REDUCING MINIMAL BREAST MILK PRODUCTION PROBLEM

TOWARD POST PARTUM PATIENT WITHIN SIX MONTH

IN OBSTETRIC& GYNECOLOGY DEPARTMENT
DR SAIFUL ANWAR GENERAL HOSPITAL
MALANG EAST JAVA INDONESIA

OBSTETRIC & GYNECOLOGY (OBGYN) DEPARTMENT

DR SAIFUL ANWAR GENERAL HOSPITAL
JAKSA AGUNG SUPRAPTO STREET NO. 2 MALANG EAST JAVA
2017
DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN

BOARD OF QCC INTAN

THE PAIN OF PROCESS IS A TEMPORARY.... BUT FEELING OF

ACHIEVEMENT LASTS FOREVER
DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN

ABSTRACT

DR Saiful Anwar General Hospital Malang, East Java have a firmly resolved on being world class
hospital of peoples choices, it is commited to give the excellent program, one of them is RSSIB (Mother and
Child Care Hospital) and concern to lactation management. Which is needed inovation to increase the
excellent services
As we know Breast Milk production problem happened toward the post partum patient, we noted
there were 41 cases from 50 patients, from the stratification were 26 post partum patients with minimum
breast milk production problems (64%) and they could not give the breast milk to their baby maximally. The
factors were midwifes had sore hand, mothers believe that the first breast milk cause a new disease, and
pathology post partum patients should not give the breast feeding for a while.
To solve this problem “QCC INTAN” made some improvement by means of making guidance leaflet ,
STIPRO (prolactine stimulation), sosialized to midwifes, nurses, patients and family about breast milk.
After the problem solved, not only reduce the case to 0 % in June 2016 but also minimize the potential
of hospital loss up to Rp. 3.075.000,-
Result : STIPRO INTAN increased breast milk production to the post partum patients maximally.

Keyword : STIPRO (prolactine stimulation), post partum patient

 DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN 1

PROCEEDINGS
A. QCC INTAN PROFILE NAME C. THE SCOPE OF HOSPITAL
Name : INTAN Increasing the patients excellent
Unit : Obstetric Gynecology (obgyn) health services which is reach plenary
Company : Dr. Saiful Anwar General Hospital Malang level the patients safety and
Facilitator : Dr. Sutrisno, Sp.OG (K) satisfaction
Head of the board : Dina A, T K R, Amd.Keb
Secretary : Syafiatus, S, Amd.Keb D.THE SCOPE OF OBGYN
Boards : 1.Alifatus,Amd.Keb Commited to give obstetric
2.Ayu F, Amd.Keb gynecology patients excellent health
3.Vivin Vera S, Amd.Keb services
Ages : 28 years old
Education : D-III Kebidanan E.THE SCOPE OF QCC INTAN
QCC established : 1992 Commited to increase the health
Meetings : 34 X services in obgyn
Attendance : 90 %
Periode : January 2016 – September 2016
Proceedings : 13

B. QCC ORGANIZATION PROBLEM FLOW

DIRECTOR

Patients will give birth

Pervaginam Sectio caesaria

VICE DIRECTOR OF MEDICAL
SERVICES & NURSING
QCC ADVISOR Labour

HEAD OF OBGYN DEPT

Patients without complication Patients with complication

Breast Feeeding

QCC INTAN Maximal Production Minimal production

F.RADAR CHART&RINDA WINDOW QCC COMPETENT AND WORK PLACE AND ENVIRONTMENT
RADAR CHART QCC RADAR CHARNMENTT GOOD 5
I
COMPETENT WORKPLACE ENVIRONMENT ZONA D-1 ZONA C-1 ZONA B ZONA A
3 A
3 2,8
4 THE RESULT : considering
2 2,6
2 3 ZONA C
V 2,6 1 3 II E 1
RINDA WINDOW ZONA D ZONA C-2 Rinda Window analyzed before
2,2 2,8 B 2
0 0
1
ZONA D-2
improvement is in ZONE C
2,4 2,8 2,6 1 2 3 4 5
2,6
IV III D C HIGH
(AVERAGE)
:PLANING : ACTUAL
G.SCHEDULE OF PLAN AND ACTIVITY REALIZATION IN 2015-2016
N Jan 2016 Feb 2016 March 2016 Apr 2016 May 2016 June 2016 July 2016 Agust 2016 Sept16 PLA
STEP 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 N
ACT
O
4
1 1
5
4
2 PLAN 2
4
4
3 3
4
2
4A
2
4 D0 and
4
4B
7
4
5 CHECK 5
4
4
6 6
4
ACTION
4
7 7
4
TOTAL
26 34
DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN 2

PLAN STEP 1 DETERMINING THE THEME AND TITLE

1.1 IDENTIFIED THE PROBLEM
A. Disobedience in 5 moment hand washing toward health officers is 43 of 68 cases.
B. The lactation problem is 41 of 68 cases.
C. Disobedience health officers in using body protection in cancer patients is 20 of 43 cases.

1.2 DEFINE THEME

1.2.1 According Severity Assesment Code (SAC)

Problems Din Sya Viv Ali Ayu Total VOTING OF SAC

V
A 2 2 1 2 1 8 13
A 20 7
8
L
B 3 2 3 2 3 13 U
E 0
A B C
C 1 1 2 1 2 7
PROBLEMS

1.2.2 According Hospital Loss Potential

Hospital Number of HOSPITAL LOSS POTENTIAL

Problems Cases
loss financial loss
2325000 3075000
4000000 1725000
A 31 Rp.75.000, Rp.2.325.000,- I
D 2000000
R
B 41 Rp.75.000, Rp.3.075.000,- 0
A B C

C 23 Rp.75.000, Rp.1.725.000,- PROBLEMS

1.2.3 According Patient Risk Level

Problems Din Sya Viv Ali Ayu Total VOTING OF PATIENT RISK LEVEL

A 1 2 1 2 3 9 V
14
A 20 9 6
L
B 2 3 3 3 3 14 U
E 0
A B C
C 1 1 1 2 1 6 PROBLEMS

According to 3 quality dimention above, QCC formulated the theme “REDUCING THE LACTATION
PROBLEMS TOWARD POST PARTUM PATIENTS IN OBGYN DEPARTMENT”, the reason is if the problem
is solved the cases of the lactation problems maybe reduce. A good implementation could accelerate the breast
feeding maximally, it will prevent the breast milk dam, support and inhance RSSIB (Mother and Child Care
Hospital) and decrease icteric case, which is give the positive effect in day care and hospital efficiency
 DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN 3

1.3 DEFINE TITLE BAR CHART OF TITLE STRATIFICATION

40 26

TOTAL CASES
N Total
Cases 20 10
o cases 5
The breast milk does not
1 10
came out 0
2 Minimal breast milk 26 A B C
The breast milk does not came out
3 Breast milk dam 5 Minimal breast milk
Total 41 Breast milk dam

From the diagram above QCC INTAN agreed to define an initial goal as follow :
“REDUCING MINIMAL BREAST MILK PRODUCTION PROBLEM TOWARD POST PARTUM
PATIENT WITHIN SIX MONTH IN OBGYN DEPARTMENT DR SAIFUL ANWAR GENERAL
HOSPITAL MALANG EAST JAVA INDONESIA”

1.3.2 The reason of determination this title are based the 5 QCSDM
Factor The reason Improvement The significances Potential problem
condition target
Improving the services
There was no specific service
quality by inovation
There are 41 The Lactation cases to help the patients and the
Quality and creativity to
Lactation cases reduce to be 0 % health officers in a lactation
maximize lactation
management problem
management
Hospital loss Reduce the hospital Prevent the aditional Needed the aditional cost to
Cost potential is loss potential to cost to patients cover the problem
Rp. 3.075.000 RP.0,- Caused by the complication
The increasing the
The emergence of patient satisfaction
Patients not cooperative
mother care toward mother care Patients feel safe and
Delivery about mother care
disatisfaction as long the lactation comfort
periode

Prevent the Prevent breast milk

The emergence
safety patients dam and icterus cases Highly risk the breast milk
Safety safety patient
incident toward the baby dam
incident
The health officers
Inhancing the The officers service
feel burden when
Increase the health creativity and declination caused by the
Moral considered to not
officers service inovation of officers patient are not cooperative
respond in the
satisfaction
service

DISPOSITION OF MANAGEMEMENT STEP I

 DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN 4

PLAN STEP II ANALYZING THE CAUSES

2.1 ISHIKAWA DIAGRAM

QCC INTAN used ishikawa diagram to find the root cause to be improve, are:

The health officers worked but not

appropriate with the working time
The Wrong position MAN
METHOD
of breast feeding Health officers gave stimulation all they can do

Latch of baby mouth to the Health officers gave the stimulation inappropriate time
the wrong breast was not well
doing given
stimulation Health officers did not give the massage
Less eficien of baby optimally
suction Minimal
Health officers were doing the massage breast
Wrong stimulation The stimulation to the brain toward inappropriate SOP milk
point position oxytocin and prolactin production production
The health officers got sore hand toward
post
Mothers had less partum
support from family Prolactine production obstructed patient

Mothers had less spirit to give breast feeding No suction Mothers had not spirit
stimulation toward to give breast feeding
hypophise
Mother did not allow to give breast feeding

Mothers believed that

the first breast milk is
Mothers had preeclampsia therapy a disease and breast
MACHINE feeding will reshape ENVIRONTMENT
MATERIAL
the breast
Pathology Post partum patients who
could not give the breast feeding

2.2 VOTING

No Factor Total Rank

Sy Di Al Vi Ay
1. The wrong doing stimulation 3 4 3 3 4 17 V
Mothers believe that the first breast milk is a disease and
2. 6 6 7 5 6 30 II
breast feeding will reshape the breast
3. Mothers had less support 1 2 1 1 1 6 VII
4. The Wrong position of breast feeding 2 1 2 2 2 9 VI
5. The health officers got sore hand 7 7 6 6 7 33 I
The health officers worked but not appropriate with the
6. 4 3 4 4 3 18 IV
working time
Pathology Post partum patients who could not give the
7. 5 5 5 7 5 27 III
breast feeding
Total 28 28 28 28 28 28 140

By the voting result and use the ½ N + 1 formula QCC got the 5 dominan factors, are :
1. The health officers got sore hand
2. Mothers believed that the first breast milk is a disease and breast feeding will reshape the breast
3. Pathology Post partum patients who could not give the breast feeding
4. The health officers worked but not appropriate with the working time
5. The Wrong doing stimulation
DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN 5

PLAN STEP III EXAMINING AND VERIFYING THE DOMINANT CAUSES

The factors of dominant causes are proved by correlation test with X (cause) and Y (effect) are:

1 X1 : The health officers got sore hand

Y1 : Health officers did not give the massage optimally

2 X2 : Mothers believe that the first breast milk is a disease and breast feeding will reshape the breast

Y2 : Mothers had not spirit to give breast feeding

3 X3 : Pathology Post partum patients who could not give the breast feeding
Y3 : Prolactine production obstructed
4 X4 : The health officers worked but not appropriate with the working time
Y4 : The officer gave the stimulation inappropriate time given
5 X5 : the wrong doing stimulation
Y5 : Wrong stimulation point position

The Result of The correlation test are proved by scatter diagram :

PATIENT BELIEVE THAT THE FIRST BREAST PATOLOGY POST PARTUM PATIENT WHO
THE HEALTH OFFICER GOT SORE HAND MILK IS A DISEASE AND BREAST FEEDING COULD NOT GIVE THE BREAST FEEDING
the number of patient
the number of officer

WILL RESHAPE
10 the number of patient who
10
doing the massage

have minimal breast milk

inappropriatespo

10
who don't want …

5
5 5
r = 0,791
0 r = 0,765
0 5 10 0 0 r = 0,715
the number of a health officer got sore
hand
0 number of patient
the 5 who dumped first
10 0 number of post5partum patient
the 10
breat milk preeclampsia

cronbach's alpha =0,881 cronbach's alpha = 0,866 cronbach's alpha = 0,826

THE HEALTH OFFICERS WORKED BUT NOT

APPROPRIATE WITH THE WORKING TIME THE WRONG DOING STIMULATION
the number of officer which give
the number od officers give massage

wrong position stimulation

8
4
6
inappropriate SOP

3
4 r = 0,600
2
2
1
0 r = 0,699

0 5 10 0
the number of patient who need
stimulations with the number of officer
0the number ofstimulation
officer who wrong doing 5

cronbach's alpha = 0,815 cronbach's alpha = 0,732

From dominant factor which have strong positive correlation which is r ≥ 0,714 there are 3 factors the dominant causes

Patology Post
partum patient
DIAGRAM PIE By diagram above the level of the dominant factors are,:
who couldn't
give the breast The health
feeding officer got 1. The health officer got sore hand (r =0,791)
(r =0,715), sore hand 2. Patient believe that the first breast milk is a disease
(r =0,791)
and breast feeding will reshape the breast (r =0,765)
3. Pathology Post partum patients who could not give
Patient believe
that the first the breast feeding (r =0,715)
breast milk is a
dissease
(r =0,765),
 DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN
6

DO STEP IV A PLANING IMPROVEMENT

DOMINANT Why What Where How How
Much
FACTORS When
Who
MAN In order to the Create the Where 1. Make the design of lactation stimulation tool Target
100 %
The health health officers inovation Room8 a. The device is consist of:
officers got give for Room4 Wooden roll as a massager
sore hand standardized performing b. Draw a picture of the device:
back massage lactation When
(gave the stimulation 09 -21
massage April
optimally) 2016

Who 2. Consult the design of the tool with the supervisor

Dina of OBGYN
3. Proposed the design which has been approved by
supervisor of OBGYN to the head of OBGYN
departement
4. Make the tools and the instruction on how to use
the tool.
5. Socialized to the officer of OBGYN
6. Monitoring the tools implementation
ENVIRON In order to the Creating Where 1. Make concept of educational program Target
100 %
MENT mothers to and Room8 2. Make leaflet design
Mothers have the spirit educational Room4 3. Consult the concept of educational program and
believe that of breast program the leaflet to PKRS (hospital healthy promotion)
the first feeding about the When departement, in OBGYN
breast milk benefits of 09 -21 4. Proposed the leaflet design to PKRS department
is a disease breast milk April 5. socialize the educational program to the after
and breast and 2016 birthing patient
feeding will colostrum 6. evaluate and monitor the implementation of the
reshape the Who program
breast Ayu
MATERIAL In order to Campaigne Where 1. Proposed the concept of campaigne about after Target
100 %
Pathology the prolactine the Room8 birthing pathology and lactation
Post partum production pathology Room4 2. Coordination with the head of PKRS departement
patients runs well afterbirthing in OBGYN
who could time and When 3. Coordination with educational department OBGYN
not give the lactation 09 -21 about the schedule
breast periode in April 4. Make a pre test post test and socialization invitation
feeding cooperate 2016 5. Invite the participant to join the campaigne
with PKRS 6. Socialization about the pathology after birthing time
Who and lactation periode
Vivin 7. Evaluate and monitor the implementation of the
program

INTERMEDIATE TARGET = 100%

DISPOSITION OF MANAGEMENT STEP IV
DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN 9
8
7

DO STEP IV B IMPLEMENTATION IMPROVEMENT

Idea Date TRIAL MONITORING QCC
AGREEMENT
IMPROVEMENT PICTURE RESULT
IMPLEMENTATION
Creating a 1. 22/04/2016 1. Making a proposal and consulting Officers no sore hand after
using lactation stimulation tool
STIPRO the design to the head of OBGYN 1

amount
INTAN 2. Sending the consultation letter to
tool which the head of OBGYN 0 THE
2. 27/04/2016
can help 3. Consulting and coordinating with 1 2 3 4 5 6 7 TRIAL
...OBSERVATION
the 3. 03/05/2016
head of OBGYN about the design ARE
officers to with the following specification, X : ...observation SUCCES
give the device is consist of : Y : the total case of FULL
massage  Modified wooden roll officer no sore hand
easily and  Concept: after using lactation
avoid the - Wood holder stimulation tool
sore hand - Roll on deodorant as a massager
- Rotation band Monitoring :
- 12 Volt motoric dynamo  After the First the
- ON/OFF Ignition to operated tool implementation of
- Electric switch lactation stimulation by
- The electricity cable conector using this tool proved
- 3-13,8 Volt adaptor there were no sore
- Water pipe hand cases
- Wooden glue  In order to reducing the
4. 16/05/2016 4. Proposing the concept design to sore hand cases, the
the head of OBGYN QCC team always
5. 18/05/2016
5. Creating the STIPRO INTAN tool monitor the room
6. 25/05/2016 6. Continuing the consultation about officer while using the
the result as follow : lactation stimulation tool
BEFORE THE REVISION toward the patients
Finding the wooden Y-Shape, hold  The monitoring is using
each ending branch for the check list
dynamo, attach roll on the dynamo Conclusion :
using wooden glue, then install the  The director and vice
desicable to the switch knop and director instruction are
connect to electricity power to the already socialized
adaptor
7. Proposing the tools design to the RESULT :  The director and vice
7. 30/05/2016
supervisor of OBGYN and director instruction to
making a revision of improvement monitoring and
The improvement are : evaluating are already
 Beautify the casing done
 Beautify the handle and branch According to monitoring
 Additional power result the officer sore
RESULT : hand dominant cause
 handle are beautified factor IMPROVEMENT
 the casing are already perfect ARE SUCCESFULL
 the dynamo is already AC 220
Volt
8. Consulting the tools to
IPSAM(medical equipment and
care instalation)- Mr.Paulus SST
8. 31/05/2016
Design improvement by IPSAM
 Give the front casing in order to
cover the cable
RESULT
 casing in order to cover the cable
are beautified
 RPM switching knop are already
DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN

install
9. Consulting the revision tool to the
supervisor, supervisor approve
9. 06/06/2016 the tool and agree to aply as a
breast milk production stimulator
10. Coordinating with the
educational department to
10. 08/06/2016
socialize the tool shcedule
Date : 09/06/2016
11. Socializing the tools to the
11. 09/06/2016 rooms
12. Trialing and Monitoring the tools
implementation
12. 13-06-2016

1. 22-04-2016
Making 1. Making socializing plan about the patient who do not want to .
leaflet and importance and benefit of the first give breast feeding
socializing breast milk for mom and child 1
0 0 0 0 0 0 0

amount
plan about 0 THE
the 2. 25-04-2016 2. Designing the leaflet 1 2 3 4 5 6 7 TRIAL
importance ...OBSERVATION ARE
and benefit 3. 26-04-2016 3. Consulting the socializing plan SUCCES
of the first and leaflet to PKRS department X : ....observation FULL
breast milk of OBGYN Y : total of patient who
for mom 4. Making permission letter to head do not want to give
4. 27-04-2016
and child of PKRS instalation breast feeding because
5. 28-04-2016
5. Sending permission letter to head they are believe the
of OBGYN wrong myth
6. 29-04-2016 6. Proposing the leaflet plan to  Reducing patient who
PKRS instalation do not want to give
7. 02-05-2016
7. Socializing about health to the breast feeding case
delivery patients as follow after give KIE by
 Health officers of room 4 (10 discussing and giving
persons ), room 8 (10 persons) leaflet
 Time : after pre conference of  After the first
each room observation there were
 Speaker : QCC INTAN no case about patient
 Place : room 4, room 8 who do not want to give
Material : breast feeding
 Breast milk and colostrum
definition Conclusion :
 The porpose and benefit of  The director and vice
breast milk director instruction are
 Lactation implementation already socialized
 Lactation stimulation methode  The director and vice
by using tool director instruction to
 pre dan post test monitoring and
Pre test : evaluating are already
2/20*100 %=10 % done
Post test : 20/20*100%=100 %
- scoring educational need toward  According to monitoring
the patient according to patient result the dominant
education form before giving the causes factors of the first
socialization breast milk is disease
- documenting the medical report and breast feeding
about the socialization reshape the breast
- asking the patient to sign the THE TRIAL ARE
medical record education form SUCCESFULL
8. monitoring and evaluating the
socialization implementation
 DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN

Confirmating 1. 22-04-2016 1. Making proposal to campaigne Patient who do not want to give
and about lactation and pathology breast feeding because of
pathology after birthing
colaborating post partum with the following 1

amount
with PKRS of specification : stationary, 0 0 0 0 0 0 0
OBGYN to schedule, place, target and 0 THE
campaigne material 1 2 3 4 5 6 7 TRIAL
about 2. 25-04-2016 2. Coordinating with head of PKRS ...OBSERVATION ARE
lactation and of OBGYN X : ...observation SUCCES
pathology 3. 27-04-2016 3. Coordinating with education Y : total patient who do FULL
post partum department of obgyn not want to give breast
patients 4. Making pre test and post test feeding because of
4. 28-04-2016
and campaigne invitation form pathology after birthing
5. 29-04-2016 5. Sending invitation to the  Reducing case of
participant patient who do not want
6. 03-05-2016 6. Socializing/campaign to give breast feeding
 Target : patology post partum case after give KIE by
patients in room 4 (10 person) discussing and giving
and room 8 (10 person) leaflet
 Time : after pre conference of
 After the first
each room
observation there were
 Speaker : QCC INTAN
no case about patient
 Place : room 4, room 8 who do not want to give
Material : breast feeding
a. definition of pathology and
lactation after birthing period Conclusion :
b. Lactation purpose
 The director and vice
c. Lactation implementation toward
director instruction are
post partum patient
already socialized
d. Method of lactation stimulation
by using tool (electrical)  The director and vice
e. Answer and question director instruction to
Pre Test : monitoring and
10/20*100%=50% evaluating are already
Post test : done
20/20*100%=100%
 According the
monitoring result the
improvement toward the
dominant cause factor
of the post partum
patology patient who do
not want to give breast
feeding THE TRIAL IS
PROVEN TO BE
SUCCESFULLY
DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN 10

DO STEP V EVALUATING THE RESULT

5.1 EVALUATING THE CAUSE FACTORS

BAR CHART DOMINANT CAUSE FACTOR

124
Cause Total cases 140 113
99
V 120
factors A
100
code 80
Before the After L
60
U 40
improvement improvement E 20 0 0 0
X1 124 0 0
The health officer Patient believe that Patology Post
get sore hand the first breast milk partum patient
X2 113 0 is a dissease who can not give
PROBLEMS the breast feeding
X3 99 0
Before the improvement
After improvement

Conclusion :
Based on the table and the bar chart above the 3 cause factors was decreasing up to 0 case

5.2 EVALUATING THE TITLE (THE INITIAL GOAL ACHIEVEMENT)

EVALUATING INITIAL GOAL ACHIEVEMENT

Problems Cases Procentage 26

30
Before the
26 0 20
improvement
10
0 0
After the
0 0 0
improvement BEFORE INITIAL GOAL AFTER
IMPROVEMENT IMPROVEMENT

It was found 26 case minimal breast milk production of 41 total lactation problem in obgyn after the
improvement it was not found minimum breast milk production. the initial goal was reached 100 % as the
target

5.3 EVALUATING THE THEME ACHIEVEMENT

EVALUATING THE THEME ACHIEVEMENT

Problems Cases 41
50
BEFORE IMPROVEMENT 41
2
AFTER IMPROVEMENT 2
0
BEFORE AFTER
IMPROVEMENT IMPROVEMENT

The team still found 2 lactation problem case of 41 patients, it was breast milk dam toward post partum patients
in obgyn. Based on bar chart evaluation of result improvement before and after improvement above, the
conclusion is the improvement have been made by QCC INTAN was efective to reduce the lactation problem in
obgyn.
DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN 11

5.4 IMPROVEMENT TARGET ACHIEVEMENT BASED ON 5 QUALITY (QCSDM)

Faktor The reason condition Improvement target Positif effect
Improving the service quality by
inovation and creativity to
There are 41 Lactation The Lactation cases reduce to be
Quality maximize lactation management
cases 0%
(inhancing breast milk production
>3 cc)
Hospital loss potential Prevent the aditional cost to
Reduce the hospital financial loss
Cost is patient
potential to RP.0,-
Rp. 3.075.000
The emergence of The increasing the patient
Delivery mother care satisfaction toward mothercare as
Patients feel safe and comfort
disatisfaction long the lactation periode

Prevent the Prevent breast milk dam and

The emergence safety
Safety safety patients incident icterus cases toward the babies
patients incident

 Increase the health officer

services
 The QCC team feel satisfied
The health officers feel because created the tool as an
Moral burden when inovation which have benefits to Inhancing the creativity and
considered to not maximalize breast milk inovation of officer satisfaction
respon in the service production
 increasing the patient satisfying
because maximum breast milk
production

5.5 NEGATIVE EFFECTS AND THE IMPROVEMENT:

No Negative effects The improvement of negative effect
1. Because of this is a new inovation the  Always stipro intan tool continually checking
tools are limited amount, so when the tools  Propose the aditional tool by using official memo to the
is broken the tools are used head of OBGYN
interchangably
2. The familiy objection of qcc intan because Giving the explanation about the QCC INTAN on coming
the team are working over shift which have a good effect to increase the lactation
production toward the post partum patient
DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN 12

5.6 THE TESTIMONIAL

Foto Nama POSITION TESTIMONY
“Because of this STIPRO tools, my breast milk is
smooth and runs well”
Maria Room 8 patient “Now, I know that I have to give breastfeeding an
hour after give birth”

“This STIPRO tool help me to maximize the breast

milk production, and my baby does not have
Dimas Ayu Room 4 patient
drinking trouble and I dont worry about
breastfeeding

No, I dont worry about the sorehand, because this

Midwife of
Hylde,Amd.Keb tool help me to give massage toward the patients
Room 4
easily, STIPRO is innovative and, amazing !!

“Marvelous “ Anytime and anywhere I can use this

Midwife of
Inge sintya,Amd.Keb STIPRO tool to help the patient without worry about
Room 8
sorehand.

I do appreciate and respect to the QCC INTAN

team which always increasing the innovation to give
Tjitjik S,E,SST Head of room 8 a good quality service and the patient satisfied.

Keep inspiring !!! This tools give a good contribution

Head of nursing and many benefits for the health officers and the
Pirniati,Amd.Keb
patients

Wooww its amazing,,This unstopable innovation

Head of obgyn helped the health officers to give lactation
Dr Sutrisno,SPOG (K)
stimulation and give a good services.

5.7 EVALUATING THE QCC COMPETENT AND WORKPLACE ENVIRONMENT

RADAR CHART RADAR CHART RINDA WINDOW
RADAR CHART OVER ALL PERMORMANCE THE RADAR CHART OVER ALL WORKPLACE GOOD 5
QCC COMPETENT ENVIRONMENT
I ZONA D-1 ZONA C-1 ZONA B ZONA A
A
4 3,4 4 4
2,8 3,4
3
2 2 2,6 3 ZONA C
E 2,2 3,6 V 3 II
2,8 B 3,8 2,6 1 ZONA D ZONA C-2
3,6 0 0 3,6 2

2,4 ZONA D-2

2,8 1
2,6 2,6 3,4
D 3,4 C 3,4
IV III 1 2 3 4 5
3,8 HIGH

: BEFORE : AFTER
Overall quality of work increased from zone C to zone B. Its meaning, that both of the performance and
ACTION STEP VI MAKING RE-STANDARDIZATION
quality of work , were very high and there were significant increases after conducting QCC
DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN 13

CHECK STEP VI MAKING RE-STANDARDIZATION

6.1 standar of procedure

6.1.1 STANDARDIZE DOCUMENT
No Document Number Picture

standar of lactation stimulation by using electrical 2.16/2/48

1 methode

6.1.2 THE STIPRO IMPLEMENTATION

1. Prepare Tools,Including:
a. STIPRO INTAN :
- CHECKING tool function and completness
- Plug the power cable to the power source
- Press ON button
- Check the tool runs well
- The tools is ready to use
b. Additional preparation:
- Baby oil / another oil (kajuput oil, coconut oil)
- Patient dress
- Breast Holder
2. Prepare The Patient:
a. DO the 5 S ( smile, greeting, courteous, and polite)
b. Introduce your self
c. Identification of patient
d. Explaining the purpose and the procedure of action
e. And sure the patient to complete a consent form
3. Prepare The Environment
a. Create an environment that is comfortable and safe
b. Close the curtain or door
4. Implementation:
a. Wash hand 6 steps
b. Use body protect after work dress
c. Ask permision the patient to undress the top and Bra, change the dress to the room dress
which has uncover the back side, ask the patient to sit with bending over/hunch and put the
patient hand in the table
d. The officer stand behind the patient
e. Rub the back side of the patient which will be stimulated with baby oil
f. Turn oN the STIPRO INTAN
g. Give Massage by using STIPRO INTAN Tool to the back side of the patient on a line to spinal
start form the nape to 5th lumbar bone, as much 15 times/ at least 15 minute
h. Turn off the STIPRO INTAN
i. Help the patient to put on the Bra
j. Explaine the patient that the action is already done
5. Clean the tool and the patient
- help the patient to have comfortable position
- tidy up the tools which are not in use
- wash hand the 6 steps
DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN 14

6. Evaluate and make documents

- Evaluate the result and the patient respon
- Note in patient medical report
1.1.3 Work-instruction of STIPRO tool
1. Prepare the STIPRO tool
2. Measure the roll appropriate to the patient backside
3. Turn ON the STIPRO INTAN
4. Give Massage by using STIPRO INTAN Tool to the back side of the patient as much 15 times/ at
least 15 minutes

6.1.4 The implementation strategy STRATEGI IMPLEMENTASI

 Install the stipro intan according to the SOP

 Clean STIPRO INTAN with alcoholic tissue and dry it
 Put The tools in room 4 and room 8
 After using the tool, midwifery /nurse responsible to clean the
stimulation tool with alcoholic tissue 70% shortly, and safe to the box
 If there is any problem about the tool, contact person incharge
 Room 4 (Alif) and Room 8 (Ayu)
 Evaluating the result in every once a month

6.2 standardizing the result

After implementing the improvement of minimum breast milk production cases toward post partum patients in
OBGYN by using STIPRO INTAN tool were able to reduce up to 100 % in 4 weeks

6.3 The BENEFIT OF STANDARIZATION

1. To the patient:
- The lactation problems which occured in Romming in were reduced
- The patients felt safe about the privacy
- The patients had the lactation period easily
- The patients were more cooperative when the action
- The patients felt comfort
2. To the officers
- The officers felt satisfy because can give the maximum care toward the patients (mom and child)

DISPOSITION OF MANAGEMENT STEP VI

DR SAIFUL ANWAR GENERAL HOSPITAL MALANG – QCC INTAN 15

ACTION STEP VII COLLECTING NEW DATA AND DETERMINING NEXT PLAN
7.1 THE RESULT OF IMPLEMENTATION

MONITORING OF IMPLEMENTATION

1
AMOUNT

0,5

0 0 0 0 0 0 0
0
W4 July W1 Aug W2Aug W3 Aug W4 Aug W1 sept W2Aug
TIME OF OBSERVATION

7.2 PROBLEMS INVENTORY

A. Disobedience in 5 moment hand hygiene toward health officers were 28 of 48 cases
B. Disobedience health officers in using body protection in cancer patients were 16 of 30 cases
C. Disobedience patients family toward the patients waiting rules in obgyn were 293 of 371 cases
D. Inaccuracy of infusion droplest in patients were 156 of 284 cases

7.3 DEFINE THE THEME

7.3.1 Based on Severity Assesment Code
VOTING SAC
Problem Din Sya Viv Ali Ayu Jml
15
A 1 2 2 2 2 9 V
20 9 8 7
B 1 2 2 2 1 8 A
L
C 1 1 2 1 2 7 U
E 0
D 3 3 3 3 3 15
A B C D
PROBLEMS

1.3.1 Based on Patient Risk Level

VOTING PATIENT RISK LEVEL
14
Problem Din Sya Viv Ali Ayu Jml 15 11
9
7
FREQUENSY

A 1 2 2 2 2 9 10

B 1 2 2 2 1 8 5

C 1 1 2 1 2 7 0
A B C D
D 3 3 3 3 3 14
PROBLEMS

According to 2 qualities dimention above, QCC formulated the theme " Reduce Inaccuracy of infusion
droplest in patients in OBGYN”

7.4 ANALYZING THE THEME

If these problems can be solved, it will increasing quality services, Prevent the safety patient incident, inhancing
hospital services