Strategic and Operational Healthcare Management

Strategic and Operational Healthcare Management 150 150 Affordable Capstone Projects Written from Scratch

Assignment 1- Strategic and Operational Healthcare Management

  • The What?

Change the wage structure of doctors and nurses in a private primary care clinic.

  • Background

Indonesia’s healthcare reform background:

Over the last two decades, Indonesia has been struggled to increased its universal health coverage for Indonesian people. The main obstacles for Indonesia’s effort lies in the financial aspect in the Indonesia’s healthcare system. Having a healthcare system that mainly financed by out-of-pocket payment to access the healthcare leads to a slow development of achieving universal health coverage in Indonesia. Nevertheless, 2014 had become a historical year for healthcare system development in Indonesia specifically in the financial aspect of the healthcare system. The year marked the implementation process of financial reform to support Indonesia healthcare system. A shifts from a system that mainly out-of-pocket based to a social health insurance scheme. One of the reforms objectives is to have all Indonesian citizen covered by health insurance under the public social health insurance organisation by 2019. Therefore, the reform process will implement incrementally with every year has its own target to cover groups of people in the new scheme.


The primary health clinic bavkground”

The national reform will definitely have impacts on the healthcare organisation especially in the primary healthcare organisation. Since the social health insurance scheme required a strong primary healthcare system as the foundation of the scheme. Therefore, new policies will be made and affects the way primary healthcare organisation delivered health service. The change management project plan will take place in a private primary health clinics. The clinics located in one of the ten biggest cities in Indonesia. The owner of the clinics is a surgeon who lives in the capital cities and occasionally come to the clinics to see how its progress. A doctor was appointed as a general manager to be responsible managing daily activity of the clinics. I was joined the clinic three years after the general manager was in charge and invite me to the management team as health service manager of the clinic. A year after I joined the clinic, the general manager was taking a residency program in an another city. However, the owner still wants the doctor keep in charge of the clinic while continuing his study. Therefore, the general manager appointed me as daily manager on his behalf and he will still responsible for the important decision the clinic will took. He will come every fortnightly or every month to manage the clinic. One year after I’m acting as daily manager, the owners’ son join the in the clinic management team as the director of the clinic.

Prior to 2014, a third of clinics revenue comes from out-of-pocket payment from the patient. The next third revenues originated from the capitation payment from the public servant health insurance and the remaining comes from general medical check-up for Indonesian workers who wants to work abroad. The out-of-pocket payment contributes to 30%-40% of doctors and nurses monthly take home pay. The take home pay of doctors and nurses divided into two part: basic wage and bonus. If a patient paid with out-of-pocket methods, a part of that payment will directly become the bonus for the doctor and nurse who served the patient. In our last trimester in 2013, the number of out-of-pocket patient visited our clinic can provide bonus up to approximately 35% of doctors or nurses monthly take home pay.


  • Strategy

SWOT analysis:


Had experiences in managing public servant health insurance

Stakeholders tends to support management decision



Doctors and nurses tends to give poor service to the non out-of-pocket patient

Regular meeting for all clinic staff is once in three months



The capitation rate in the new system will increase compare to the previous

The increasing trend of patient visit



The information about transition process is very limited

The exact rate for the capitation payment hasn’t been finalised until very last minutes


Change management framework? (kotter 8 step etc?)


  • Objectives

Developed a new wage structures for doctors and nurses to be align with the universal health coverage reform

  • Communication strategy



  • Stakeholder identification
  1. Yose
  2. Langgo
  3. Miss mimi
  4. Doctors
  5. Nurses


  • Stakeholder management (analysis)

4 quadrants stakeholders analysis.

  • How to manage the process

Explanation of strategy


  • Project plan
  • Same with change management framework?