simple 4. Number of Procedure 5. Average length of stay Current Year

CLINICAL OUTCOME REVIEW This is particularly to review the clinical outcome performed by medical staff based on clinical indicator/clinical pathway/etc : 1. Unplanned Re-admission (72 hours) 2. Unplanned Return to OT 3. Unexpected Admit to Intensive Care 4. Nasocomial infection
Pressure Ulcer

ILO (surgical side infection)

5. Mortality Rate