THE IMPLEMENTATION EFFECTIVENESS OF HOSPITAL RESPONSIBILITY TOWARDS HEALTHCARE WORKERS IN COVID19 ERA AT HOSPITAL X SUKABUMI

Since the Coronavirus Disease 2019 (COVID-19) pandemic occurred in Indonesia, the health workers have become both an important entity in fighting COVID-19 and has high risk of being exposed to COVID-19. They required high protection for their safety. This work aimed to describe the applicable laws and regulations in Indonesia regarding the responsibility of Hospitals to Healthcare Workers in the COVID-19 Era and to test the effectiveness of regulation implementation. A phenomenological study approach was applied in this study. The thematic analysis was conducted to obtain the main theme of this study. The results revealed six laws and regulations were related to the hospitals’ responsibility toward healthcare workers which were Law number 36 of 2009 concerning Health, Law number 44 of 2009 concerning Hospitals, Government Regulation Number 88 of 2019 concerning Occupational Health, Minister of Health Regulation number 66 of 2016 concerning Hospital Occupational Health and Safety, Minister of Health Decree number 413 of 2020 concerning Guidelines for the Prevention and Control of Coronavirus Disease 2019, and Decree Number 392 of 2020 concerning Incentives and Death Compensation for Healthcare Workers.


A. Introduction
On December 29, 2019, at a hospital in Wuhan, Hubei Province, China, it was reported that an unknown disease had developed pneumonia. The PRC government then informed the World Health Organization (WHO) about the emergence of this disease after going through a verification process. Then on January 8, 2020, the pathogen from this incident could be identified as the 2019 Novel Coronavirus (nCoV-2019), and its gene structure was immediately sent to WHO. On January 30, 2020, it was declared the declared COVID-19 as a public health emergency for which prevention efforts must be made. Then on April 13, 2020, the Government also issued another Presidential Decree regarding the stipulation of COVID-19 as a National Disaster. The people most at risk of infection are those who are in close contact with COVID-19 patients or who care for COVID-19 patients. Healthcare workers at the forefront of the COVID-19 pandemic response are at greater risk of exposure to infection. 3,4 It is proven that on April 13,22 doctors, 6 dentists, and 10 nurses had died from  The vicarious liability theory implies that the employer is responsible for the other party's losses incurred by the person or employee under their supervision. 6 Corporate liability theory has the same meaning as vicarious liability. According to this doctrine, the institution which houses a group of workers has responsibility for the labor it employs. 7 Another theory regarding accountability is the gevaarzetting theory which teaches that a person who asks for help from a third party to do an action for him must be brave to take the risk of his actions in the work for which they are used.5 There is also Shared Responsibility Theory which means that cooperation between workers and employers is the best way to reduce occupational incidents. 8 Occupational safety and health are instruments that protect workers, companies, the environment, and the surrounding community from the dangers of work accidents. This protection is a human right that must be fulfilled by the company. 9 . 2, Issue. 3, Sept 2021P-ISSN: 2807-193X | E-ISSN: 2746 The Implementation Effectiveness of Hospital Responsibility Towards Healthcare Workers in… [3] In Health Law No. 36 of 2009, Article 165 states that workplace managers are required to make all forms of health efforts through prevention, improvement, treatment, and recovery for workers. Besides, the following article also states that employers or employers are obliged to guarantee the health of workers through prevention, improvement, treatment, and recovery and are required to bear all costs of health care for workers and also costs for work-related health problems suffered by workers under statutory regulations. 10 In Hospital Law Number 44 of 2009, specifically in Article 3 paragraph 2 states that the purpose of running a hospital is one of which is to protect the safety of patients, the community, the hospital environment, and human resources in the hospital; but it does not specifically regulate how the form of hospital responsibility to healthcare workers who are human resources who work in the hospital environment, especially in the era of COVID-19. 11 Based on the explanation above, this study aims to determine the responsibility of hospitals toward healthcare workers, especially in the era of the COVID-19 pandemic from a juridical perspective.

Vol
We conducted a qualitative study using documentary studies to identify the law and regulation concerning hospitals' responsibility towards healthcare workers in this COVID-19 Pandemic situation and also conducted in-depth interviews to identify the implementation of the laws and regulations at one of the hospitals in Indonesia, which is hospital X Sukabumi. A better understanding of the laws and regulations could help hospitals in carrying out their obligations and maintain the rights of the healthcare workers, especially the right to be in good health in this pandemic situation.

B. Method
A qualitative study was conducted by documentary study and also in-depth interviews between 15 July 2020 and 15 August 2020. The study took place at Hospital X in Sukabumi district, West Java Province, Indonesia. This hospital was chosen because it also serves COVID-19 patients daily and has also been appointed as a Referral Hospital for Certain Emerging Infectious Diseases in West Java Province. Each participant has explained the purpose of the study and asked to sign the informed consent form to allow tape recording during the in-depth interview process.

a. Population and Samples
The study population was comprised of those who were directly involved in serving COVID-19 patients daily at Hospital X, Sukabumi, Indonesia. The two main groups of the study population were the hospital management and the healthcare workers who are Vol. 2, Issue. 3, Sept 2021P-ISSN: 2807-193X | E-ISSN: 2746 working together at Hospital X, Sukabumi in handling COVID-19 patients. Samples included 4 key informants purposively selected as informants by the researcher as they could give valuable insights into this research. The first group comprised 2 key informants mainly the director of hospital X, Sukabumi, and the head of the human resource department. The second group included a member of the hospital occupational health unit and also the head of the emergency department, both were also healthcare workers at Hospital X Sukabumi, Indonesia.

b. Data Collection Procedure
The documentary studies were conducted to obtain or search for concepts, theories, principles, and other ideas related to research problems. The documentary study carried out includes research on documentation carried out by studying various regulations, cases, and documents that are related to research problems.
In-depth interviews were conducted by using a semi-structured interview, with open-ended questions following an interview guideline. Each interview took place at a hospital X Sukabumi for approximately 30-60 minutes. All interviews were audiotape recorded and were transcribed by the interviewer. The interview guidelines were classified into two sub-groups of key informants as follows: (1) hospital management included the themes of laws and regulation related to hospital's obligation toward healthcare workers, implementation of the laws and regulation; (2) healthcare workers included the themes of perceived support from the hospital, implementation of the laws and regulation. Before research was conducted, three experts checked the interview guidelines. A detailed explanation of the themes explored by each sub-group of key informants is summarized in Table 1. Concerning the hospital's responsibility for healthcare workers is found in this Ministerial Decree. This can be seen in the formation of a verification team at health service facilities, which states that the verification team for health service facilities or health institutions that submit proposals for incentives for health workers to the District /City Regional Health Office, with elements consisting of at least Internal Supervisory Unit, Element of service in health service facilities or health institutions, Elements of management of health service facilities or health institutions.

The Implementation Effectiveness of Hospital Responsibility Towards Healthcare Workers in…
[9] The duties of the verification team for health service facilities or health institutions that submit proposals for incentives for health workers to the District / City Regional Health Office include verifying and validating the required documents, making notes on the results of verification and validation if necessary; and lastly is to submit recommendations on the results of verification and validation to the Head of District/City Health Service.
Based on the interview conducted, Hospital X Sukabumi has formed a verification team and has also made recommendations to the local government. However, until this research was conducted, this incentive had not yet been realized.
"Yes, we have formed a verification team, and have also made a recommendation to the local health office, but I heard is that the incentive has not been issued." (Director, Male, 35-years-old).
"The hospital has asked us for data. However, we have not received incentives until now." (HCW, Female, 28-years-old). Table 2   Hospitals have specific occupational safety and health risks so they need to be managed properly so that they can become a healthy, safe, and comfortable workplace, especially in this era of COVID-19. Therefore, a commitment from the Head or Director of the Hospital as manager of the workplace is required to implement the applicable laws and regulations related to the Hospital's responsibility to the Health Workers who work in the hospital. Therefore, it is hoped that the workplace manager, in this case, the hospital or hospital leadership, can refer to these regulations regarding what hospitals should do with health workers in this era of COVID-19. Because after all, COVID-19 not only causes death but also causes considerable economic loss, so knowledge is needed in carrying out prevention efforts including prevention and control by protecting health workers on duty.
Conducting education and training for human resources is required by law to increase the ability to provide the need for health services. However, Hospital X Sukabumi has not been fully implemented. The connection with education and training Vol. 2, Issue. 3, Sept 2021P-ISSN: 2807-193X | E-ISSN: 2746 The Implementation Effectiveness of Hospital Responsibility Towards Healthcare Workers in… [11] on COVID-19 must be carried out properly because without good and correct knowledge about this pandemic it can have serious implications not only for health workers but also for hospitals. Few studies suggested that healthcare workers surveyed during emerging infectious disease times demonstrated a lack of knowledge surrounding these pathogens and a need for further education/training. 12,13 Outbreaks of novel pathogens can be extremely stressful to healthcare workers, but this stress can be lessened by clear guidelines from hospitals and IPC teams. 14 Regarding occupational health standards that are provided by the Indonesian Government such as prevention, health improvement, treatment, and health recovery standards, Hospital X only manages to implement disease prevention and treatment standards. However, health improvement and health recovery standards have not been fully implemented. For health workers who are sick due to work-related accidents or are exposed to occupational diseases, in this case being infected with COVID-19, a return to work assistance program is needed. The goal is to ensure that health workers can return to work according to their previous function, but if they cannot return to work, then it can be considered to be transferred to another place so that services to patients can also be served properly. Hospitals are required to carry out rehabilitative activities, namely by establishing a return to work assistance program for hospital human resources who experience limitations after experiencing illness for more than 2 weeks. 15 Regarding Organizing Hospital Occupational Health and Safety (HOHS), hospital X has Implemented HOHS partially, in which there is no work nutrition and mental and spiritual program and also return to work program. One main focus is that there is still a vacant position as head of the HOHS unit at the hospital. It is feared that the hospital environment will become unsafe not only for health workers but also for patients and their families because no one is responsible for implementing HOHS at the Hospital X Sukabumi.
Incentives from the government aimed towards those who serve COVID-19 on daily basis and also for death benefits for those deceased while serving COVID-19 patients, where hospital responsibility is to verify the data and submit the recommendation has already been done by Hospital X Sukabumi to the local health office.

D. Conclusion
Our findings help to identify the hospital responsibility towards healthcare workers P- ISSN: 2807-193X | E-ISSN: 2746 [12] In COVID-19 based on Indonesian Laws and Regulations and also its implementation at Hospital X Sukabumi. We collected information from different perspectives of hospital management and also healthcare workers. Data were obtained through documentary studies and in-depth interviews with key informants. Both hospital management and healthcare workers revealed that Hospital X Sukabumi has effectively implemented the laws and regulations but there are still few things that have not been fully implemented such as partially conducted education and training for healthcare workers, health improvement and recovery standards have not yet been implemented, no work nutrition, mental and spiritual and return to work program, and also the vacant position as head of HOHS unit. Hospital X Sukabumi should consider getting the implementation done because such things are crucial both for the hospital and also the healthcare workers.