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LANGKAH ANALISIS MODUS KEGAGALAN, DAMPAK &
PENYEBAB
(AMKDP)/
HEALTHCARE FAILURE MODE EFFECT & CAUSES ANALYSYS
(HFMECA)
1. Pilih Proses yang berisiko tinggi dan Bentuk Tim
2. Gambarkan Alur Proses
3. Diskusikan & Prioritaskan Modus Kegagalan
4. Brainstorming Dampak Modus Kegagalan
5. Identifikasi Penyebab Modus Kegagalan
6. Hitung Total NPR (Nilai Prioritas Risiko)
7. Disain ulang proses / Re-disain Proses8. Analisa & uji Proses baru
9. Implementasi & Monitor Proses baru
HFMECA : Healthcare Failure Mode Effect , Causes and Analysis
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LANGKAH 1 : PILIH PROSES YANG BERISIKO TINGGI
Pilih Proses berisiko tinggi yang akan dianalisa.
Judul Proses :
BENTUK TIM
Ketua : ____________________________________________________________
Anggota 1. _______________ 4. ________________________________________2. _______________ 5. ________________________________________
3. _______________ 6. ________________________________________
Notulen _________________________________________
Apakah semua Unit yang terkait dalam Proses sudah terwakili ? YA / TIDAK
Tanggal dimulai ____________________ Tanggal selesai ______________________________
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LANGKAH 2A DIAGRAM PROSES
LANGKAH PROSES :
Gambarkan proses secara grafis,sesuai kebijakan & prosedur untuk setiap tindakan dan nomor dibawah ini.
Jika proses terlalu kompleks,anda memilih satu langkah proses atau sub proses untuk ditindak lanjuti
Cantumkan beberapa sub proses untuk setiap tahapan prosesTahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses
A. ----------------------- A. ----------------------- A. ----------------------- A. ----------------------- A. ----------------------- A. -----------------------
B. ----------------------- B. ----------------------- B. ----------------------- B. ----------------------- B. ----------------------- B. -----------------------
C. ----------------------- C. ----------------------- C. ----------------------- C. ----------------------- C. ----------------------- C. -----------------------
D. ----------------------- D. ----------------------- D. ----------------------- D. ----------------------- D. ----------------------- D. -----------------------
E. ----------------------- E. ----------------------- E. ----------------------- E. ----------------------- E. ----------------------- E. -----------------------
Pengadaan
TGM
Penerimaan &
Pengecekan TGM
dari Supplier
Penyimpanan
TGM di Instalasi
Gas Central
Pengecekan Ulang
Di Unit Penerima
Perencanaan
Ketersediaan
TGM
Pendistribusian
TGM ke
Unit2
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LANGKAH 2A DIAGRAM PROSES
LANGKAH PROSES :
Gambarkan proses secara grafis,sesuai kebijakan & prosedur untuk setiap tindakan dan nomor dibawah ini.
Jika proses terlalu kompleks,anda memilih satu langkah proses atau sub proses untuk ditindak lanjuti
Cantumkan beberapa sub proses untuk setiap tahapan prosesTahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses
A. ----------------------- A. ----------------------- A. ----------------------- A. ----------------------- A. ----------------------- A. -----------------------
B. ----------------------- B. ----------------------- B. ----------------------- B. ----------------------- B. ----------------------- B. -----------------------
C. ----------------------- C. ----------------------- C. ----------------------- C. ----------------------- C. ----------------------- C. -----------------------
D. ----------------------- D. ----------------------- D. ----------------------- D. ----------------------- D. ----------------------- D. -----------------------
E. ----------------------- E. ----------------------- E. ----------------------- E. ----------------------- E. ----------------------- E. -----------------------
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LANGKAH 2B DIAGRAM SUB PROSES
LANGKAH SUB PROSES :
Gambarkan Subproses secara grafis,sesuai kebijakan & prosedur untuk setiap tindakan dan nomor dibawah ini.
Jika proses terlalu kompleks,anda memilih satu langkah Subproses untuk ditindak lanjuti
Catat Modus Kegagalan untuk setiap langkah Sub proses
Modus Kegagalan Modus Kegagalan Modus Kegagalan Modus Kegagalan Modus Kegagalan
----------------------- ------------------------ --------------------------- ---------------------------- -------------------------------
------------------------ ------------------------- --------------------------- --------------------------- -------------------------------
------------------------ ------------------------- --------------------------- --------------------------- -------------------------------
------------------------ ------------------------ --------------------------- --------------------------- -------------------------------
------------------------ ------------------------ --------------------------- --------------------------- -------------------------------
------------------------ ------------------------ -------------------------- --------------------------- -------------------------------
------------------------ ------------------------ -------------------------- --------------------------- -------------------------------
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LANGKAH 3
BRAINSTORMING POTENSIAL MODUS KEGAGALAN & BUAT
PRIORITAS MODUS KEGAGALAN
Proses Modus Kegagalan Bahaya Probabilitas Skor
Risi
ko
(3X
4)
Bands Kontrol Deteksi NPR
(5X7
X8
Ranking
Modus
Kegagalan
1 2 3 4 5 6 7 8 9 10
1 2 3 4 5 1 2 3 4 5 1-25 L M H E 1 2 3 4 1 2 3 4 5
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Modus Kegagalan Dampak Bahaya Probabilitas Skor
Risiko
(3X4)
Bands Kontrol Deteksi NPR(5X7X8)
1 2 3 4 5 6 7 8 9
1 2 3 4 5 1 2 3 4 5 1-25 L M H E 1 2 3 4 1 2 3 4 5
LANGKAH 4
BRAINSTORMING DAMPAK MODUS KEGAGALAN
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Modus
Kegagalan
Dampak Penyebab Bahaya Probabilitas SkorRisiko
(4X5)
Bands Kontrol Deteksi NPR
(6X8X9)
1 2 3 4 5 6 7 8 9 10
1 2 3 4 5 1 2 3 4 5 1-25 L M H E 1 2 3 4 1 2 3 4 5
LANGKAH 5
IDENTIFIKASI PENYEBAB MODUS KEGAGALAN
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LANGKAH 6
HITUNG TOTAL NPR
No Modus
Kegagalan
NPR
Modus
Kegagalan
Dampak NPR
Dampak
Penyebab NPR
Penyebab
Total NPR Ranking
1 2 3 4 5 6 7 8 9
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LANGKAH 7
PROSES DISAIN ULANG
1 2 3 4 5 6 7 8 9
Proses Modus
Kegagalan
Dampak Penyebab Rekomendasi
Redisain
Proses
Penanggung
jawab
Tanggal
Diselesaikan
Tanggal Dilaksanakan
Proses Baru
Ukuran
Outcome /
Pengawasan
Kinerja
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No injuryFirst aid
treatmentonly with no
lost time, norrestricted
duty injuries
nor illnesses
Medical expenses,
lost time orrestricted duty
injuries orillness for 1 or
2 staff
Hospitalization
of 1 or 2 staff or3 or more staff
experiencing losttime or restricted
duty
injuries or
illnesses
Death or
hospitalizationof 3 or more
staff
Staff
Outcome
Evaluated &
First aid
treatment
No injury but
increased
LOS tomonitor
effects
MINOR
2
No injuryInjury with no
permanent loss of
function or
Evaluation &
treatment for1 or 2 visitors
(less than
hospitalizatin )
Injury with
permanent loss of
function
Or Hospitalization
of 1 or 2visitors
Death,
hospitalization
of 3 or more
Visitor
Outcome
No injuryInjury with no
permanent loss of
function
Injury with
permanent
loss offunction
DeathPatient
Outcome
INSIGNICANT
1
MODERATE
3
MAJOR
4
CATASTROPHIC
5
SEVERITY RATINGSEVERITY RATING(Modified by IMRK)(Modified by IMRK)
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PROBABILITY
(Modified by IMRK)
Very likely to occur every monthAlmost certain5
Likely to occur immediately or within a short period
(may happen several times in one year )
Likely4
Possible will occur
(may happen several times in 1 to 2 years)
Possible3
Unlikely to occur
(may happen sometimes in 2 to 5 years)
Unlikely2
Very Unlikely to occur
(may happen sometime in 5 to 30 years)
Rare1
DefinitionDescriptionRating
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RISK GRADING MATRIX
ExtremeHighModerateLowLowRare
1
ExtremeHighModerateLowLowUnlikely2
ExtremeExtremeHighModerateLowPossible3
ExtremeExtremeHighModerateModerateLikely4
ExtremeExtremeHighModerateModerateAlmost certain5
Catastrophic
5
Major
4
Moderate
3
Minor
2
Insignificant
1
Potenci al Concequences
Probability/Likelihood
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Sample Detectability Scale
(Modified by IMRK)
0 out of 10
2 out 0f 10
5 out of 10
7 out of 10
10 out to 10
Probability of
Detection
Detection not possible at any pointAlmost certain
not to detect5
Unlikely to be detectedLow likelihood4
Moderate likelihood of detectionModeratelikelihood3
Likely to be detectedHigh likelihood2
Almost always detected immediatelyCertain to detect1
DefinitionDescriptionRating
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CONTROLLABILITY
Controls and Status are unknown or Residual riskDifficult4
Controls are either not practically in place not effective, not
communicated and or not complied with no reviews undertaken or
Controls can be introduced to reduce risk to an acceptable level butwill take longer than 1 year or entail significant effort or exp ensive
Moderate
difficult
3
Sufficient effective controls procedures are substantially in place
for specific circumstances, communicated & are complied with
periodic reviews are conducted or
Controls can be introduced to reduce risk to an acceptable level
within 1 year or at cost
Moderate
easy
2
Comprehensive effective controls fully in place, communicated,
complied with, maintained, monitored, reviewed & tested
regularly. All that is practicable to be done is being done orRisk can be introduced 1 month / or low cost or
Easy1
DefinitionDesriptionRating