KnE Life Sciences | The 2nd International Conference on Hospital Administration (The 2nd ICHA) | pages: 315–328

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1. Introduction

Mankind are created by God to serve two functions, that is to become the servant of God and the vicegerent of God on Earth. Allah ordained in the Quran, `We have not created jin and man except to worship (Allah)' in Surah Adz-Dzariyat verse 56. Thus, every activities in human life is for obedience, submission and devotion. The Islamic shariah is to facilitate the performance of ibadah in all aspects of life. It is also aimed to govern individual and societal affairs in life so as to uphold justice, mercy, wisdom and common good in those affairs, namely ibadah (worship), mu'amalah (dealings with fellow human), munakahah (marriage) and jinayah (criminality) [1].

God sent down the Islamic shariah as guidance for man's life, and it is acceptable and applicable to all mankind. From the aspect of usulfiqh these purposes are called maqasid as-shari'ah, the purpose and objectives of the Islamic shariah. The scholars defined the purpose of shariah in five aspects: Hifzh Ad-Din (protection of religion), Hifzh An-Nafs (protection of life), Hifzh Al-'Aql (protection of the mind), Hifzh An-Nasl (protection of progeny), and Hifzh Al-Maal (protection of wealth). These five purposes of the Islamic law in literature is called al-maqasid al-khamsah or al-maqasid ash-shari'ah [2].

The purpose of the shariah is to bring goodness for mankind. Maqasid Shari'ah is a concept to understand the hikmah (the shariah values and objectives contains explicitly and implicitly in the Quran and hadith), set by God for mankind. The ultimate goal of the law is to bring maslahah or goodness and benefit for mankind both in this world (through mu'amalah) and the hereafter (by aqidah and ibadah). In order to gain maslahah, man has to take everything that is beneficial to meet the needs of dharuriyat (primary needs), to complete hajiyat (secondary needs), and tahsiniyat or kamaliyat (tertiary needs). Man has also need to prevent and prohibit mudarat that is useless and harmful to life [2].

The awareness for the need to practice Islam in all aspects of life has brought many Muslims to realize the importance of following the shariah. This awareness has created the demand for new products and services based on shariah to be introduced into the market.

Healthcare service is one of the most important areas in public service. As the world's most populous Muslim country, Indonesia carries the responsibility to establish an Islamic healthcare system that is of superior quality. From the Islamic perspective, medicine is looked into from the physical-medical and psycho-spiritual perspectives. Healthcare service in Islam is holistic, adopting the universal Islamic values. A shariah compliant hospital is an organization which has the scope of work, policies, procedures and staffing requirements that complies to the shariah principle in totality. It does not only focus in halal products or shariah compliant services, nor provide an Islamic alternative within a conventional system. Rather, it is an all-new comprehensive system, formally recognized and certified by an independent body which has the authority to carry out the accreditation process to ensure the organization is following procedures as per shariah requirements.

Believing that Islamic Shariah is the best system for any activity, the need to translate the system into a measurable and objective healthcare quality tools are eminent. In 2015, the Islamic Health Institution Network of Indonesia or Majelis Upaya Kesehatan Islam Seluruh Indonesia (MUKISI) published a hospital service standard based on Islamic Shariah principles, which complements the National Hospital Accreditation Standards. Two hospitals became the pilot projects. In 2016 the National Shariah Council of Indonesian Council of Ulama or Dewan Syariah Nasional Majelis Ulama Indonesia (DSN-MUI) produced a fatwa on the implementation of Shariah Hospital. In 2017, a second version of the Standard was published to be formalized by the National Shariah Council as the awarding body. This effort was initiated back in 2009 during the national work meeting (RAKERNAS) of MUKISI in Batu Malang, then in Serang Banten on 2012, and in Bandung early 2015.

The process of producing the standard for service and management in shariah hospital underwent a very long in depth study and discussions between MUKISI and DSN-MUI. The medical aspects of the standards were tackled by MUKISI and the shariah critical control points were addressed by DSN-MUI. The first version of the standard (version 1436H) were implemented to the pilot projects, and after one year, assessments were carried out and revision, improvement, enhancement and refinement were made, thereupon produce the second 1438H version of the standard.

2. Methods

This is a literature study using thematic approach to analyse shariah hospital in Indonesia from the history, background, establishment, implementation and evaluation. Lessons learned of the journey of shariah hospital in Indonesia are extracted from several journal articles, shariah hospital standards, hospital reports and assessments.

3. Results and Discussion

The awarding body

In Indonesia, the Indonesian Council of Ulama or Majelis Ulama Indonesia (MUI) is an independent body representing the Islamic scholars of Indonesia to rectify public issues pertaining to the Islamic law. MUI is an independent non-governmental organization that accommodates Islamic scholars to guide and nurture the Muslims in Indonesia. It was established in 7 th Rajab 1395 Hijriyah or 26 th July 1975 in Jakarta, Indonesia [3]. Among others, the roles of MUI are: (1) providing guidelines to Muslims in Indonesia to practice religious living in a community blessed by Allah; (2) providing advice and fatwa on religious and societal issues to the government and the public, to promote ukhuwah Islamiyah (Islamic brotherhood) and harmony in multi-religious community in uniting the nations; (3) becoming the liaison between the Islamic scholars and the government, and the reciprocal translator for the public and the government in order to achieve national development; (4) increasing cooperation between organizations, Islamic institutions and Islamic scholars in providing guidelines for the public through consultations and reciprocal information.

Some of the agencies under MUI that are related to healthcare services are (1) Fatwa Commission or Komisi Fatwa; provide consultation, perform research and produce fatwa related to issues pertaining the Islamic law in general; (2) National Shariah Council or Dewan Syariah Nasional (DSN); provide consultation, perform research and produce fatwa on specific issues related to economy or financial activities; (3) Appraisal Body for Food, Drugs and Cosmetics or Lembaga Pengkajian Pangan Obat-obatan dan Kosmetika (LPPOM); provide halal consultation and research, set the regulations and procedures for halal certification, perform halal audit and certification.

In October 2016, DSN-MUI produced fatwa No. 107/DSN-MUI/X/2016 on The Guidelines of Hospital Administration Based on Shariah Principles, which emphasized on four critical elements that must comply with the shariah principles, namely the akad (contracts), services, halal food and drugs, and financial management. The scope and points discussed in the fatwa is summarized in Figure 1.

Figure 1

The scope of the Fatwa on guidelines of hospital administration based on Shariah principles.


Shariah-compliant hospital

A shariah compliant hospital is where healthcare services provided are in accordance with the shariah principles, or simply means implementing the maqasid shariah in the hospital governance.

What are the characteristics of a shariah compliant hospital,that made it different from other hospital? The following are some unique features of a shariah compliant hospital. Implementation of these components will truly reflect Islam as the comprehensive way of life: (1) understanding the basic principles of shariah; (2) understanding the principles of halal and haram; (3) understanding the principles of mualamat; (4) implementing the concept of quality in Islam; (5) establishing the Islamic core values within the hospital organization [1].

These component is then translated into operational management and services in the book of standard [4]. Some of the characteristics are: (1) Shariah Supervisory Board is appointed to supervise the hospital's operation; (2) Hospital By Laws includes shariah aspects, (3) the mission and vision of the hospital explicitly states Islamic objectives; (4) conducts shariah contracts (akad) with staffs, patients, logistics suppliers, financial institution and others; (5) management of human resources applies the shariah principles in its practice; (6) the accounting and financial management uses shariah principles; (7) provides physical means and facilitate the performance of worship to patients, staffs and visitors; (8) provides spiritual guidance for patients and specific spiritual coaching for terminally ill patients; (9) ensures halal, hygienic and safe food and nutritional therapy; (10) guarantees the effort to cover patient's aurah (private parts), like-gender services and prevention of ikhtilat (free mixing); (11) infection control and its prevention uses the principle of taharah (cleanliness); (12) conducts mandatory religious training for all staffs; (13) handles complaint, conflict or difference in opinion, in accordance with the shariah; (14) provides Islamic reproductive health service; (15) the hospital pays institutional zakat (obligatory alms) which is used to help patients in need.

The hospitals are managed and the delivery of healthcare services are in accordance with the shariah principles and practices. It upholds the universal values of Islam, the principle of justice, peace, freedom and equality in its daily operation.

From the management perspectives, rezeki or livelihood is guaranteed by God. Income cannot be defined only through financial quantification. The owner and the shareholders did not build the hospital with a profit-making paradigm only, but rather how barakah (blessing) can be felt. The implementation of zakat in the financial management of the hospital has proven to increase its income. The hospital also pays extra attention towards efficiency through the implementation of several policies like Lean management, and fostering values on the concept of preventing mubazir (waste) into the mental model of the staffs. The management sets a shariah policy to establish quality work culture in staffs because staffs are the one who carry out the services in the hospital. Policies implemented by the management are perceived by employees as an effort to establish discipline and good work commitment. A disciplined and committed employee will show good attitude and performance, perceived by patients as the recipient of service [5].

When patient comes to the hospital, they were treated as though a guest. Hospital service system and the staffs put efforts in delivering the best service. This concept is internalized in all hospital service elements because honouring guest is part of Iman (faith). When staffs realized that the service they provide to patients is a manifestation of their faith in God, they will strive to give their best [5].

Working is an act of worship and provides the chance to perform good deeds. Every aspect of human life is part of ibadah, including work. Staffs are the hospital's biggest and most important asset. When staffs understood that work is not a burden but an ibadah, they will put effort to perform [5]. The hospital provides an avenue for staffs to achieve Islamic fulfilment and obligation in their personal and professional lives devoid of dichotomy and dualism. It is not only a working place but also provides the means for tarbiyah (Islamic training) to the staffs.

Some of the improvement perceived by patient and visitors are from the aspect of staffs attitude, service delivery, physical facility and level of cleanliness in the hospital after the implementation of Shariah Hospital standards. Shariah values implemented such as efficiency, maintenance of patients aurah and privacy, the reminder for salah (praying) time, spiritual guidance, security assurance, halal assurance for food and medications are among others that were mentioned as a unique experience in the hospital [5].

Healing is only from God. This concept is the very foundation of healthcare service in the hospital. When this concept is truly internalized, both patient and the healthcare provider will give their best effort in getting cure, but still aware that it is God who has the right to heal. So whatever the outcome of the effort is, it is accepted obligingly [5]. The spiritual wellbeing is regarded as important as the physical wellbeing. Being sick is an awakening moment, where one needs to take a break from worldly matters, introspect into one's life, realizing that this worldly life is just a timeline to move to another dimension; the eternal hereafter. As much as we prepared for the birth of a baby, the same preparation needs to be done in facing the death.

Shariah hospital certification

In the governance of an organization, compliance has the meaning of following a specification, standard or regulations set by the authority. The specification, standard or regulations can be in the form of policy or work procedure, which when implemented correctly and well, the internal control system will run effectively and prevent the possibility of fraud. The term shariah compliant indicates compliance towards the Islamic shariah law in the governance and operation of the organization [6].

The shariah compliance concept was developed initially in the banking industry, hence the popular term `Islamic Banking'. Eventually develop in other industry like food industry through the halal assurance system, the fashion industry, cosmetics, tourism and others. This development are based on high market demand of products with the shariah compliant label or recognition [7].

Shariah compliance simply means implementing the maqasidshariah in the governance of a system. A standard reference and system is needed to ensure compliance. Thus, the standard of Shariah Hospital Certification is published to provide the reference in the implementation of the maqasidshariah in healthcare service system in a hospital [4]. The standard of Shariah Hospital Certification consists of five chapters which is a breakdown of the maqasidshariah. Each chapter is divided into two groups; the shariah management standards and the shariah service standards [4]. This will serve as a reference and guidelines for any hospital to be certified as Shariah Hospital in the future. The hospital then needs to translate the operational and work process in the delivery of healthcare services into policies, guidelines and standard operating procedures (SOPs).

The basic format of the standards uses the hospital accreditation standards format by the National Hospital Accreditation Commission or Komisi Akreditasi Rumah Sakit (KARS). This is to facilitate the management and hospital staffs in implementing the shariah standards in a similar mindset. The nature of the standards is also complementary to that of the KARS standards. The shariah standard only mentions aspects that contain shariah critical control points as an addition. The normative ones and the ones which do not contain shariah values within their documentation and implementation are not included into the certification standard of shariah hospital. From those standards, the elements of assessment are determined to assess the level of compliance. The element of assessment consists of documents review, patient survey and facility survey which are also in accordance with the assessment methodology by KARS hospital accreditation. Assessors conducting the survey are from DSN-MUI and MUKISI.

The certification standard of shariah hospital consists of five chapters of the maqasidshariah, and each chapter is divided into two standard groups; the shariah management standard group and shariah service standard group. The systematic of the standard of Shariah Hospital Certification explained in Table 1.

In the book of standards, the standards and their elements of assessments are presented using alpha-numeric code to facilitate the assessment process. The standards and their elements were presented in narrative form in the first part of the book, and then presented in table form in the second part of the book. The coding of the Standard of Shariah Hospital Certification are explained in Figure 2. The standard and its key elements are explained briefly in Tables 2 and 3.

Figure 2

Coding standard of Shariah hospital certification.

Table 1

Standards and assessment elements of Shariah hospital certification version 1438.

Chapter Shariah Management Standard Group Elements of Assessment Shariah Service Standard Group Elements of Assessment
Chapter 1 hifzh al-din 1. Shariah Standard on Organizational Management (SSMO) 28 1. Shariah Standard on Service access and continuity (SSAPK) 6
2. Shariah Standard on Human Capital Management (SSMMI) 14 2. Shariah Standard on Patient Assessment (SSAP) 3
3. Shariah Standard on Accounting and Finance Management (SSMAK) 5 3. Shariah Standard on Patient Service (SSPP) 19
4. Shariah Standard on Marketing Management (SSMP) 8 4. Shariah Standard on Shariah Medication (SSPO) 9
5. Shariah Standard on Facility Management (SSMF) 8 5. Shariah Standard on Spiritual Service and Guidance (SSPBK) 8
6. Shariah Standard on Quality Management (SSMM) 7 6. Shariah Standard on Patient and Family Education (SSPPK) 4
Chapter 2 hifzh al-nafs Shariah Standard on Facility Management (SSMF) 4 1. Shariah Standard on Infection Control and Prevention (SSPPI) 2
2. Shariah Standard on Spiritual Service and Guidance (SSPBK) 14
Chapter 3 hifzh al-‘aql Shariah Standard on Human Capital Management (SSMMI) 6 Shariah Standard on Patient and Family Education (SSPPK) 9
Chapter 4 hifzh al-nasl    - - Shariah Standard on Patient Service (SSPP) 7
Chapter 5 hifzh al-maal Shariah Standard on Accounting and Finance Management (SSMAK) 12 Shariah Standard on Patient Service (SSPP) 2
Total 92 Total 83

From all five chapters in the standard, participating hospital are required to pass over 80% of chapter 1 as a mandatory passing requirement. An obligatory pre requisite for the Shariah Hospital Certification assessment is that the hospital must pass the hospital accreditation by KARS. This is made compulsory for shariah compliant certified hospital to be of superior quality and to ensure patient safety [4].

In general, the Shariah Hospital Certification standard combines the principles in hospital accreditation which are; the concept of service quality, quality assurance, quality improvement, and value based medicine, with the shariah principles namely the maqasid shariah, halal assurance, Islamic branding and shariah compliance. The certification provides added value to the hospital. In the conventional healthcare services, value are perceived by monetary unit. But in Islam, the longevity of value extends beyond this worldly life.

Table 2

Standard and key elements of Shariah management group.

Chapter Standard Key Elements
PROTECTION OF RELIGION (HIFZH AD-DIN) Shariah Standard on Organization Management (SSMO) Responsibility and accountability of the hospital owner can be certified by the completeness of document
Shariah Supervisory Board (DPS) is appointed by the owner to supervise the hospital operation
Hospital By Laws which includes shariah aspects are stipulated by owner
Hospital establishes vision and mission which conveys Islam explicitly
The hospital appoints shariah committee to ensure the service operation in the hospital is conducted based on shariah principles
Hospital administrator appoints institution for mosque caretaker (takmir) to conduct da'wah and run the hospital's mosque/musolla
Hospital administrator appoints spiritual advisory unit within its organization and governance
The hospital establishes guidance on shariah hospital ethics
The hospital conducts shariah contract (Akad)
Shariah Standard on Human Capital Management (SSMMI) The hospital has shariah human capital management in their recruitment process, competency development and career management
The hospital has shariah human capital management in the determination of the key performance indicators (KPI), performance assessment, and reward and punishment system
The hospital has a guidelines in the implementation of general and specific hospital orientation activities that contains Islamic values
The hospital applies the shariah hospital doctor's ethical code
Shariah Standard on Accounting and Finance Management (SSMAK) The hospital has shariah accounting and finance management
Shariah Standard on Marketing Management (SSMP) The hospital has shariah-compliant marketing management
The hospital may promote health services to the public by not violating the principles of shariah
Shariah Standard on Facility Management (SSMF) The hospital takes principles of shariah into account in facility provision and management
Shariah Standard on Quality Management (SSMM) The hospital sets policies and guidelines on quality which includes the maintenance of aqidah, worship, morality and mu'amalah(financial transaction).
PROTECTION OF LIFE ( HIFZH AL-NAFS ) Shariah Standard on Facility Management (SSMF) Facility and environmental risk management program includes prayer facility fulfilment and management
Shariah Standard on Infection Control and Prevention (SSPPI) The hospital has infection control and prevention program based on modern science corresponding to applicable law and constitution, sanitation standard and cleanliness based on shariah principles
PROTECTION OF THE MIND (HIFZH AL-`AQL) Shariah Standard on Human Capital Management (SSMMI) The hospital determines the policy on staff's competency on the fiqh (Islamic jurisprudence) of the sick
PROTECTION OF WEALTH (HIFZH AL-MAL) Shariah Standard on Accounting and Finance Management (SSMAK) The hospital and/or staffs pay zakat (obligatory alms), infaq and charity (ZIS)
Table 3

Standards and key elements of Shariah service group.

Chapter Standard Key Elements
PROTECTION OF RELIGION ( HIFZH AD-DIN ) Shariah Standard on Service Access and Continuity (SSAPK) Hospital defines the standard of operational procedures for patient reception, direction and discharge
The hospital complements the transportation standards with Islamic audio or video media
Shariah Standard on Patient Assessment (SSAP) The hospital sets a spiritual assessment for the patient to obtain the patient's religious data
Shariah Standard on Patient Service (SSPP) The hospital sets policies and procedures on the services for high-risk patients terminal illness
Hospital ensures the halal, hygiene and safety of the food and nutritional therapy given to patients
Hospital guarantees the effort to cover patient's aurah(private parts), services according to like-gender and the prevention of ikhtilat(free mixing) element
Hospital guarantees anaesthetic and surgical services is according to shariah principles
Hospital provides service for the management of ruqyahshar'iyah (shariah exorcism).
Shariah Standard on Shariah Medication Hospital seeks drug formularies which do not contain elements of the unlawful (haram) substances.
The hospital complements supporting documents in drug delivery to patients by stating Islamic values
Hospital staff delivers medicine to patients together with the delivery of religious messages
Shariah Standard of Service and Spiritual Guidance (SSPBK) The hospital provides Islamic spiritual guidance to patients
The hospital provides advisory services to patients who have special requests
Hospital provides services for end of life care based on shariah principle
Shariah Standard on Patient and Family Education (SSPPK) The hospital educates about family participation in the healing process of the patient
PROTECTION OF LIFE ( HIFZH AL-NAFS ) Shariah Standard on Spiritual Service and Guidance (SSPBK) The hospital provides shariah funeral service
The hospital provides pain management service
The shariah regulation on human tissue waste management
The procurement of water source based on shariah principle
PROTECTION OF THE MIND (HIFZH AL-`AQL) Shariah Standard on Human Capital Management (SSMMI) The hospital holds mandatory religious training for all staffs
Shariah Standard on Patient and Family Education (SSPPK) The hospital provides library with Islamic literatures
The handling of complaint, conflict or difference in opinion, in accordance with shariah
Education and training through good communication helps in maintaining health
Islamic education to the visitors
PROTECTION OF PROGENY (HIFZH AL-NASL) Shariah Standard on Patient Service (SSPP) The hospital provides Shariah maternal and infant healthcare service
The hospital provides Islamic reproductive health service
PROTECTION OF WEALTH ( HIFZH AL-MAL ) Shariah Standard on Accounting and Finance Management (SSMAK) The hospital in managing cash, financing, and investment cooperates with shariah financial institution
The hospital has the policy and mechanism to manage patient who cannot afford the bill
The hospital sets operational standard to be aware of billing miscalculation

Implementation of Shariah Hospital Certification Standards

In 2015, two hospitals were appointed the pilot projects using the version 1436H standards. Those two hospitals are Sultan Agung Islamic Hospital in Semarang and Nur Hidayah Hospital in Yogyakarta. Sultan Agung Islamic Hospital is a class B regional referral and teaching hospital, whereas Nur Hidayah Hospital is a class D district hospital. Both hospitals achieved the `Mumtaz' predicate on their certification assessments. `Mumtaz' is awarded with five crescents, `Jayyid jiddan' presented with four crescents and `Jayyid' is given three crescents. The reason behind the appointment is to prove that the Shariah Hospital Certification is relevant and implementable to both big and small hospital, to both complex and simple work processes.

Recently in June 2017, a formal assessment survey were conducted by DSN-MUI and MUKISI to both hospital, using the latest version 1438H standard. The survey results were brought to a panel meeting by the DSN-MUI to be further evaluated to determine the predicate of the certification. Both RSI Sultan Agung and RS Nur Hidayah passed the assessment and received the certification in August and September 2017, respectively. Many hospitals have signed up to wait for their turn to be assessed as Shariah Hospital.

The milestone achieved on this journey is impressive. It took six years from 2009 to 2015, to actually materialize the standards for shariah hospital from what at first seemed to be an impossible notion. Then, within two years of the formulation of the standards, through rounds after rounds of studies, meetings and discussions between MUKISI and DSN-MUI, the fatwa for the implementation of shariah hospital was produced, marking the historical moment for Islamic healthcare services in Indonesia. The standards are now officially owned by DSN-MUI as the awarding body. In a few years, the target is to get the recognition and endorsement

4. Conclusion

The journey to produce the Shariah Hospital Certification standards went through long, rigorous and in depth study by MUKISI and DSN-MUI, as a reference for shariah compliant hospital management and services. The Shariah Hospital Certification standards provides added value on top of the national hospital accreditation standards. Hospital performance is expected to improve through the implementation of Shariah Hospital Certification by means of establishing quality work culture in hospital staffs through the inculcation of shariah values.



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