Faktor Organisasi yang Mempengaruhi Pelaksanaan Audit Maternal

Prita Muliarini, Edi Sumarsono


Maternal audits are part of a change in health care organizations. However, complicated and rigid bureaucracy resulting in difficulties for the organization to accept change without clear and convincing scientific evidence. The maternal mortality remains high, indicating that the maternal audit is not optimal. Often audit recommendations are not implemented so that the expected changes do not occur. This study aims to find suboptimal organizational aspects in the implementation of audits to encourage all parties to collaborate in sustainable, targeted and planned changes. This is a qualitative research with a narrative review approach using secondary data from the previous seven articles. Articles were analyzed to find various obstacles and constraints on maternal audit, and then categorized based on the context of organizational behavior, namely individual, group and structure. This study identified complexities in maternal auditing, interrelated between individual, group and structural aspects, including problems of persecution, low cooperative behavior, and political policies. Those have a major impact on efforts to reduce maternal mortality. Therefore, it requires clinical and non-clinical interventions, as well as political, in accelerating the reduction of maternal mortality. The arrangement of policies, analysis processes, and follow-up on maternal audits must involve every element of the organization, both individuals and groups, in the organizational structure.


Maternal Audit; Obstacles Of Maternal Audit; Organizational Behavior; Organizational Change


Bain, L. E., & Kongnyuy, E. J. (2018). Legal and ethical considerations during maternal death surveillance and response. African Journal of Reproductive Health, 22(2), 17–25. https://doi.org/10.29063/ajrh2018/v22i2.2

Bandali, S., Thomas, C., Hukin, E., Matthews, Z., Mathai, M., Ramachandran Dilip, T., Roos, N., Lawley, R., Igado, O., & Hulton, L. (2016). Maternal Death Surveillance and Response Systems in driving accountability and influencing change. International Journal of Gynecology and Obstetrics, 135(3), 365–371. https://doi.org/10.1016/j.ijgo.2016.10.002

Bandali, S., Thomas, C., Hukin, E., Matthews, Z., Mathai, M., Ramachandran, T., Roos, N., Lawley, R., Igado, O., & Hulton, L. (2016). Maternal Death Surveillance and Response Systems in driving accountability and influencing change. International Journal of Gynecology and Obstetrics, 135(3), 365–371. https://doi.org/10.1016/j.ijgo.2016.10.002

Bayley, O., Chapota, H., Kainja, E., Phiri, T., Gondwe, C., King, C., Nambiar, B., Mwansambo, C., Kazembe, P., Costello, A., Rosato, M., & Colbourn, T. (2015). Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: A pilot study in rural Malawi. BMJ Open, 5(4). https://doi.org/10.1136/bmjopen-2015-007753

Boyle, A., & Keep, J. (2018). Clinical audit does not work, is quality improvement any better? British Journal of Hospital Medicine, 79(9), 508–510. https://doi.org/10.12968/hmed.2018.79.9.508

BPS. (2015). Penduduk Indonesia: Hasil Survei penduduk Antar Sensus 2015. Badan Pusat Statistik.

Burke, W. W. (2018). Organization Change (5th ed.). SAGE Publications, Inc.

Chambers, R., & Wakley, G. (2005). Clinical Audit in Primary Care: Demonstrating Quality and Outcomes. In Abingdon: Radcliffe Publishing. Taylor & Francis Group.

Esposito, P. (2014). Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology. World Journal of Nephrology, 3(4), 249. https://doi.org/10.5527/wjn.v3.i4.249

Fry, M., & Dombkins, A. (2017). Interventions to support and develop clinician-researcher leadership in one health district. International Journal of Health Care Quality Assurance, 30(6), 528–538. https://doi.org/10.1108/IJHCQA-07-2016-0104

Healthcare Quality Improvement Partnership. (2018). Criteria and indicators of best practice in clinical audit. Healthcare Quality Improvement Partnership (HQIP). https://www.hqip.org.uk/wp-content/uploads/2018/02/best-practice-in-clinical-audit.pdf

Hyre, A., Caiola, N., Amelia, D., Gandawidjaja, T., Markus, S., & Baharuddin, M. (2019). Expanding Maternal and Neonatal Survival in Indonesia: A program overview. International Journal of Gynecology & Obstetrics, 144, 7–12. https://doi.org/10.1002/ijgo.12730

Jacquemont, D., Maor, D., & Reich, A. (2015). How to beat the transformation odds. McKinsey & Company. https://www.mckinsey.com/business-functions/organization/our-insights/how-to-beat-the-transformation-odds

Kediegile, G., & Madzimbamuto, F. D. (2014). Obstacles faced when conducting a clinical audit in Botswana. Southern African Journal of Anaesthesia and Analgesia, 20(2), 127–131.

Kementerian Kesehatan Republik Indonesia. (2016). Pedoman Surveilans Kematian Ibu. Kementerian Kesehatan Republik Indonesia.

Kongnyuy, E. J., & van den Broek, N. (2008). The difficulties of conducting maternal death reviews in Malawi. BMC Pregnancy and Childbirth, 8, 1–7. https://doi.org/10.1186/1471-2393-8-42

Lewis, G. (2014). The cultural environment behind successful maternal death and morbidity reviews. 24–31. https://doi.org/10.1111/1471-0528.12801

McErlain-Burns, T. L., & Thomson, R. (1999). The lack of integration of clinical audit and the maintenance of medical dominance within British hospital trusts. Journal of Evaluation in Clinical Practice, 5(3), 323–333. https://doi.org/10.1046/j.1365-2753.1999.00195.x

Mitchell, G. (2012). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32–37. www.nursingmanagement.co.uk

Palmer, I., Richard, D., & Buchanan, D. A. (2017). Managing organizational change: A Multiple Perspecties Approach (3rd ed.). McGraw-Hill Education.

Pozo-Rodríguez, F., Castro-Acosta, A. A., & Álvarez-Martínez, C. J. (2015). Clinical audit: Why, where and how? Archivos de Bronconeumologia, 51(10), 479–480. https://doi.org/10.1016/j.arbr.2015.08.006

Prasad, K. R. S., & Reddy, K. T. V. (2004). Auditing the audit cycle: An open-ended evaluation. Clinical Governance, 9(2), 110–114. https://doi.org/10.1108/14777270410536394

Robbins, S. P., & Judge, T. A. (2017). Organizational Behavior. In Pearson Education Limited (17th ed.). Pearson Education Limited.

Robbins, S., & Timothy, J. (2018). Essential of Organizational Behaviour. Pearson Education Limited.

Semple, D. M., Khaled, K., & Maresh, M. J. A. (2000). Monitoring quality of audit in obstetrics and gynaecology. Quality in Health Care, 9(1), 37–41. https://doi.org/10.1136/qhc.9.1.37

Smith, H., Ameh, C., Roos, N., Mathai, M., & van den Broek, N. (2017). Implementing maternal death surveillance and response: A review of lessons from country case studies. BMC Pregnancy and Childbirth, 17(1), 1–11. https://doi.org/10.1186/s12884-017-1405-6

Stokes, T., Shaw, E. J., Camosso-Stefinovic, J., Imamura, M., Kanguru, L., & Hussein, J. (2016). Barriers and enablers to guideline implementation strategies to improve obstetric care practice in low- and middle-income countries: A systematic review of qualitative evidence. Implementation Science, 11(1), 1–10. https://doi.org/10.1186/s13012-016-0508-1

Taylor, A., Neuburger, J., Walker, K., Cromwell, D., & Groene, O. (2016). How is feedback from national clinical audits used? Views from English National Health Service trust audit leads. Journal of Health Services Research and Policy, 21(2), 91–100. https://doi.org/10.1177/1355819615612826

Thompson, J. M. (2010). Understanding and managing organizational change: Implications for public health management. Journal of Public Health Management and Practice, 16(2), 167–173. https://doi.org/10.1097/PHH.0b013e3181c8cb51

Undang-Undang Nomor 25 Tahun 2009 Tentang Pelayanan Publik, (2009).

Vahidi, R G, Tabrizi, J. S., Iezadi, S., Gholipour, K., Mojahed, F., & Rasi, V. (2013). Organizational facilitators and barriers to implementing effective clinical audit: Systematic review. Journal of Pakistan Medical Students, 3(August), 38–45. http://www.jpmsonline.com/wp-content/uploads/2013/01/JPMS-VOL3-ISSUE1-PAGES38-45-RA.pdf http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed11&AN=2013184086 http://sfx.scholarsportal.info/mcmaster?sid=OVID:embase&id=pmid:&id=doi:&issn

Vargas, I., Eguiguren, P., Mogollón-Pérez, A. S., Bertolotto, F., Samico, I., López, J., De Paepe, P., & Vázquez, M. L. (2020). Understanding the factors influencing the implementation of participatory interventions to improve care coordination. An analytical framework based on an evaluation in Latin America. Health Policy and Planning, 35(8), 962–972. https://doi.org/10.1093/heapol/czaa066

WHO. (2016). Time to respond: A report on the global implementation of Maternal Death Surveillance and Response.

WHO, UNFPA, & CDC. (2013). Maternal Death Surveillance and Response Techincal Guidance.

WHO, UNICEF, UNFPA, World Bank, & United Nations Population Division. (2015). Trends in Maternal Mortality: 1990 to 2015. World Health Organization.

Willis, C. D., Saul, J., Bevan, H., Scheirer, M. A., Best, A., Greenhalgh, T., Mannion, R., Cornelissen, E., Howland, D., Jenkins, E., & Bitz, J. (2016). Sustaining organizational culture change in health systems. Journal of Health, Organisation and Management, 30(1), 2–30. https://doi.org/10.1108/JHOM-07-2014-0117

DOI: https://doi.org/10.34149/jmbr.v18i2.279

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