ANALYSIS OF THE MIDWIFE’S PERFORMANCE AT DR. SAYIDIMAN MAGETAN AFTER AN ACCREDITED HOSPITAL

Hospitals that are accredited are a tool to measure the performance of hospitals. The design of this study was qualitative using purposive sampling snowball with the research focus directed at analyzing the performance of midwives at RSUD dr. Sayidiman Magetan after hospital accreditation. With a sample of 7 people and triangulation of 3 people. Based on the results of the study, it can be concluded that in general the performance development of midwives after hospital accreditation has not increased, but the regulations applied at the hospital, for example patient visiting hours have not been fulfilled. The number of midwives is large, but the problem is the use of midwives who are not in accordance with their main duties, for example delivery rooms for supervisors 2, then skilled midwives 4, skilled midwives 16.


INTRODUCTION
According to WHO (World Health Organization), the hospital is an integral part of a social and health organization with the function of providing comprehensive services, cure (curative) and disease prevention (preventive) to the community.The hospital is also a training center for health workers and a medical research center.
Based on law no.44 of 2009 concerning hospital, which is meant by hospital is a health service institution that organizes complete individual health services that provide inpatient, outpatient and emergency services.
While the definition of hospital according to the Regulation of the Minister of Health of the Republic of Indonesia No. 1204 / Menkes / SK / X / 2004 concerning Hospital Environmental Health Requirements, states that "a hospital is a health service facility, a gathering place for sick and healthy people, or it can become a place for disease transmission and allow environmental pollution and health problems to occur".From the above understanding, hospitals carry out several types of services including medical services, medical support services, nursing services, rehabilitation services, prevention and health improvement, as a place for education and or training for medical and medical professionals, as a place for research and development of science and technology in the health sector.as well as to avoid risks and health problems as intended, so it is necessary to maintain the health of the hospital environment in accordance with health requirements.
Based on the decision of the Minister of Health of the Republic of Indonesia No.983 / Menkes / per / II 1992 the task of the hospital is to carry out health efforts as well as effective and effective by prioritizing healing and recovery efforts which are carried out harmoniously and integratedly with efforts to increase and prevent and carry out referral efforts .
To carry out these tasks, the hospital has the following functions: Maintenance function : Includes promotive (health improvement), preventive (disease prevention), curative (disease healing), rehabilitative (disease recovery), use of nutrition, personal services, etc. Educational Function : Critical right (the right use includes: the right drug, the right dose, the right way of administration, and the right diagnosis).
Research Function :Medical knowledge about disease and hospital service improvement (Depkes RI).

Research purposes
Analyzing the performance of midwives at Dr. Sayidiman Hospital in maintaining and improving postaccreditation performance.

METHODS
This research uses a qualitative method with a case study approach, which explores a problem with detailed boundaries, has in-depth data collection, and includes various sources of information.This research is limited by time and place and the cases studied are programs, events, activities or individuals.
In this study, the researcher acts as the main research instrument as well as data collection.The researcher chose the research location in the city of Magetan where he was in Dr. Sayidiman and the implementation time was in early December 2019.The sample in this study was named as a resource, participant, informant, friend, or teacher in the study who was willing to become an informant for a semistructured interview consisting of 7 main informants and 3 people.Triangulation informants.The types of data collected are primary data and secondary data.Primary data obtained from interviews with informants with interview guides.From the data obtained, source triangulation was carried out.According to Lomenta (2003), accreditation is closely related to the quality of service provided by hospitals.This means that if the accreditation is done properly, there will be an increase in the quality of hospital services.However, according to Pangestuti, Kumtjoro and Utarini (2002) the results of accreditation do not automatically improve the quality of hospital services.This is because the accreditation of health services in Indonesia has not yet assessed the clinical indicators of health services (Soepojo, Kuntjoro, and Utarini, 2002).
According to Mangkunegara (2001: 67) performance is the result of performance that has been achieved in quality and quantity by a career or employee in carrying out his duties in accordance with the responsibilities that have been given to him, what is meant by quality here is seen in terms of cleanliness , refinement and accuracy in carrying out their duties and jobs, while what is meant by quantity is seen from the large number of jobs that must be completed by the employee and the work.
Another opinion regarding the performance put forward by Hugh J. Arnold and Daniel C Feldman (in Nina Lamatenggo and Hamzah, 2012: 118) states that performance is a series of individual behaviors and activities in accordance with organizational expectations or goals, which can be seen from the explanations of informants who Second, states that the difference in the performance of accreditation and post-accreditation is the same, but when it comes to accreditation, the performance increases and after accreditation the performance returns to the beginning before accreditation.(informant 2).In addition, informant 3 also added that for the performance accreditation it is the same and after accreditation we need to improve it and be better than the previous one.(Informant) 3. From the answers of the two informants, the 6th informant will also add them, namely accreditation and postaccreditation, because we work in accordance with existing SOPs and know more about accreditation than before because we will be given guidance again (informant 6).
From the explanation of the three informants, namely that at the time of accreditation and postaccreditation their performance was the same and in accordance with the existing SOPs where they knew more about the accreditation system and they were given guidance again in the hope of improving and bringing about a better performance change and experiencing an increase.Previously, the definition of a midwife was only a designation for people who study in special schools to help women, it does not mean that a midwife can be perceived as a helper.Helper here can be defined as someone who can provide assistance in the form of adequate health services to mothers who are giving birth or giving birth.Real childbirth is to place a mother as the main actor while the people around her are the status of a helper, including as a midwife and obstetrician.A delivery that is assisted by a midwife is a normal delivery, if an abnormality is found, a midwife must refer to a specialist doctor (doctor Sp.O.G.) for further assistance in overcoming the disorder.

Constraints Affecting Midwives
The Indonesian midwife association stipulates that a midwife is a woman who graduated from a midwife education that is recognized by the government and professional organizations in the territory of the Republic of Indonesia and has the competence and qualifications to be registered, certified and / or legally licensed to practice.
According to Law No. 36 of 2014 concerning health personnel, midwives are health workers who are classified into midwifery workers, have the authority to provide women's reproductive health services and family planning.In certain circumstances, namely a condition where there are no health workers who have the authority to take the necessary health service measures and cannot be referred to, a midwife can provide medical and / or pharmaceutical services beyond their authority to a certain extent.Motivation is a reflection of the desire or willingness that comes from the employee / employee to carry out an activity or action.The higher the motivation, the greater the tendency of employees / employees.Conversely, if the motivation of the employee / employee is at a low level, the employee / employee will become lazy and tend to be slow in doing their job.The following is the story of the informant 4 If there is a separate team for accreditation, the one who specifically holds the book, we have to deposit the data, we just need to provide the data and we keep the service going and if the problem is stressful, the most on the day of the event, the one who watches the morning and afternoon for preparation is normal, the problem is Already in the cover, the bosses hold a higher stressor on the day of the day.There are also directions from the head of the room, the working group, the PPI.It still exists to provide motivation, for example the stressor team checks the data and if there is something missing we have to complete it again.
From the statement of informant 4, it can be concluded that when preparing for accreditation there was already a separate group or team so that in carrying out their services they already understood what to do so that the data was not neglected and was immediately handled by the data holder so that the stress level did not really affect them and they were motivated.motivationfrom the superior of the head of the room.

Implementation of Performance of Midwives with Owned Human Resources
Human resources are one of the most important factors that cannot be separated from both an institution and a company.Resources are also a key factor in determining the development of a company.An organization is formed to achieve a common goal, but to achieve this goal requires reliable and professional performance from the apparatuses or employees of the organization concerned.
The concept of performance can basically be seen from two aspects, namely employee performance (individual) and organizational performance.
Employee performance is the result of individual work in an organization while organizational performance is the totality of work achieved by an organization.In a division of midwives in the hospital, the standard of service capability, evaluation, and resources owned.It's good enough from the previous one and to motivate yourself back to the individual, but still under the control of the superior and the resources are appropriate but not yet known for sure.
And from the two informants, the 8th informant will explain again, namely the triangulation informant.Evaluation of each midwife where at the end of each year they provide a form or blank assessment and it is filled in by each head of the room or the boss.There are things that are not appropriate, right here, clinic midwife one two three should be in one clinic midwife the main task should match the clinic midwife but yeah that was because here there are still less clinic midwives there are more clinic midwives one automatically she has to demand the condition she must be able dividing the two clinic midwives because no one is in position and besides that they also work together with the team.
From the explanation of the third informant, it can be concluded that the performance of midwives has been effective, because they work in accordance with the standard SOPs in the hospital and when accreditation activities are held, the midwives will receive training to prepare for the accreditation process.Employee performance appraisal is a form of motivation as well as appreciation in the world of work.With this assessment, an employee / employee will be motivated to always give their best performance because they always get support and appreciation.

CONCLUSION
Based on the discussion of the research results that have been described by the author about the analysis of the performance of midwives in Dr.

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RSUD) dr.Sayidiman Magetan is a class C Hospital belonging to the Regency Government, Magetan which is one of the referral places for Seen from the human resources, Dr. Sayidiman Magetan has around 798 people consisting of medical personnel, nursing staff, community health personnel, nutrition workers, physical therapy personnel, medical health workers, and other non-health workers.