BALTIC JOURNAL OF LAW & POLITICS

A Journal of Vytautas Magnus University

VOLUME 15, NUMBER 2 (2022)
ISSN 2029-0454

Cite: Baltic Journal of Law & Politics 15:2 (2022): 1947-1968

DOI: 10.2478/bjlp-2022-001123

Organizational Transformation at Regional General Hospital

of Prof. Dr. H. M. Anwar Makkatutu, Bantaeng Regency

Muhajir
Student of Public Administration Doctoral Program, Universitas Negeri Makassar,
Indonesia
Correspondent Author: muhajir.bone@gmail.com

H Akib
Universitas Negeri Makassar, Indonesia
Email: haedarakib@unm.ac.id

R Niswaty
Universitas Negeri Makassar, Indonesia
Email: risma.niswaty@unm.ac.id

Received: July 11, 2022; reviews: 2; accepted: October 22, 2022.

Abstract

Hospital organizational transformation as an adaptation process for its existence.

Hospitals can no longer maintain the status quo and are forced to change or move because
otherwise their survival will be threatened. Regional General Hospital (RGH) of Prof. dr.H.M.
Anwar Makkatutu has undergone a transformation journey from class changes from class D
to class C and from class C to class B, the hospital has also changed financial management
by implementing the Financial Management Pattern of the Regional Public Service Agency,
but a number of indicators do not show optimal performance. The objectives of study to
describe the implementation, identify of determinant factors and describe the hospital
organizational transformation strategy. The method used in this research is descriptive with
a qualitative approach. The informants of this study consisted of structural officials, the head
of the installation and staff. This study collects primary data and secondary data. The results
showed that RGH Prof dr. H. M. Anwar Makkatutu had implemented a transformation
referring to 10 steps which completed the 8 steps of transformation according to Kotter and
brought changes to the structure, culture and increased number of types of services.
Organizational culture factors and transformative leadership have influenced Prof dr. H. M.
Anwar Makkatutu Hospital to transform. Finding strategies for better transformation with
quality improvement activities through accreditation and by developing business strategies.
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Keywords

implementation, determinant, organizational transformation, hospital

Introduction

Transformation as an adaptation process for the existence of an

organization. There are times when an organization can no longer maintain the
status quo and is forced to change or move because if not, then the sustainability
of an organization will be threatened (Thalib, 2015). Organizations need to adapt
to environmental changes that take place rapidly and dynamically. According to
Ferbriaty et al., (2020) states that the challenges of global expansion, domestic
and international competition, cultural shifts and behavior control, challenges to
creating quality products and services, demands for more creative, dare to take
risks, able to work in increasing demands and pressures to improve performance
in order to exist, able to compete and realize competitive advantage. This is the
reason for the need for management or organization to follow the dynamics of
change. This is the reason for the need for management or organization to follow
the dynamics of change.
Furthermore, according to the Republic of Indonesia Law Number 44 of 2009
concerning Hospitals, the dynamics of change will bring the organization from the
old forms and systems to the new forms and systems. Meanwhile, for health
facilities, organizational change is intended to meet patient needs in improving
public health status (Basabih, 2017) and more guaranteeing future discoveries
(Anderson et al., 2014). According to Handy (1996) and David (1995) in Widayat
(2009) to anticipate global competition and increase hospital competitiveness,
according to Sajadi et al. (2017) improve access and quality of services in hospitals.
With the use of information technology, it will increase operational efficiency and
hospital resilience (Kraus et al. 2021; Singh et al., 2021).
Synergistic with the explanation of Article 36 of the Republic of Indonesia
Law Number 44 of 2009 that good hospital governance is the application of hospital
management functions based on principles including transparency, accountability,
and responsibility. The status brings the organization from the old form and system
to the new form and system by adapting all its elements. This is an effort to respond
to changes in the external and or internal environment of the hospital (Law RI No.
44 of 2009) and in order to meet the demands of excellent public services (Law of
the Republic of Indonesia No. 25 of 2009).
According to the explanation of the Law of the Republic of Indonesia Number
25 of 2009 concerning Public Services, that today the implementation of public
services is still faced with conditions that are not in accordance with the needs and
changes in various fields of social, national and state life. This can be caused by
unpreparedness to respond to the transformation of values that have broad
dimensions and the impact of various complex development problems. Meanwhile,
the new order of Indonesian society is faced with global hopes and challenges

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triggered by advances in science, information, communication, transportation,

investment, and trade. This also applies to regional general hospitals (Müssig &
Graupner, 2020; Takacs, Miri, & Kovach, 2020).
Organizational transformation at Regional General Hospital (RGH) of Prof.
Dr. H.M. Anwar Makkatutu with higher types, transformation of quality culture with
more complete accreditation and implementation of Financial Management Pattern
of the Regional Public Service Agency, further competition with other health
facilities, changes to the tiered referral policy from Social Security Administrator
and the existence of the pandemic of corona virus disease 19 should make this
hospital have a good performance as a the only reference in the internal area and
one of the external referrals in Bantaeng Regency. In accordance with the vision
as a prima donna hospital in the southern region of South Sulawesi Province,
however, there are still a number of gaps in performance achievement. In 2020,
patient visits decreased by 52,121 22.13% from the previous year in 2019 with a
total of 66,937. The bed occupancy rate (BOR), which is the percentage of home
bed users in 2020, is only 54.66% (below the value of 65-85%, the Indonesian
Ministry of Health Standards, 2005 and the Indonesian Ministry of Health, 2011).
AVLOS (average length of stay) is the average length of stay of patients with values
from 2016-2020 under standard (6-9 days). This indicator also provides an
overview of the service quality culture, which is not yet included in the standard
category. BTO (bed turn over) which is the number of bed turnover or the frequency
of bed use in a period of one year also has not shown consistency in the standard
area from 2016-2020 (40-50 times). Compliance with clinical pathways (clinical
flow), namely the compliance of medical staff or doctors in charge of services in
using clinical pathways to provide standardized and integrated clinical care for
patients. Achievement in this aspect is only 80%. The hand hygiene indicator,
namely the culture of six steps of hand washing according to accreditation
standards as part of the quality culture, shows that it is still low and far from the
85% standard. In 2018 the achievement was 49.3%, in 2019 the achievement was
67% and in 2020 it was 75%. The use of personal protective equipment (PPE) has
not shown achievement according to the 100% standard, while hand hygiene and
PPE facilities are sufficient, including during the pandemic of corona virus disease
19. The achievement of PPE uses in 2018 was 53%, in 2019, 54% and in 2020
amounting to 86%.
Furthermore, the culture of compliance with filling in the initial medical
record file (during registration) until 2020 is only 78% and filling out medical
records after 24 hours of completion of service until 2020 has only achieved 80%
of the 100% standard. Furthermore, the culture of adherence to service readiness
by complying with the service schedule from specialist doctors is still low, up to
2020 at 60%. The interesting thing about the achievement of these indicators is
that this hospital has been accredited by five service groups in 2009- and five-star
plenary accreditation in 2018, where accreditation is an acknowledgment of the
quality of hospital services. On the other hand, the increasing number of health

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facilities, both within and outside the Bantaeng Regency, can become a rival and a
threat to RGH of Prof. dr. H.M. Anwar Makkatutu, especially hospitals with PPK-
BLUD status. The data shows the increase in two hospitals within the scope of
Bantaeng Regency, a private hospital, namely a maternal and child hospital and an
government hospital unit of type D. The growth of specialist clinics which until now
has seven units and the existence of an integrated nutrition service unit.
The change in the Social Security Administrator tiered referral system policy
which was implemented as an adjustment to the change in hospital type from type C
to type B hospitals, and with the corona virus disease 19 pandemic, has caused a
decrease in patient visits by 22.13% in 2020. The decline in visits will have an impact
on decrease in hospital income, and affect the hospital's ability to finance its
operations. The level of hospital independence in 2020 is only 44%, which means that
the hospital's ability to finance capital expenditures/assets is still 44%, thus requiring
other sources of income, to increase capacity. Therefore, it is necessary to adapt and
innovate services according to customer needs and changes in the hospital
environment. Organizational transformation of RGH. Prof.dr. H.M. Anwar Makkatutu
has not shown a significant increase in performance. This can be seen from the
achievement indicators of a number of performance indicators. Ideally, hospitals
should be able to transform by adapting to the needs and changes in their
environment. Achievement of sub-optimal performance can occur if they have an
unequal understanding of the direction of organizational change, or a number of parties
do not accept change, and do not learn to make change happen. It is suspected that
the transformation steps were not carried out effectively and efficiently.
This study aims to describe the implementation of organizational
transformation, identify of determinant factors and describe the hospital
organizational transformation strategy at RGH of Prof.dr. H.M. Anwar Makkatutu.

Research Methods

The method used in this research is descriptive with a qualitative approach.

The informants of this study consisted of hospital management (structural officials),
the head of the installation, staff and patients. This study collects primary data and
secondary data. Primary data were obtained from in-depth interviews and
observations. Secondary data obtained from documentation and literature study.
The data collection tools are in the form of interview guidelines, recording devices,
documentation and field notes.

Results And Discussion

1. Implementation of organizational transformation

RGH of Prof. dr. H.M. Anwar Makkatutu Bantaeng, which was founded in
1921, has undergone many changes. a type D hospital based on the Decree of the
Minister of Home Affairs of the Republic of Indonesia in 1994 concerning
Organizational Guidelines and Work Procedures for Regional General Hospitals with

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the status of the Technical Implementation Unit of the Bantaeng District Health
Office. Decree of the Minister of Health of the Republic of Indonesia number
1284/MENKES/XII/2004 dated December 17, 2004 concerning Class Improvement
of Regional General Hospital of Prof.dr. Anwar Makkatutu became a class C hospital.
Changes in hospital structure based on Government Regulation number 41 of 2007
concerning Regional Apparatus Organizations. Furthermore, based on Government
Regulation Number 72 of 2019 concerning Regional Apparatus, and based on the
Decree of the Governor of South Sulawesi number 5/J.09/PTSP/2020 concerning
the Operational Permit of the RGH of Prof. dr. H.M. Anwar Makkatutu Bantaeng as
a class B hospital. In addition to the change in the hospital class, there was a
change in financial management, namely becoming a hospital that implements the
pattern of financial management of regional public service agencies based on the
results of the 2013 assessment with half and then in 2016 set with full.
RGH of Prof dr. H.M. Anwar Makkatutu Bantaeng has undergone a number
of transformations, both changes in organizational structure, culture, business
strategy, infrastructure, competence and number of people. This is in accordance
with Walton (2000) in Kadjatmiko (2003) that organizational transformation is
organizational change from current conditions to expected conditions. The
transformation involves elements of organizational structure, organizational
culture, business strategy, infrastructure, competencies and people. Meanwhile,
the theory of Generic Process Transformation Model according to Hernaus (2008)
is transformation with a focus on process changes in organizations. This model has
3 (three) stages, namely: (1) a strategic phase where the organization realizes the
importance of change for the progress of the organization; (2) the transitional
phase, namely the transition phase of the organization to make changes; (3) the
operative phase, namely making changes based on the processes implemented in
the organization.
In the implementation of organizational transformation at RGH of
Prof.dr.H.M. Anwar Makkatutu, what was done was as follows
a. Identify of problems, possible solutions by analyzing strengths, weaknesses,
opportunities and threats.
b. Convey the importance of changing hospital classes, or changing financial
management. Class changes will change the organizational structure and
become an opportunity for employees to occupy structural positions and
increase the quantity and quality of services as well as the flexibility of
financial management. Information is conveyed predominantly through
meetings and morning apples.
c. Forming a working group or team with a director's decision letter consisting of
management or structural elements and to prepare documents to meet the
requirements of the intended change and guard it until it is determined.
d. The vision of the hospital was changed according to the dream the hospital wanted to
achieve as a prima donna hospital in the southern region of South Sulawesi.
Likewise, changing the mission to adapt to the changing vision of the hospital.

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e. Changes in vision and mission are socialized through meetings, morning apples,
posters in every installation within the hospital area. The mission change
only involved a small team, did not involve all installation units. The
weakness is that the hospital does not have a regular meeting schedule,
both weekly and monthly. Meetings are only held if there are urgent and or
emergency interests.
f. Furthermore, according to the 2012 version of the accreditation standard, every
household employee is required to know and memorize the vision and
mission, including cleaning service and security. Leaders encourage the
achievement of the vision with the support of resources.
g. Hospitals have annual and five-year plans through the hospital's strategic plan or
strategic business plan. Annual and five-year performance indicators are
included in the document.
h. The leadership together with officials and heads installations conducts evaluation
meetings every 6 months to assess the achievement of the coverage of
service quality indicators and hospital performance indicators, synergistic
with the preparation of budget changes. Each section and installation is
given the opportunity to convey the problems faced (gaps between reality
and standards), possible solutions. the leadership determines solutions and
steps for acceleration and improvement to increase the achievement of
these indicators. Furthermore, the planning section compiles a change
document to accommodate programs and activities.
i. In the evaluation meeting, new steps or approaches which are considered to have
had a successful impact on the achievement of indicators, are stipulated in
the director's policy regulations, guidelines and standard operating
procedures are made in the hope that they will form a culture. Furthermore,
it will be part of the main tasks and functions of the related sections and
installation. Thus the urge becomes strong and can be grounded in the
hospital. This is in line with hospital accreditation.
j. Hospitals transformation through collaboration and partner with non-government
external parties to oversee and help achieve higher hospital performance
and quality indicators. Collaborating with legal aid institutions, namely legal
aid agency Suardi and Partners and the non-governmental organization
Balang Institute.
The hospital realizes the importance of transforming in order to achieve its
vision and mission and adapt to the demands of society. The transformation steps
carried out by the hospital still refer to the 8 steps of organizational transformation
(Kotter, 2011), with the addition of two aspects so that it becomes 10 steps,
namely identifying problems and collaborating or partnering with external parties.
non-government. This is intended to make the transformation step more effective
and efficient. This is supported by research. According to Zhenxiang (2014) a SWOT
analysis (strengths, weaknesses, opportunities, and threats) is needed in hospital
transformation, strengths related to marketing systems and facilities as well as

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complete types of services, while weaknesses is related to weaknesses in resource

management, technology, human resources, asset accumulation and fixed asset
scale. lack of professional and technical personnel, poor executive cultural
strengths, and poor structure. Opportunities with the increase in people's living
standards, public health awareness also increases, the desire to pursue a high-
quality life and respect health. The community's need for quality medical services
is increasingly real and on the other hand, the health insurance system is
optimized. Threats namely the existence of competition in the form of hospital
construction, improvement of government policies to support the development of
private hospitals.
The changes from organizational transformation in hospitals are changes in
organizational structure, changes in culture and additional types of hospital
services. Changes in structure are in line with changes or increases in hospital class
(class D, class C and B) and changes by the existence of laws and regulations, for
example by Government Regulation number 41 of 2007 concerning Regional
Apparatus Organizations which give rise to heads of fields/sections (echelon III.B)
under the director. Regulation of the Minister for Empowerment of State Apparatus
and Bureaucratic Reform Number 17 of 2021 concerning Equalization of
Administrative Positions into Functional Positions, which eliminates section heads
and sub-sections (echelon IV A) in the organizational structure and is equated with
functional positions and Regulations of the Minister for Empowerment of State
Apparatus and Bureaucratic Reform number 25 of 2021 concerning Simplification
of Organizational Structure in Government Agencies for Bureaucracy Simplification.
Meanwhile, cultural changes in hospitals consist of positive cultural changes and
negative cultural changes. Positive and negative cultures that arise from the long
journey of transformation are the emergence of the following cultures. This is
consistent with Kirk, Andersen, and Petersen (2019) statement that sustainable
transformation in organizations focuses on structural change and cultural aspects.
The organizational structure of the hospital is a horizontally complex type,
which is profession-intensive, specialist-intensive with service units whose growth
in the number of units is increasing, which in 2007, amounted to 12 installations
and 2 committees, growing until 2021 as many as 22 installations and 10
committees and with the addition of structural officials from 4 echelon III to 8
people. Furthermore, with the Regulation of the Minister for Empowerment of State
Apparatus and Bureaucratic Reform Number 17 of 2021 concerning Equalization of
Administrative Positions into Functional Positions, there was a reduction in the
bureaucracy, there was a cut at the hierarchical level. There is no section head,
and directly to the head of the field. The role of functional positions is more open
and larger in hospital operations. All personal functional positions for service
operations, and structural officers are in one location of the hospital complex,
making it easier for decision making and coordination quickly and with digital
communication tools facilities will make everything easier. Since the accreditation
activities and the implementation of regional public service bodies, there have been

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additional regulatory documents, not only sub-district regulations related to main

tasks and functions, but also other regulations such as hospital by low, minimum
service standards, hospital governance patterns, and policy documents as in
hospital accreditation standards. On the other hand, by simplifying the
bureaucracy, the equalization of the positions of section heads becomes functional,
so that centralization is also reduced. Installations with specializations have more
space in making service operational decisions. Decision makers are not focused on
the hospital director. With these conditions, the hospital is more directed to a
combination of simple operating care.
The hospital structure is simplified because it adapts to the needs of the
bureaucracy to speed up decision making, administration and delivery of public
health services. The obstacles are the appointment of officials who are not in
accordance with the competence in the structure of the hospital, the allocation of
activities that are not in accordance with the sections and the centralization of
budgeting in certain sections, so that other fields and sections cannot carry out
their activities quickly.
The main elements of organizational structure according to Robbin (1990)
in Kusdi (2018), are complexity, formality, and centralization. Complexity describes
the degree of horizontal, vertical, and spatial differentiation. Horizontal
differentiation is the degree of separation among units in the organization, as
measured by the number of units in the organization. Vertical differentiation
describes the hierarchical layers in the organization or the depth of the hierarchy
which is usually measured by the number of organizational levels. Meanwhile,
spatial differentiation describes the extent to which the organization's facilities and
personnel are geographically dispersed. Formalization in the organizational
structure, concerning the number or number of written rules in the organization.
Centralization is defined as the degree to which formal authority to make free
choices is concentrated on a person, unit or level. Meanwhile, according to Henry
Mintzberg in Budihardjo (2011), there are five basic elements to form an
organizational structure, namely Apex, middle line, technostructure, supporting
staff and operating staff/cares. The form of the structure is based on the dominance
of one of its elements. If the dominant element is the apex, then the form of the
structure is simple structure. If the dominant element is technostructure, then the
structure is machine bureaucracy. If the dominant element is supporting staff, then
the form of the structure is professional Bureaucracy. If the dominant element is
the middle line, then the structure is a divisional structure. If the dominant element
is operating care, then the adhocracy structure. But in reality there can be a
mixture of structures, for example simple technostructure, simple machine
bureaucracy and others.
So there is a change in the structural and contextual dimensions in the
transformation of the hospital organization. Structural dimensions related to formality
are getting higher, specialization is getting more and more, standardization is getting
stricter with accreditation, centralization is reduced, span of control is getting shorter,

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and the division of activities is getting more diverse horizontally, and getting simpler
vertically, professionalism is getting higher with increasing master's education,
specialist and sub specialists and configuration of activity divisions by director's decree.
Changes in the contextual dimension, where the number of personal hospital
employees was 215 people in 2007 (112 civil servants and 112 non civil servants,
balanced position) and in 2021 there were 658 people (245 civil servants or 37.39%
and 412 non civil servants or 62.61%). Agility and speed of work are higher for non-
civil servants and those with information technology skills. The medical technology
owned by this hospital is in accordance with the standards of a class B hospital, with
excellent services for heart care, eye care, and several service innovations. This is in
accordance with what was conveyed by Lubis (2015), that organizational
transformation will cause changes in structural and contextual dimensions.

Table 1. Cultural Changes in RGH of Prof.dr.H.M. Anwar Makkatutu

Old Culture
Closed
Based on Habits
Focus on officers
Awaited
Low learning motivation
Just doing the routine
Mutual cooperation
Unmeasured service sharing
Manual
High brotherhood
culture of shame and mutual respect is upheld (in Makassar language: “siri’
sipakatau”)
Patience and resolution of conflicts or complaints is low
Patients are treated equally for all
innovation culture has not received attention
Paramedics don't have high confidence yet
Authoritarian and closed leadership culture
don't want to risk
New Culture
Transparency, public openness
Accreditation quality standard culture
Focus on the patient
Waiting (discipline)
Learning for competency development
There is concern for the task
Calculation according to main duties and SOP
Fairly measurable service distribution with the principle of remuneration
Information technology (digitalization)
High competition
culture of shame and mutual respect is no longer respected
Patience for conflict or high complaints and resolution becomes more effective and
integrated
There are priority services for the elderly and special disabilities in outpatient care
Innovation is starting to be encouraged in the installation
Paramedics have equal trust and partners with medical personnel
Transformative and open leadership culture
want to take the risk

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The impact of changes in the form of additional services, illustrated that the
transformation journey has increased the quantity of services in hospitals. Since
class D until 2004, the hospital has 19 types of services. At the time of class C, it
had 20 types of services. Class C with changes based on Government Regulation
of the Republic of Indonesia Number 41 of 2007 to 2016, 38 types of services.
Class C with the implements the pattern of financial management of regional public
service agencies until 2021, has 56 types of services and since becoming class B
until 2022 it has had 59 types of services. The innovation services that have been
born in hospitals include:
a. Lotus continues to develop is a physiotherapy service for children with
special needs and integrated growth and development for all, namely integrated
integrated services between health centers, special schools, pediatrician services,
nutrition specialists and physiotherapy. This service started in 2019
b. Pandora Gesit is an integrated blood donor service, which is an external
blood donor activity in hospitals by actively involving regional government
agencies, central, professional organizations, community organizations, schools
and mosques to meet blood needs in the health services of RGH Prof.dr.H.M. Anwar
Makkatutu and the house. neighboring district hospitals (Jeneponto and Bulukumba
district). Innovation born since 2017
c. Raja Smile's innovation, which was born in 2019, is an outpatient service
with an excellent service information system, namely an online registration service
using an application with the name SI PANDAI application. It has been developed
with the addition of priority services (elderly and the child with special
needed/disabled, patient escort services and drug couriers to patients' homes.
These services are contested in national innovation competitions and have won the
top 45.
d. The innovations that have been born by each candidates for civil servants
starting from acceptance in 2019 are through the candidates for civil servants basic
training actualization program. The innovation from the basic training actualization
program is a simple innovation that was born as an adaptation and solution to the
problems faced by the unit/installation, so that innovation still exists today.
According to Basabih (2017), the establishment of a hospital as a unit that
implements the Financial Management Pattern of the Regional Public Service
Agency is one form of hospital transformation. The purpose of the hospital
implementing this is to improve services, and accelerate the response to customer
needs because they get convenience in financial management. flexibility in financial
management, is expected to stimulate growth and at the same time fulfill resources
for developed innovations.
The existence of service innovation as a form of adaptation to suit the
demands and needs of the community, as stated by Sisca et al., (2021) the
products produced by the transformation will be in accordance with customer
needs. Synergistic with this opinion, there are experts who state that the dynamics
of change will give birth to ideas for improvement (Akib, 2011), organizations are

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more adaptive, and proactive in dealing with change and reducing reactive behavior
(Kotter, 2011), to achieve goals effectively and efficiently (Budihardjo, 2011),
behavior change and organizational performance improvement (Schneider and
Betty in Ritonga, Manurung, and Tan, 2019), improve bureaucratic performance
(Martini et al., 2019), and the resulting product will be in accordance with customer
needs (Sisca et al., 2021).
There are 8 main factors that influence cultural transformation in RGH
Prof.dr.H.M. Anwar Makkatutu are: 1) the breadth of health information and other
information with increasingly open information technology, 2) increasing the
quantity of learning through education and training, especially health functional
positions, 3) integrated improvement activities through hospital accreditation
activities 4) inspiring transformational leadership and provide obedience, 5) justice
in the distribution of services, 6). the factor of fear and wanting to be safe from
danger or epidemics, so adapting and the birth of a new culture, for example the
fear of being infected with the corona virus, so that a new culture is born, for
example the culture of keeping a distance, using personal protective equipment
(masks, handscoons, face shields, hazmat clothes) , boots) and avoiding crowds.
Furthermore, washing hands in five conditions, namely before touching the patient,
before carrying out aseptic procedures, after being contaminated with the patient's
body fluids, after touching the patient and after touching the patient's
environmental area. Furthermore, 7) choosy nature (like being picky) and likes to
demand from patients or patients' families and 8) regulatory changes, including
from the guarantor, for example Social Security Administrator.
On the other hand, there are 11 (eleven) things that hinder the change in
the culture of innovation, namely 1). experience is treated unfairly, 2). the local
culture of “ siri’sipakatau” or culture of shame and respect is thinning, 3) not being
invited to participate, 4) not wanting to be busy outside the main tasks and
functions and feeling safe in the comfort zone, 5) having a monopoly on certain
parts or units 6). the unit in charge is closed, 7) the principle is about to retire, 8)
support is not available in full, 9) The explanation is not given in full, open and
clear, 10) Rewards are given unfairly and 11) the distribution of service fees for
employees has not been fair. The pattern of distribution of services has not used a
remuneration system, so that still 35% of employees receive income less than the
regional minimum wage. The Yamali study (2018) found evidence that there is a
significant positive relationship between compensation and organizational culture
Efforts made by the management or elements of the leadership of the
hospital in anticipating the rejection of transformation are: (1) providing
information, socializing and convincing the importance of change, (2) directing, (3)
team approach, (4) inviting and providing support, (5) increasing creativity and
innovation, (6) open communication, (7) comparative study. Efforts to anticipate
the rejection of transformation according to Sutrisno (2018) are: (1) providing
information, socializing and convincing, (2) inspiring, (3) directing, (4) individual
approach, (5) providing support, (6) preparing and develop individual abilities, (7)

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increase creativity and innovation, (8) let individuals choose attitudes, (9)
negotiation, (10) team approach, (11) provide concrete examples/results, (12)
develop a design and organizational climate that conducive and (13) coercion.
According to Kurniawan & Maarif (2017) in the transformation at the
unfreezing stage, there is an element of determining the reasons as the basis for
the transformation and the process of the transformation resulting in changes in
goals, culture, technology improvements, organizational structure improvements
and an increase in the volume of activities. As also found in the research of Buvat
et al. (2017) that some of the inhibiting factors for transformation include a culture
that is difficult to change, lack of employee digital skills, small change initiatives
because employees are not empowered, not compensated for learning and there
are no incentives. According to Santiago, Baro, and Anna (2019), there are 3
(three) factors that influence transformation, namely digitalization, sustainable
evolution and humanization.
According to Anderson et al. (2014) stated that organizations with creativity
(idea generation) and innovation (idea implementation) will guarantee greater
depth in future inventions. According to Ferbriaty et al., (2020) states that the
challenges of global expansion, domestic and international competition, cultural
shifts and behavior control, challenges of creating quality products and services,
demands to be more creative, dare to take risks, able to work in increasing
demands and pressures. to improve performance in order to exist, be able to
compete and realize competitive advantage.
2. Determinant Factors of Transformation
a. Hospital organizational culture
There is a culture contained in the hospital strategic plan, namely 1)
honesty, 2) hard work, 3) humility, 4) willingness to serve patiently, sincere,
empathetic and sincere, 5) competent, 6) rational, 7) commitment and 8)
tolerance. Meanwhile, from the interview, it was found that what had an effect on
the transformation in the hospital were 1) hard work, 2) mutual assistance and
mutual assistance even though it later became thin, 3) honesty 4) Mutual respect,
along with changes then became thin 5) open and friendly communication , 6)
learning culture and 7) use of information technology.
In Zhenxiang's research (2014), the function of hospital culture, (1) The
function of cohesion and stability, namely core values are widely recognized and
the stronger the belief in accepting core values, the stronger the hospital culture
and the greater its influence on behavior; (2) The function of motivation and
restraint is to restrain the behavior of every employee and to encourage civilization
to advance and the formation and development of a new healthy and orderly
environment in the hospital; (3) The guiding and shaping function is that a good
hospital culture will guide employees to voluntarily comply with the principles of
serving the community wholeheartedly, fulfilling responsibilities and working with
integrity and being able to solve problems at work. Companies that are in a period
of transformation, various foreign cultures, traditional corporate cultures and

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modern cultures will intertwine, collide and clash with each other. Then there is
cultural integration, namely the process by which different cultures adapt and
coordinate with each other, and then cultural innovation is carried out by selecting
and integrating appropriate cultural elements to form a new culture. Furthermore,
the need for cultural reconstruction in the transformation of culture in hospitals.
The birth of a number of service innovations as an effort to promote a culture of
innovation is an effort to improve service quality. Synergistic with Hill (2017), in
the digital era, companies must be able to innovate faster than competitors and to
encourage rapid innovation, leaders build a culture of creativity. Confidence at
every level from new hires, to an active role-modeling culture that encourages risk
taking and discovery. Companies that avoid risk will be too slow to innovate.
According to Wisnu (2019), organizational culture can be developed, regulated, and
changed through organizational design. Organizations need structures and cultures
that accelerate adaptation and respond quickly to changing environmental
conditions and need flexibility to accelerate decision-making and discovery of new
goods and services. Meanwhile, according to Thyagaraju (2018), no organization
can develop without having a strong organizational culture
b. Transformative Leadership
In the aspect of transformative leadership in the transformation of hospital
organizations, it was found that leadership that was successful in bringing about
transformation was leadership that had the characteristics of 1) having hospital
knowledge skills 2) tiered disciplinary control 3) having speed of execution of
strategies 4) paying attention to employee welfare, 5) empowering staff 6)
developing staff potential, 7) encouraging organizational learning, 8) conflict
resolution management, 9) encouraging cultural and structural change, 10)
encouraging the growth of innovation, 11) open and friendly communication and
12) establishing and encouraging cooperative partnerships.
In this study, organizational culture and leadership have a major influence
in transformation. The fulfillment of the number of human resources, capital
adequacy and structure will not optimally deliver transformation without soft
elements including positive culture in hospitals and leadership. This is still in
accordance with the theory proposed by Ritonga et al. (2019) that the influential
elements in organizational transformation are hard factors, namely structure,
number of human resources, and capital adequacy, while soft factors are
organizational culture, communication, leadership and team work. Meanwhile,
according to Saxena and Prasad (2020), there is a relationship between leadership
ethics and an innovative work culture. Innovative work behavior forms a
competitive advantage. Ethical leadership at individual and collective levels has a
positive impact on an innovative work culture. Synergy with Parashakti, Rizki, &
Saragih (2016) in their research states that organizational culture and
transformational leadership have a significant effect on innovative behavior in
companies. The hospital transformational leadership occording to Dlamini et al.
(2017), occurs when the leader motivates, inspires, and intellectually stimulates

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subordinates by behaving charismatically and employees follow a series of activities

in achieving organizational goals. Synergistic with this, Pearch and Robinson,
(2017) in Hartawan, Mas'ud, & Sopanah, (2021) state that the leadership of an
organization must take action to direct the organization in dealing with changes
that occur continuously by building an organization and forming an organizational
culture. to suit the opportunities and challenges so as to be able to face change.
Meanwhile, according to Tika (2006) in Hartawan, Mas'ud, & Sopanah (2021)
leaders who succeed in forming a strong organizational culture will encourage
attitude change, self-alignment, be proactive and reactive in dealing with
environmental changes to achieve better performance.

Table 2 Typical Characteristics of Leadership RGH Prof.dr.H.M. Anwar Makkatutu

Bantaeng
Typical Characteristics of Hospital Transformation in
Category
Leadership Hospital
The ability of the hospital is very good,
Honesty is maintained, Discipline, Hard
work, according to the vision and mission,
commitment to patient care, firm and
commitment to staff performance
Hospital class upgrade
Category 1 standards, high commitment to learning
from class D to class C
culture, very concerned about staff
welfare, resolution of internal conflicts,
open with staff, lack of tolerance with any
party if it is not in accordance with
regulations and is quite empowering
Moderate discipline, there are staff
performance targets, closed with staff,
employee welfare is not a concern, does Changes to the structure
Category 2 not build conflict resolution, lacks without changing the
tolerance with any party if it is not in hospital class
accordance with interests. Less
empowering
Lack of hospital control, very little
discipline control, lacking in staff welfare
Category 3 No changes
arrangements, not building conflict
resolution, less empowering
Hospital science capabilities, discipline is
Five service group
controlled in stages, there is a strategic
accreditation certificate
plan/strategic business plan, strategy
2009 and 2018 plenary
execution, pays attention to staff welfare,
accreditation, implements
empowers staff/develops staff potential,
the pattern of financial
Category 4 encourages learning and education, pays
management of regional
great attention to conflict resolution,
public service agencies
encourages structural change, encourages
with full status in 2016,
cultural change, encourages innovation,
increased hospital class
open/friendly communication, establish
from C to B class
and encourage partnerships

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A hospital that is characterized by capital-intensive, labor-intensive,

technology-intensive, profession-intensive, problem-intensive. On the other hand,
it must move dynamically and adapt to exist and at the same time meet the
demands of the community regarding health services. If the hospital is transformed
without a model or reference, or trial and error, it will be possible to move
inappropriately and inefficiently, thus requiring a trajectory with certain aspects as
the key to its strategy. There are 2 things raised in this research, namely the
implementation of accreditation and business strategy.
a. Implementation of Hospital Accreditation
Accreditation activities at RGH of Prof.dr.H.M. Anwar Makkatutu has been
carried out since 2007 and in 2009 he received an accreditation certificate for 5
service groups (management administration, medical records, emergency
department, medical services, and nursing services) and in 2018 received a five star
accreditation certificate version of the accreditation version. 2012 with 15 chapters
(323 standards and 1,218 assessment elements). The implementation of
accreditation begins with preparations which include the preparation of all licensing
documents, the director is a doctor, and all medical personnel have a registration
certificate and a practice license. RGH of Prof.dr.H.M. Anwar Makkatutu conducts
standardization socialization, budget planning, sends training participants, forms an
integrated and collaborative team with director's decree, team meeting, guidance
from the hospital accreditation committee. At the accreditation implementation
stage, RGH quarantines document creation, ensures with verification by internal
assessors that the documents that have been made are suitable for assessment,
evaluates the achievements of each working group, sends documents, conducts pre-
surveys, conducts surveys (tracing and field visits) and assessments. Post-
accreditation, announcement of graduation and submission of accreditation
certificate valid for three years, evaluation and follow-up for improvements based on
recommendations for improvement from the hospital accreditation committee.
Accreditation version 2012, every year an accreditation verification survey is
conducted. In 2019 an accreditation verification survey was carried out, but in 2020
and 2021 it was not carried out due to the corona virus disease pandemic and the
accreditation certificate was automatically extended. Currently, the hospital is
preparing to implement the 2022 version of the accreditation
The strategy that is the key to the success of accreditation at RGH of Prof
dr.H.M. Anwar Makkatutu
1) Establishment of a working group team, a combination of units/installations in
accordance with chapters, standards and assessment elements, between
old and new employees.
2. The division of work of the working group members according to the standards
and elements of the assessment with their respective main tasks and
functions.
3). Exemption from the main duties and functions in the quarantine of document
preparation.

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4). Evaluate team achievement every week

5) learning within the organization through in-house training and education.
6). Document storage and sharing management
7). Strong control from leaders, team leaders and internal assessors.
8). Communication and use of information technology.
From the results of the interview, the benefits obtained from accreditation
related to hospital transformation are 1) accreditation ensures that the
implementation of the hospital structure's main tasks and functions is getting
better, faster and more precise in order to encourage the creation of a quality
culture to increase the quantity of services and improve their quality, 2). encourage
changes in the structure and main functions in accordance with the needs of
services to customers, 3) become a requirement in cooperation with the guarantor
(social security administrator and other insurance) and a requirement for an
increase in hospital class.
According to Barnas et al. (2019) Globally, healthcare leaders are making
efforts to instill principles of continuous quality improvement in their organizations.
Empower staff to provide safe, high-quality, and reliable care/services in change to
achieve results.
b. Business strategy
RGH of Prof.dr.H.M. Anwar Makkatutu initially had a strategic plan in 2008
(2008-2013 strategic plan). The Strategic Plan contains 4 (four) chapters. Chapter
1 contains information on the legal basis of the Bantaeng Regency Regional
Regulation Number 27 of 2007 concerning the Establishment of the Organization,
Position, Duties and Functions of the Bantaeng Regency Regional Technical
Institution, the duties and functions of the hospital, vision and mission statements.
Mission with 2 (two) statements with each explanation. His vision is to realize RGH
of Prof.dr. H.M. Anwar Makkatutu Bantaeng as a quality and affordable hospital in
the Southern region of South Sulawesi in 2010. Its mission is to (1) provide quality,
fast, precise, accurate and friendly emergency services (2) implement quality and
affordable health services for all community with a touch of love. Next is the
organizational structure. Chapter 2, contains projections of problems and obstacles,
Chapter 3, discusses general policies, program activities for the 2008-2013 fiscal
year and targets to be achieved. Policies include; (1) increasing the type of hospital
from type C to type B (2) providing health services for the poor in class, (3)
improving health service facilities and infrastructure (4) procurement of hospital
equipment and supplies (5) improving referral health services (6) increasing and
developing the professionalism of hospital staff and (7) improving the quality of
health services.
The application of the strategic plan is the emergence of quality
improvement activities in hospitals with accreditation activities, planning and
construction activities of a modern 8-floor hospital building and the procurement of
sophisticated medical equipment which began in 2010 and then began to be utilized
in 2016, encouraging the addition of doctor services. specialists and sub-specialists,

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the change of status to a hospital that applies the Financial Management Pattern of
the Regional Public Service Agency which has been in effect since January 2016.
The Strategic Business Plan for 2016-2020 at the Regional Public Service Agency
has a study that looks at the customer perspective, internal business processes,
growth and learning and financial perspectives. Analysis of the external
environment was analyzed using a competitive setting profile method to assess
competitive conditions in the hospital business. The Strategic Business is also a
reference in submitting a class upgrade to a class B hospital.
The results of the interview stated that the hospital business plan has the
following benefits: 1) a guideline that becomes a reference for hospitals in moving
to transform to fulfill their vision and mission as a dream hospital in the southern
region of South Sulawesi, 2) as an assessment standard in determining the
progress or achievement of home performance. hospital, 3) as a trigger for
inspiration in making changes or transformations for hospitals in adapting to the
service needs of the community in Bantaeng Regency and its surroundings, and 4)
documents that become concoctions in bringing out superior hospital services.
The weaknesses and obstacles in the preparation of business strategic plans
and achieving results are:
1). Installations and supervisory boards of regional public service agencies
as representatives of owners, are not present in the preparation of the strategic
plan
2). The hospital has not yet formed a team tasked with specifically reviewing the
strategic plan in order to maximize the hospital's transformation
3). Evaluation has not been carried out regularly and periodically related to
achievements as indicators in the strategic plan.
4). the strategic plan has not referred to the potential for development, and the
addition of unit services as market potential, so there are still a number of
opportunities that have not been taken as additional services.
5). Slow execution of strategy from the leadership
6). A number of activities are not mandated to related fields.
According to Pella (2020) the wrong strategy will contribute to failure in
organizational transformation. Strategy execution is the main job of every top
leader of the organization. There is a range of 70% to 90% of organizational failures
caused by strategy execution. So what is really important is after choosing a
strategy that is considered appropriate, then the next is how to execute it.
The results of the interview found several opportunities that have not been
glimpsed but have promising market potential, including: 1). Home care
physiotherapy is physiotherapy services to patients' homes, especially for stroke
patients, 2). Home care laboratory, namely taking samples at the patient's home and
providing information on results via whatsapp, 3). Laundry service for patient
companions, families, and officers, so that the needs for clean clothes can be met
quickly and in a short and affordable time, 4). Healthy food services for companions,
families and staff, so that they can meet the needs of healthy food and balanced

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nutrition, 5). Medical gas sales services to the general public, clinics and hospitals
within Bantaeng Regency, 6). Maintenance repair clinic that can provide repairs and
maintenance for patient office/home equipment, patient companions, community
and staff, 7). Place/room rental services, such as rental housing for
students/patients, canteen and supermarket rentals within the hospital area.
The transformation strategy built through integrated and comprehensive
quality improvement activities with the implementation of hospital accreditation,
which measures a number of performance indicators and evaluation of hospital
programs, ensures the implementation of regulations, policies and standard
operating procedures (SOPs) as quality assurance efforts. Furthermore, there is a
business plan that maps out objectives, how to reallocate resources, proper
placement of activities, and hospital development.
Hospitals need to make strategic efforts in improving business plan
documents in the following ways
1). Business planning starting from the unit/installation by actively involving the
supervisory board to explore development potential, and adding unit
services as market potential.
2). Formation of a work team to specifically examine the strategic plan in
overseeing hospital transformation
3). Periodically evaluate the achievement of strategic plan indicators.
4). Increase the speed of execution of strategy from the leadership
5). Placement of business potential according to related fields.
Accreditation activities are an effort to overcome weaknesses and improve
the system in hospitals at RGH of Prof dr.H.M. Anwar Makkatutu. According to
Adisasmito (2008) in the face of globalization, hospitals make changes by
overcoming weaknesses by: (1) improving systems in hospitals; (2) improving
human support facilities and systems, (3) transforming hospital management.
Thus, the implementation of the transformation that has been designed in the
business strategy with the fulfillment of resources, will be formulated with
accreditation activities, so that the output of the transformation will be of high
quality. This is still in line with Timmons et al. (2019) there are 10 (ten) strategies
in organizational transformation, namely (1) clear and consistent goals, (2) agency
culture, (3) proper work placement, (4) strong external and internal communication
planning, (5) reallocation/restructuring of resources, (6) professional development,
(7) consumer focus and engagement, (8) performance measurement, quality
assurance and program monitoring, (9) holistic approach and (10) multi-
community partnerships.

Conclusion

RGH of Prof dr. H. M. Anwar Makkatutu has implemented a transformation

referring to the 10 steps that complete the 8 steps of transformation according to
Kotter so as to perfect the theory. Organizational culture factors and transformative
leadership have influenced RGH of Prof dr. H. M. Anwar Makkatutu in transforming

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so as to produce changes in structure, culture and an increase in the number of

types of services. Finding strategies for better transformation with quality
improvement activities through accreditation and by developing business strategies

References

Adisasmito, W. (2008). Hospital Readiness in Facing Globalization. Faculty of Public

Health,Jakarta: University of Indonesia, 1–17.
Akib, H. (2011). Observing the Organizational Transformation Heuristic: Actualizing
Human Creative Behavior Through a Knowledge Management Approach.
Journal of Indonesian Entrepreneur Management, 40 Number 3, 225–244.
Anderson, N., Potočnik, K., & Zhou, J. (2014). Innovation and Creativity in
Organizations: A State-of-the-Science Review, Prospective Commentary,
and Guiding Framework. Journal of Management, 40(5), 1297–1333.
https://doi.org/10.1177/0149206314527128
Barnas, K. (2019). Creating a culture of excellence, How healtcare Leaders Can
Build And Sustain Continous Improvement. KMPG International Healthcare
Practice.
Basabih, M. (2017). Regional Hospital White Book: Inspires Regional Hospital's
Journey to Change in the Future. Jakarta: ARSADA.
Budihardjo, A. (2011). Towards Achieving Optimum Performance; Theory
Synthesis to uncover the Organization's "Black Box". Jakarta: Prasetiya
Mulya Publishing.
Buvat, J., Solis, B., Crummener, C., Aboud, C., Kar, K., Aoufi, H. E., & Sengupta,
A. (2017). The Digital Culture Challenge: Closing the Employee-Leadership
Gap. Digital Transformation Institute, 1–32.
Dlamini, N. N. N., Garg, A. K., & Muchie, M. (2017). The impact of transformational
leadership style on organisational commitment in the hospitality industry.
African Journal of Hospitality, Tourism and Leisure, 6(3), 1–21.
Ferbriaty, Revida, E., Simarmata, J., Suleman, A. R., Hasibuan, A., Purba, S.,
Butarbutar, M., & Saputra, S. (2020). Corporate Change Management in the
Digital Transformation Era (A. Rikki (ed.); 1st ed.). Our Writing Foundation.
Government of the Republic of Indonesia (2007). Government Regulation of the
Republic of Indonesia Number 41 of 2007 concerning Regional Apparatus
Organizations.Jakarta
Government of the Republic of Indonesia (2019) Government Regulation Number
72 of 2019 concerning Regional Apparatus. Jakarta
Hartawan, D., Mas’ud, M., & Sopanah. (2021). The Effect of Transformational
Leadership and Compensation on Job Satisfaction Through Organizational
Commitment. Bulletin of Management and Business, 2(1), 12–24.
https://doi.org/10.24856/mem.v33i1.624
Hernaus, T. (2008). Generic Process Transformation Model: Transition to Process-
based Organization. Working Paper Series: Paper No. 08-07, 385(08), 1–
16. Retrieved from http://www.efzg.hr/wps wps@efzg.hr

1965
BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454
VOLUME 15, NUMBER 2 2022

Hill, J. B. (2017). Leading through digital disruption: Gartner insights on spotting

and responding to digital disruption. Gartner. Insights on Spotting and
Responding to Digital Disruption. Retrieved from https://www.gartner.com/
imagesrv/books/digital-disruption/pdf/digital_disruption_ebook.pdf?elq
TrackId=8c6b54de14a74ab897515cb3c3573078&elqaid=1838&elqat=2
Indonesian Ministry of Health. (2005). Instructions for Filling in, Hospital Data
Processing. Jakarta
Indonesian Ministry of Health. (2011). Instructions for Filling in Data Processing for
Hospital Reporting Information Systems. Jakarta
Kadjatmiko. (2003). Organizational Transformation Perspectives And Heuristics. In
Entrepreneur : Vol. 12 TH XXXI (pp. 34–40).
Kirk, J., Andersen, O., & Petersen, J. (2019). Organizational transformation in
health care: an activity theoretical analysis. Journal of Health Organization
and Management, 33(5), 547–562. https://doi.org/10.1108/JHOM-10-
2018-0284
Kotter, J. P. (2011). Leading Change: Why Transformation Efforts Fail. Harvard
Business Press Books.
Kraus, S., Schiavone, F., Pluzhnikova, A., & Invernizzi, A. C. (2021). Digital
Transformation in Health Care: Analyzing the Current State-of-Research.
Journal of Business Research, 123, 557–567. https://doi.org/10.1016/
j.jbusres.2020.10.030
Kurniawan, B., & Maarif, S. (2017). Organizational Transformation of Health
Insurance Service Providers (Study on the Transformation of PT. Askes
(Persero) into BPJS Health. Scientific Journal of Public Administration and
Development, 8(1), 61–72.
Kusdi. (2018). Organizational and Administrative Theory. Jakarta: Salemba
Humanika
Law of the Republic of Indonesia. (2009). Law of the Republic of Indonesia Number
25 of 2009 concerning Public Services.Jakarta
Law of the Republic of Indonesia (2009) Law of the Republic of Indonesia Number
44 of 2009 concerning Hospitals. Jakarta
Lubis, H. S. (2015). Organization. Jakarta: Open University
Martini, A., Suradinata, E., Kusworo, K., Lambelanova, R., & Thahir, M. I. (2019).
The Effect of Organizational Transformation, Compensation and
Organizational Culture on Performance of Regional Government
Bureaucracy in Sumedang Regency West Java Province. Journal of Public
Administration and Governance, 9(1), 236. https://doi.org/10.5296/
jpag.v9i1.14439
Minister of Home Affairs of the Republic of Indonesia (1994) Decree of the Minister
of Home Affairs of the Republic of Indonesia Number 22 of 1994 concerning
Organizational Guidelines and Working Procedures of Regional General
Hospitals.Jakarta
Minister of Health of the Republic of Indonesia (2004) Decree of the Minister of

1966
BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454
VOLUME 15, NUMBER 2 2022

Health of the Republic of Indonesia Number 1284/MENKES/XII/2004

concerning the class improvement of the Regional General Hospital Prof.dr.
Anwar Makkatutu became a class C hospital. Jakarta
Müssig, J., & Graupner, N. (2020). Test Methods for Fibre/Matrix Adhesion in
Cellulose Fibre-Reinforced Thermoplastic Composite Materials: A Critical
Review. Reviews of Adhesion and Adhesives, 8(2), 68-129.
https://doi.org/10.7569/RAA.2020.097306
Parashakti, R. D., Rizki, M., & Saragih, L. (2016). The Influence of Transformational
Leadership and Organizational Culture on Employee Innovative Behavior
(Case Study at PT. Bank Danamon Indonesia). Journal of Theory and Applied
Management, 9(2), 81–96. https://doi.org/10.20473/ jmtt.v9i2.3015
Pella, D. A. (2020). Seven Steps of Performance Management Transformation,
Secrets of Business and Organizational Performance Transformation.
Jakarta: Infini
Ritonga, I. D., Manurung, S. S., & Tan, H. (2019). Creating Organizational
Transformation Through Leadership and Organizational Learning. Medan:
Yayasan Kita Menulis
Sajadi, H., Sajadi, Z., Sajadi, F., Hadi, M., & Zahmatkesh, M. (2017). The
comparison of hospitals’ performance indicators before and after the Iran’s
hospital care transformations plan. Journal of Education and Health
Promotion, 6, 1–6. https://doi.org/10.4103/jehp.jehp
Santiago, N., Baro, X., & Anna, R. (2019). The Competency-Based Management
Model as a Springboard for Transformation in Health Care and Social Care
Organisations. World Hospitals and Health Services, 55(2).
Saxena, A., & Prasad, A. (2020). The Relationship Between Ethical Leadership and
Innovative Work Behaviour. 133–147. https://doi.org/10.4018/978-1-
5225-9675-2.ch009
Singh, I., Kumar, A., Deepshikha, Singh, S., Pahwa, R., & Odeku, O. A. (2021).
Vaginal Mucoadhesive Drug Delivery Systems: A Comprehensive Review.
Reviews of Adhesion and Adhesives, 9(4), 481-494.
https://doi.org/10.47750/RAA/9.4.05
Sisca, Simarmata, H. M. P., Grace, E., Purba, B., Dewi, I. K., Silalahi, M., Fajrillah,
Sudarso, A., & Sudarmanto, E. (2021). Innovation Management (J.
Simarmata (ed.); 1st ed.). Medan: Yayasan Kita Menulis.
Sutrisno, E. (2018). Organizational culture. (5th ed.). Jakarta: Prenadamedia
Group.
Takacs, G. A., Miri, M. J., & Kovach, T. (2020). Vacuum UV Surface Photo-Oxidation
of Polymeric and Other Materials for Improving Adhesion: A Critical Review.
Reviews of Adhesion and Adhesives, 8(4), 555-581.
https://doi.org/10.7569/RAA.2020.097311
Thalib, J. (2015). Introduction to Conflict Management. Yogyakarta: LeutikaBooks.
Thyagaraju, N. (2018). Human Resources Management (HRM) As a Strategic tool
in Organizational Transformation of Indian Banks in Globalisation of Indian

1967
BALTIC JOURNAL OF LAW & POLITICS ISSN 2029-0454
VOLUME 15, NUMBER 2 2022

Scenario. Journal of Management Research and Analysis (JMRA), 05(03),

209–214. Retrieved from http://jmraonline.com
Timmons, J. C., Kamau, E., Lyons, O., & Enein-Donovan, L. (2019). Provider
strategies on ten elements of organizational transformation. Journal of
Vocational Rehabilitation, 50(3), 307–316. https://doi.org/10.3233/JVR-
191012
Widayat, R. (2009). Being Great and Sustainable Hospital. Beberapa Pitffall
Manajemen Yang Harus Diwaspadai. Jakarta: PT Gramedia Pustaka Utama.
Wisnu, D. (2019). Organization Theory: Structure and Design. Malang: University
of Muhammadiyah Malang.
Yamali, F. R. (2018). Effect of Compensation, Competencies and Organ izational
Culture on Organizational Commitment its Implicationson Expecrt
Performance of Constructiuons Services Company. International Journal of
Advances in Management and Economics, 7(2), 29–42.
Zhenxiang, R. (2014). Construction of Hospital Organizational Culture after
Transformation of Public Hospitals, The Case of R Hospital. ISCTE University
Institute of Lisbon.

1968