Corresponding Author: Sandry
Tri Summary
E-mail: [email protected]
INTRODUCTION
The COVID-19 Pandemic is an extraordinary situation
changing fundamental aspects of life, especially health services. Based on
previous research conducted in America, there will be a shortage of 9,000
regular beds and 9,000 Intensive Care Unit (ICU) beds due to the COVID-19
Pandemic (COVID & Murray,
2020). Meanwhile, it was estimated that hospitals in
Indonesia would be overrun by patients suffering from financial problems and
staff shortages (Herlina, 2021). However, this is also accompanied by a significant
reduction in the number of patients in other sectors, such as polyclinics,
inflicting serious economic damage to the healthcare industry (COVID & Murray,
2020).
With rapid fluctuations in the number of patients and
income, a significant danger is imposed on the hospital�s sustainability as a
form of business (ELSukkary &
Youssef, 2021) (Mahubessy &
Darmawan, 2022). Rapid decrease in patient numbers, increasing costs
due to the addition of infrastructure and operational standards following
COVID-19, and financial difficulties are things that hospitals must face during
the COVID-19 Pandemic (Khullar et al., 2020).
Hospitals in Indonesia also feel these phenomena.
Based on a previous publication, hospitals in Indonesia would experience four
enormous �waves� of COVID-19-related problems. These four waves were 1) a rapid
increase in patients and death, 2) financial crisis, 3) staff shortage and
burnout, and 4) increased morbidity and mortality due to delayed healthcare
services (Herlina, 2021).
Two years following the initiation of the pandemic
status, various advancements had been made to cope with the situation. The �infection
curve� had also been flattening due to various restrictions imposed on the
population. However, the damage had been done. There was a significant impact
on the financial and healthcare industry, forcing various hospitals to default
or close (Pragholapati, 2020). The �new normal� status has also brought many
changes to the healthcare industry (Pragholapati, 2020).
Therefore, an innovative change in strategy and
management is needed during the COVID-19 Pandemic. Challenges far from usual
encourage healthcare facilities to adapt to current conditions, such as
humanitarian facilities and businesses (Adelaja et al., 2020). Unfortunately, there has yet to be a comprehensive
study on the factors affecting hospital business continuity in Indonesia during
the COVID-19 Pandemic. This study examines the factors affecting hospital
business continuity in Indonesia during the COVID-19 Pandemic.
METHOD
This research is a
scoping review based on the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR)
(Suhartini, 2022). Guidelines in March � May 2022 to determine the factors
affecting hospital business continuity in Indonesia during the COVID-19
Pandemic.
This research used
the population, concept, and context (PCC) framework recommended by the Joanna
Briggs Institute for Scoping Review. The PCC framework for this study can be
observed in Table 1.
Table 1. PCC
Framework of the Study.
|
Population
|
|
Hospitals
|
|
Concept
|
|
Business continuity
|
|
Business Survival
|
|
Context
|
|
Hospital setting Indonesia
|
|
Published during the COVID-19 Pandemic
|
The study
eligibility criteria in this study were: 1) an original research study, a
review, or a case study in a hospital, 2) not a correspondence study or a
policy brief, 3) Focusing on the hospitals in Indonesia, 4) Published since the
COVID-19 Pandemic announced (November 2019), 5) Written in English or
Indonesian, 6) can be accessed in full (full text), and 7) there is no
duplication of studies between databases. The study search in this research was
conducted on three online databases: Pubmed, Google Scholar, and Garuda Portal.
RESULTS AND DISCUSSION
During the initial literature search, 366 kinds of literature were
obtained. After the duplicate screening, a total of 326 types of literature
were obtained. After thoroughly screening the articles� titles and abstracts, a
total of 320 articles were excluded. Of these, 317 were excluded due to being
irrelevant to the topics. In comparison, three themes were excluded due to the
wrong location. Afterward, a total of 6 studies were identified and analyzed.
However, a full text of a thesis article was not available. Therefore, five
studies were included and analyzed in this study.
Figure 1. Study Selection with Prisma ScR diagram
Studies Characteristics
Among five articles analyzed and synthesized, two systematic reviews, one
literature review, one case report, and one cross-sectional study were
obtained. One review analyzed the strategic planning of hospitals in dealing
with the pandemic situation. Two reviews analyzed the financial aspect of
hospitals during a pandemic crisis. The case report explained the preparedness
of an orthopedic hospital for the approaching COVID-19 Pandemic. The
cross-sectional study analyzed customer loyalty to medical checkup clinics in a
hospital.
Studies Search Results
The results of the articles search were categorized and tabulated. The
results can be found in Table 2.
Table 2.
Literature Search Results
|
Author
|
Title
|
Aim
|
Study
design
|
Results
|
|
(Master, 2020)
|
Applying Generic Strategy in Creating
Customer Loyalty in The Middle of Virus Covid-19 Pandemic in Polyclinic MCU
XYZ Cardiovascular Hospital
|
Top
determine the factors affecting customer loyalty in medical checkup clinics
during the COVID-19 Pandemic.
|
Cross-sectional using questionnaires
|
1.
Customer loyalty is one of the determining factors in the number
of visiting patients to the police in hospitals.
2.
Factors affecting customer loyalty to hospitals during the
COVID-19 Pandemic were hospital differentiation, cost leadership strategy,
and a focus strategy implementation.
3.
Cost leadership includes delivering the most efficient care with
minimal patient cost.
4.
Hospital differentiation strategy includes a decision to wrap
the products, quality, or brand differently from other competitors.
|
|
(Jatnika et al., 2021)
|
Strategy For Anticipating the
Hospital�s Financial Condition During The COVID-19 Pandemic
|
To determine
the strategies for anticipating the hospital�s financial condition during the
COVID-19 Pandemic.
|
Systematic review
|
1.
Hospitals have many challenges in surviving the COVID-19
Pandemic, including financial challenges.
2.
Various strategies have been proven to repair and regenerate the
hospital system while restoring the hospitals� financial stability.
3.
The strategies used were leadership style change, social media
strategy, funding allocation system, income rejuvenation, restructuring the
emergency department, and following the health policy.
4.
The funding allocation system was further categorized into the
postponement of irrelevant medical devices investment, delays in
unprioritized infrastructure repairs, postponement of non-mainly maintenance,
renegotiation of loans and payments, reducing interest rates, not conducting
CME, and not recruiting additional personnel.
5.
Income rejuvenation may be done by reducing hospital operating
costs, reviewing the strategic business plan, implementing health service
innovations, modifying hospital behavior, and shortening hospitalizations.
|
|
(Fransisren, 2021)
|
Systematic Review:
Hospital Strategic Planning in VUCA (Volatile, Uncertain, Complex, Ambiguous)
Corona Virus Disease 2019 (COVID-19) Pandemic Era
|
To evaluate
the strategic business plan of the hospitals during the COVID-19 Pandemic.
|
Systematic review
|
1.
The COVID-19 Pandemic is a VUCA (volatile, uncertain, complex,
and ambiguous) situation requiring special management.
2.
Utilizing available resources (material, men, method, money, and
machine) is the main strategy in facing COVID-19 Pandemic.
3.
Hospitals must fulfill the 4S (space, staff, system, and
supplies) to survive the Pandemic.
4.
Space parameter includes the capacity to deliver the standard
treatment using available resources.
5.
Staff parameter includes the availability of competent staff and
the fulfillment of their rights.
6.
System parameter includes the management system of COVID-19 and
non-COVID patients.
7.
The supplied parameter includes the fulfillment of required
materials to deliver standard care for the patients.
|
|
(Yusri, 2021)
|
Tinjauan
Atas Peningkatan Pendapatan Rumah Sakit Dalam Optimalisasi Layanan Kesehatan
Ditengah Pandemic COVID-19
|
To show an
overview of strategies needed for hospitals to survive the COVID-19 Pandemic.
|
Literature review
|
1.
There has been a significant drop in hospitals� income during
the COVID-19 Pandemic, with as low as a 50% decrease in a hospital in
Pontianak.
2.
Strategies to be implemented during the COVID-19 Pandemic
include fulfilling good services and delivering healthcare innovations.
3.
Good healthcare services need to be identified for each
hospital.
4.
Healthcare innovations include telemedicine and social media
utilization.
|
|
(Utomo et al., 2022)
|
Emergency Department Preparedness of
Prof. Dr. R. Soeharso Orthopaedic Hospital against Coronavirus Disease-19
Pandemic: Understanding the Challenges
|
To explain
the challenges and preparations done in the orthopedic emergency department
during the COVID-19 Pandemic.
|
Case report
|
1.
Strategies used to anticipate the COVID-19 Pandemic in the
emergency department were health standard protocol and PPE, triage management
in ED, prehospital screening triage, management of resuscitation, management
of staff health care, and emergency surgery management.
2.
Health standard protocol and PPE were defined and upheld for
each emergency department staff.
3.
Triage management during the COVID-19 Pandemic was categorized
into prehospital and hospital triage.
4.
Resuscitations in emergency departments were held in
isolation-type resuscitation areas with negatively pressurized rooms with
HEPA filters.
5.
Patients undergoing emergency surgery would be carefully
selected.
|
Throughout the study, a total of 5 articles were included and analyzed.
Due to the limitations of the pandemic situation, three of the studies were
either literature reviews or systematic reviews. Meanwhile, one study was a
case report, and the other was a survey. Most of the studies pointed out
managerial strategies as a solution to the indeterminate situation of the
COVID-19 Pandemic. Moreover, the studies pointed out the financial problem as
the most impactful factor of a hospital�s business continuity (Mastari & Astari,
2020) (Fransisren, 2021).
The COVID-19 Pandemic brought extraordinary circumstances surrounding
every aspect of hospital management, both as a healthcare facility and a
business. Fransisren et al. (2021) defined the situation as VUCA (volatile,
uncertain, complex, ambiguous), derived from a critical condition in strategic
leadership which was first introduced by (Pandit,
2020). The dangers of COVID-19 could
be categorized into biological, financial, and resource management problems.
The aerosol transmission of
COVID-19 carried significant implications for protocols and infrastructures in
hospitals. Inhalation of air bringing very small fine droplets and aerosol
particles containing the SARS-CoV-2 virus highly contributes to the rapid
spread of COVID-19 (Stadnytskyi et al.,
2020). The provision of standard protections for medical
personnel, non-medical staff, and patients is essential to reduce virus
transmission (Utomo et al., 2022). Moreover, additional
infrastructures such as HVAC (heating, ventilation, and air conditioning)
systems should be modified to comply with the health standard. These problems
would also bring a heavy financial burden to the hospitals during a pandemic.
The rapid decrease in police patients and surge of emergency patients
tremendously change the income stream for each unit in a hospital. Due to the
fear of contracting COVID-19, most patients would hesitate and delay their
routine medical appointment. Moreover, they would also choose nearer and more
trusted hospitals. Regarding the conditions, customer loyalty is essential in
determining the continuation of the hospital business. (Mastari
& Astari, 2020) Wrote that customer loyalty is affected by hospital
differentiation, cost leadership, and focus strategy implementation. For
instance, pregnant patients would rather take their routine antenatal care in
maternal and child hospitals, as it would lower their chance of being in the
same room as COVID-19 patients.
The previous study (Yusri,
2021) showed that hospitals were faced with significant
drops in income during the COVID-19 Pandemic, even as low as a 50% decrease.
Therefore, critical changes must be implemented during the COVID-19 Pandemic,
including (Jatnika et al.,
2021) :
1.
Identification and fulfillment of profitable
services
2.
Innovations in health services, including the use of
telemedicine and social media utilization.
3.
Reducing hospital costs and modifying hospital
behavior.
Resource management problems also brought a significant challenge for hospitals
worldwide. In contrast to the decrease of the patient in policlinics, the
emergency department would experience a sudden surge of patients during the
COVID-19 Pandemic. The sudden increase in patient numbers would significantly
burden the medical staff and infrastructures. Exhausted medical teams are more
prone to contracting COVID-19, exacerbating the deficiency of staff further and
creating an unending loop. Therefore, control of the patient number and staff
protection is essential in the emergency department (Utomo et al., 2022). Medical staff security can be ensured by providing
standard PPE, applying standard health protocol, and carefully selecting
patients eligible for emergency services and surgeries (Utomo et al., 2022).
CONCLUSION
The
COVID-19 Pandemic brought significant challenges for hospitals around the
world. Factors affecting hospital business continuation in Indonesia appear in
biological, financial, and resource management problems. Changes and
innovations to each situation would be necessary to ensure the business�s
continuation.
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