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Budgeting Dalam Pelayanan


DR.Rr.Tutik Sri Hariyati, SKp., MARS

• Budgeting: is an ongoing activity in which revenues
and expenses are managed to maintain fiscal
(financial) responsibility and fiscal health
• It is the process of planning and controlling future
operations by comparing actual results with planned
• A budget is a plan, roadmap, or a tool used by
managers to ensure that quality and cost-effective
services are provided to patients

(Hartley, 2007, Danna, 2001)

• To plan the objectives, programs, &
activities of nursing services
• To motivate nurse managers and nursing workers
• As a standard to evaluate the performance pf nurse
administrator and managers

• Budget are used to plan, monitor,control and

measure performance
Budgeting Procedure
• Productivity goal determination
• Forecast Workload
• Budgeted patient care hour
• Budgeted patient care hour & staffing scedules
• Planned nonproductive hours: holiday, education
leave, sick leave, etc.
Budgeting Procedure
• Productive time: time spent on the job in patient
care, administration of the unit, conferences,
educational activities & orientation
• Supplies & services
• Capital budgets
Role of Nurse Manager
• It is important that nurse managers are familiar with
the different types of budgets, specifically the
operating budget, because it is the nurse manager
who is closest to the patient and knows exactly
what is needed to provide care and services.
(Finkler, 2001).
Stage of the budget (1)
• Formulating stage
– Develop Objectives & management plan
– Gather all financial, historical & statistical data &
distribute to cost center manager
– Analyze data
Stage of the budget (2)
• Review & Enactment Stage
– Prepare unit badgets
– Present unit budget for approval
– Revice & combine into organitional budget

(justification, objectives, cost of additional resources,

resources of funding, be persuasive, negotiating the
Stage of the budget (3)
– Direct and Evaluated expenses and Receipts
– Revise budget if indicted
Budget Type
1. Budget Operational
2. Budget of Staff
3. Budget Capital
Budget Type (1. Operational)
• the nurse manager who is closest to the patient and
knows exactly what is needed to provide care and
services. (Finkler, 2001).
• Each nursing unit is considered a cost center and
has an operating budget. It is important to note that
nursing services are included in the overall charges
of room and board and nursing costs are not
considered revenue producing (Graf, 2001).
Budget Type (1. Operational)
The major components of the operating budget
include revenues and expenses:
– Revenue: patient visit, procedure, or inpatient hospitalization
from medicare, medicaid, managed care, private insurers, and
self-pay patients.
the revenues will be projected from patient days, average
daily census, or procedures
Expenses include the cost of staff, activities, supplies, and so
forth in running the nursing unit
two main categories found in an operating budget:
employment costs and non-salary expenses (Graf, 2001).
Budget Type (1. Operational)
Expenses: salary

• Contract labor
• Education , Orientation
• Benefits: Common benefits
include vacation, holidays,
and sick time
Budget Type (1. Operational)
Expenses: Non salary

– Medical supplies
– Office supplies
– Equipment lease/rental
– Repair and maintenance
– Travel
Budget Type (1. Operational)
Expenses: interdepartmental charges

– Pharmacy
– Central supply
Budget Type (1. Staff)
• Why is staffing so important?
– Nursing Salary & wages are 68% of the nursing
direct expense budget.
– Nursing Salary & Wages are 15% of the hospital
direct expense budget.
– Scheduling is a major reason nurses change jobs
Budgeting Staff-Direct Caregivers
• Volume X HPPD or HPV = Required Patient Care Hours
• Volume determination
– The cornerstone in calculating staffing needs
– The unit of service for most hospitals is patient days
– Some departments may use visits or procedures for their unit of
– Average daily census is calculated by dividing total volume by 365

– HPPD: Hour PerPatient Day.

Budget Staff-Direct Caregivers
• Volume
– Volume must be forecast for the entire year
– The forecast must also include the distribution of
volume, by month, day of the week, etc.
– Forecasts are usually based on past history and
adjusted for new programs.
Budgeting Staff
Required Patient Care Hours
• Determine the total number of patient days (visits).
• Determine from your patient classification system
the number of days (visits) in each classification.
• Multiply the HPPD per classification, times the
number of days budgeted (or HPV times visits).
• Total the number of patient care hours needed.
Sample Budgeting Staff
Required Patient Care Hours
Required Patient Care Hours
Patient Number of Patient Days HPPD Total Hours
1 1500 2.5 3750
2 3700 4.7 17,390
3 2400 8.0 19,200
4 900 12.2 10,980
5 500 19.0 9500
Total 9000 60,820
Sample Budgeting for Staffing
Required Patient Care Hours
7200 Required Patient Care Hours
Patient Number of Patient Days HPPD Total Hours
1 6300 9.72 61,236
2 (1:3) 190 9.8 1862
3(1:2) 9 13.8 1242
4(1:1) 1 25.8 25.8
5(2:1) 0
Total 6500 64,366
Budgeting Staff
• Used for budgeting core staff to a unit
Total FTE needed =

Total Patient Care Hours = 64366

#productive hrs./FTE 1872

Non productive: Vacation 16 days + Holiday 7days + avarage sick time 4 days = 26
26 X 8 hour + 208 non productives
Productive: 2080 -208 + 1872
(40 hour per week, 52 weeks per year +2080)
Budget for Staffing
Non Productive Time

Productive Hours/Paid Hours=% Productive

% Productive X 2080 = #Productive hr/FTE

Budgeting Staff

• Daily FTE required-used to plan daily staffing

Total Patient Care Hours = Daily Hours of Care

For 8 hour shifts Daily Hours/8
For 12 hour shifts Daily Hours/12
Budgeting Staff

• Total FTE Budget

– Used to allocate core staff to units
– Allocates staff to cover, vacation, sick, FMLA
Budgeting Staff

• Daily FTE Needs

– Used to develop basic staffing pattern
– Divided by shifts
– Divided by skill mix
– Equals core staffing pattern
Budgeted Staffing

• Skill Mix
– Based on patient needs
– ICUs usually 90-100% RN
– General Care Units usually- > 60% RN
– Rehab/Psych Units usually- ~50%
Budgeting Staff-Indirect Caregivers
• Secretaries and non-nurses
• Other Nurses
– Managers
– Education
Budgeting Staff-Patient Outcomes

• Potter et al. (2003) Decreased RN hours> patient’s

increased perception of pain & higher RN hours > higher
perception of satisfaction by patients.
• Cho et al. (2003) An increase of 1 HPPD associated with
8.9% decrease in odds of pneumonia, 10% increase in
%RN associated with 9.5% decrease in odds of
pneumonia, increased HPPD > higher probability of
pressure ulcers.
Budgeting Staff-Patient Outcomes

• Aiken et al. (2002) Each additional patient cared for by a

nurse was associated with a 7% increase likelihood of
dying within 30 days of admission, and odds of failure to
rescue, a 23% increase in nurse burnout and a 15%
increase in job dissatisfaction..
• Estabrooks et al. (2005) Decreased mortality with
increased BSN & increased RN mix.
Remunerasi Perawat
• Kinerja – HPPD
• Masa Kerja
• Jenjang karir fungsional
• Indeks resiko
• Indeks tanggung jawab/jabatan
Remunerasi Berdasarkan PCS
• Contoh di Swedia
Jenis Layanan Minimal Intermediate

Kep. Langsung 430 SEK 530 SEK

Kep Tdk Langsung 250 SEK 320 SEK

Waktu personal 460 SEK 460 SEK

Biaya total 1160 SEK 1310 SEK

1 Swedia Korn?SEK =1300

Penetapan Renumerasi-Ina DRG
(Dx related group) VS Nanda, NIC

• Penentuan PCS
• Penentuan diagnosis (ICD 10) • Penentuan Dx Kepwt:
• Pengelompokan tindakan NANDA
Medis (ICD 9)
• Penentuan Intervensi: NIC
• Identifikasi total biaya secara
akurat • Identifikasi intervensi yg
• Mengalokasikan biaya mempunyai biaya non jasa
langsung & tidak langsung • HPPD
Langkah Menyiapkan Remunerasi
• Mengkaji dan Identifikasi CPS per shift
• Menetapkan Dx. Keperawatan
• Selalu identifikasi dan MelaksanakanKeperawatan
Langsung, Tidak Langsung, Edukasi Kesehatan
• Pencatatan dan Evaluasi: alternatif menggunakan
• Analisis Kinerja
• Indeks Faktor lain
Budget Type ( 3. Capital)

• The capital expenditure budget is established to

fund the purchase of major equipment or
projects like expansion, improvement or
replacement of the physical plant and