Learning IFAM by using ITS Medical Centre as a Case: #1-Identifying the Function, Medical Service, Infrastructure & Facility

Nowadays, Infrastructure & Facility Asset Management (I&FAM) is essential in Indonesia. Indonesian Law on State Treasury was decreed in 2014, which makes the term I&FAM still relatively new in Indonesia. Therefore, the researcher must develop about I&FAM studies, such as doing a practice. For example, the ITS Medical Center (MCITS) use as a case for learning I&FAM. The first step is to identify the statement of the function, the service, and the infrastructure & facility. This research used a straightforward method by reading related document and reconnaissance survey. The research produces three principal results, giving medical service for the ITS' community and the surrounding area, and giving another income for ITS. The ITS Clinic occupies a special clinic building of 2 stories high, equipped with a garage, parking lot and a sign. As a facility, the clinic is equipped with a building, the building facilities, standard clinic medical equipment, and an ambulance.


INTRODUCTION
In developing countries, Infrastructure and Facility, Healthcare Facility, as hospital and clinic, can be considered as Facility, which should be managed as an asset. Asset Management is already becoming an important matter. In Indonesia, after the instauration of Indonesian Law Researches on Infrastructure Asset Management have been done a lot. Among others are on the manual development in Korea (Lee, Park & Kim 2010), on the state-of-the-art of municipal infrastructure asset management in Canada (Halfway, Newton & Vanier 2005).
Researches on Healthcare Clinic have been done. Among others, these discuss on university clinic as innovative model in Australia (Warner, Jelinek & Davidson 2017), readiness of nursing student to face clinical practice in Indonesia (Rofiah & Syaifudin 2014), degree of satisfaction of student to university healthcare clinic in Jordania (Alshurideh 2014), and college clinic quality and patient satisfaction in India (Deshwal, Ranjan & Mittal 2014).
The Institut Teknologi Sepuluh Nopember (ITS) has a Medical Center (MC), which seems run well since several years ago. This ITS Medical Center (ITS-MC) is relatively small but not simple facility. The ITS-MC has a building which can be considered as infrastructure and has quite numbers of medical facilities from static facilities and moving facilities. Meanwhile, not all of the Indonesian universities have a health clinic already. Therefore, analyzing ITS-MC Management by using the I&FAM Principle will be an excellent case for understanding and developing the theory of the Infrastructure and Facility Asset Management.
This paper presents an attempt to reveal the ITS-MC Function Definition, the Health Care Services, and the Infrastructure & Facilities in existence. This revelation will serve as the first step to analyze the Infrastructure and Facility Asset Management aspect of the ITS-MC.

RESEARCH METHOD
The general objective is Learning the I&FAM by using a Real Case. Analyzing the Health Clinic by using the I&FAM Principle. For this first step, the analyze is consists of getting the overview, identifying the function statement, identifying the stated medical services offered, and identifying the infrastructure and facilities in existence in general.

LITERATURE REVIEW
Three Literature Reviews are needed to Learn the I&FAM of ITS-MC, i.e., the I&FAM Principle, the Hospitals and Health-Clinics, the University Clinics, and the Hospital Management. This Literature Review is also written for preparing further I&FAM Research on Hospital and Health-Clinics.

I & FAM Principle
I&FAM, in general, is defined as the program or the knowledge to manage Infrastructure and Facility (I&F) along is life span in order that the I&F can always function well, economical, efficiently, effectively, and sustainably, with considering all the major risks possible. The I&F must also be guarded for always being beneficial for the I&F owner (ISO 41001; ISO 55000; Suprayitno & Soemitro 2019).

Hospital and Health-Clinic
The principal difference between hospital and clinic can be stated as follow. Hospital is a healthcare facility on the care of inpatients and outpatients for any sickness. While Health-Clinic is focused on the care of outpatients for basic medical care. Thus the clinic is much smaller and simpler than the hospital. For the patient, if the clinic is not able to take care, the patient must be referred to the hospital (PMK 9/14; PMK 56/14; UU 36/09; UU 44/09).

Hospital
The hospital treats the inpatient, outpatient, and emergency patient in order to recover the health of the patient. The hospital does medical service in terms of sick healing and health maintenance. The hospital must do also referred the patient to the hospital. The hospital's main function, in general, can be mentioned as follows (UU 44/09).
 Organizing medical services  Service supporting medical and non medical  Refered service  Education and training  Reasearch and development  General and financial administration A hospital can be classified into hospital type and hospital class. The hospital class is related to hospital capacity in bed and the variety and completeness of medical services. By type, the hospital can be classified as a general hospital and special hospital. The general hospital treats various sickness depend on its competence.
In Indonesia, the General Hospital is classified into four classes, depending on its medical services coverage, i.e., Hospital Class A, Hospital Class B, Hospital Class C, and Hospital Class D (PMK 56/14; UU 44/09). The definition of each class is presented below.
 Hospital Class A have facilities and competence to deliver specialistic and subspecialistic medical care.  Hospital Class B have facilities and competence to deliver at least 11 specialistic medical cares and several subspecialistic medical cares.  Hospital Class C have facilities and competence to deliver basic specialistic medical cares.  Hospital Class D have facilities and competence to deliver basic medical care.

Health Clinic
The clinic is a Health Service Facility to give personal healthcare service, either basic medical healthcare or specialistic healthcare. Based on the healthcare service, the clinics are classified into Pratama Clinic or Utama Clinic. Pratama Clinic gives basic general medical healthcare service. Utama Clinic provides special healthcare service and/without general healthcare service. The clinic provides healthcare service mainly for outpatient, but certain clinic can serve a limited number or limited case of inpatient. A clinic may be equipped with 5-10 inpatient beds. A clinic can do homecare. A clinic can be developed by the government, by local government, by private (PMK 9/14).
Some examples of Utama Clinic or Specialized Clinic, in Indonesia, can be presented as below.

Hospital Management
Hospital Management in Indonesia is regulated by a series of regulation, among others are the Law on Health and the Minister of Health Decree (KepMenKes 129/98; UU 44/09).

The I & FAM System Analyse for ITS Health Clinics
The analyze must be developed step by step, starting from a very general analyze down to more in detail analyze. Tha analyze could follow the following steps :  General analysis of function, services, and facilities  Demand analysis  Supply analysis  Operation system analysis  Maintenance system analysis  Facility analysis  Manpower analysis  Financial analysis  Client satisfaction analysis  Management system analysis  Certification analysis  Etc.

General Overview of ITS Medical Center
Before 1982, medical services for ITS student was held on the cabinet of dr. Kabat, in Nias Street. Since 1982, by using a room in Jl. Teknik Geodesi R2, a house of Ir. Hoedijono Ismarwanto MT. Medical services were open at 16:00 -18:00, Monday to Friday, and served by a general practitioner dr. Sulistywati Hoedijono. Since 1998, with the increasing number of student and the increasing number of department, the student medical service has been moved to ITS Staff Dormitory, which has been renovated. General medical service opened morning and afternoon, served by two general practitioners, while one dentist served the dental medical service. Along with the augmentation of student number, the medical service was extended from 09:00 to 19:00, served by three general practitioners and a dentist in the afternoon.
In 2001-2004, there was an addition of medical care as an alternative served by dr. Sulistyowati. In 2004-2006, management by BP ITS was taken over by UPT Fasum, with service hour of 08:00 -13.00. Starting from 2004, the service was done at ITS Clinic, and it covered the General Clinic and Dental Clinic. The General Clinic was served by a general practitioner, while Dental Clinic was served by a dentist. Apart from the clinic, ITS has a drugstore and Bina Saha Health Laboratory as ITS working partner. The Clinics utilization was not yet optimal, except for General Clinic. In

ITS Medical Center Main Function Statement
It is stated in ITS Medical Center Document that ITS Medical Center TWU (Technical Working Unit) duty is to manage the ITS Clinic. ITS Medical Center job is to do the healthcare for ITS Civitas Academica and the surrounding population as another income for the ITS.

Function
It is written that the function of ITS Medical Center TWU covers three main functions mentioned as follows.  Developing the system and healthcare service program.  Implement coordination and services according to the health facility service system and program.  Developing the cooperation of healthcare service program with other institutions outside ITS.

Objective
The general objective of the Clinic Operation is to develop the better access dan quality of the healthcare service for ITS Academic Community and population in East Surabaya region needs healthcare services, all for achieving the high standard health condition.
The general objective can be derived afterward into Special Objective cover four following special objectives :  The being held of basic healthcare service  The being held of referred healthcare service  The being held of healthcare service supporting activity  The being held of an accurate medical record and a good record of all healthcare activities

ITS Medical Center Main Facilities
ITS is situated in the middle east of Surabaya City. While, the ITS Medical Center is located in the middle south of ITS Campus, right on the Arif Rahman Hakim street, facing to the south. The location map is presented in Figure 1 below.

Figure 1. ITS Campus and ITS Medical Center Location in Arief Rahman Hakim Street
ITS Medical Center occupies a Special Clinic building of 6 x 12 sq.meter in 2 stories with Clinic Sign on it. The building is equipped with parking lots for cars, motorcycles, and management's car, and also with a garage for an ambulance. The infrastructure is presented in Figure 2 below.

CONCLUSIONS
The first step objective, of the I&FAM Learning, has been successfully fulfilled. Several main conclusions can be drawn below.
 As it is stated, the ITS Medical Care main function is to serve medical services for ITS Community and the surrounding population.  As it is stated, the ITS Medical Care medical service consists of general medical service, dental service, dermatology and aesthetic service, and psychological consultation service.
 As gotten from a reconnaissance survey, the ITS Medical Care infrastructures consists mainly of two stories main building, a garage for an ambulance, a car parking lot, a motorcycle parking lot.  As gotten from a reconnaissance survey, the ITS Medical Care facilities consist of general building facilities, general medical practice equipment, and an ambulance.
To complete, the I&FAM Learning by using the ITS Medical Care, further analyse need to be done, among others are to analyse whether the existing medical service already conforms to the stated function, to analyse the Clinic Operation System, to analyse the Clinic Demand, to analyse the Clinic Service Supply, to analyse the Clinic Maintenance System, to analyze the Clinic Administration System, to analyze the Clinic Financial System, to analyze the Conformity with the Existing Related Regulation, etc.