Analysis of the Implementation of Midwife Performance Management in Improving Clinical Quality: Study at TPMB (Midwife Independent Practice) Purwakarta Regency, Indonesia

Midwife performance management is a systematic and planned process for assessing the performance of midwives in providing midwifery services. Improving clinical quality is the main goal of midwife performance management. This study aims to analyze the implementation of midwife performance management in improving clinical quality at the TPMB (Midwife Independent Practice) Purwakarta Regency, Indonesia. This research uses a qualitative method with a case study approach. The research informants consisted of TPMB management midwives, implementing midwives, and pregnant/maternity women who had utilized TPMB services. Data collection was carried out through in-depth interviews, observation and document review. The research results show that the implementation of midwife performance management in TPMB Purwakarta Regency has been able to improve the clinical quality of midwifery services. This can be seen from the increase in knowledge, skills and attitudes of midwives in providing midwifery services. Midwives have been able to apply midwifery service standards consistently so that they can provide safe, effective, efficient, and quality midwifery services.


A B S T R A C T
Midwife performance management is a systematic and planned process for assessing the performance of midwives in providing midwifery services.Improving clinical quality is the main goal of midwife performance management.This study aims to analyze the implementation of midwife performance management in improving clinical quality at the TPMB (Midwife Independent Practice) Purwakarta Regency, Indonesia.This research uses a qualitative method with a case study approach.The research informants consisted of TPMB management midwives, implementing midwives, and pregnant/maternity women who had utilized TPMB services.Data collection was carried out through in-depth interviews, observation and document review.The research results show that the implementation of midwife performance management in TPMB Purwakarta Regency has been able to improve the clinical quality of midwifery services.This can be seen from the increase in knowledge, skills and attitudes of midwives in providing midwifery services.Midwives have been able to apply midwifery service standards consistently so that they can provide safe, effective, efficient, and quality midwifery services.
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quality of midwifery services.[6] Increasing the knowledge, skills, and attitudes of midwives can improve the quality of midwifery services because midwives will be able to provide midwifery services in accordance with midwifery service standards.Increasing the consistent implementation of midwifery service standards can also improve the quality of midwifery services because midwives will provide safe, effective, efficient, and quality midwifery services.Increasing patient/client satisfaction can improve the quality of midwifery services because patients/clients will receive midwifery services that suit their needs and expectations.Implementing midwife performance management is an important effort to improve the quality of midwifery services.][9][10] This study aims to analyze the implementation of midwife performance management in improving clinical quality at the TPMB (Midwife Independent Practice) Purwakarta Regency, Indonesia.

Methods
This research uses a qualitative method with a case study approach.Qualitative methods are research methods used to understand a phenomenon in depth and holistically.The case study approach is a research approach used to study a phenomenon in depth in a particular context.The research informants consisted of TPMB management midwives, implementing midwives, and pregnant/maternity women who had utilized TPMB services.Research informants were selected using purposive sampling, namely taking into account that the informants had knowledge and experience that was relevant to this research.Data collection was carried out through in-depth interviews, observation, and document review.
In-depth interviews are conducted to extract in-depth information from informants.Observation is carried out to observe the phenomenon under study directly.
A document review was carried out to obtain information from documents that were relevant to this research.The research method used in this research has advantages and disadvantages.The advantage of the qualitative method with a case study approach is that it can provide an in-depth and holistic understanding of a phenomenon.The disadvantage of the qualitative method with a case study approach is that it requires a relatively long time and costs.Indepth interviews were conducted using interview guidelines that had been prepared previously.In- Qualitative analysis is carried out by organizing data, describing data, and interpreting data.

Results and Discussion
The research results show that the implementation

Conclusion
The implementation of midwife performance management in TPMB Purwakarta Regency has been able to improve the clinical quality of midwifery services.This can be seen from the increase in knowledge, skills, and attitudes of midwives in providing midwifery services.
of midwife performance management in TPMB Purwakarta Regency has been able to improve the clinical quality of midwifery services.This can be seen from the increase in knowledge, skills, and attitudes of midwives in providing midwifery services.The increase in midwives' knowledge can be seen from the midwives' ability to explain midwifery service standards completely and correctly.The increase in midwife skills can be seen in the midwife's ability to carry out midwifery service procedures according to standards.The improvement in midwives' attitudes can be seen in the friendly, polite, and professional attitude of midwives in providing midwifery services.Apart from that, the implementation of midwife performance management has also encouraged midwives to implement midwifery service standards consistently.This can be seen from the results of observations, which show that midwives have implemented midwifery service standards completely and correctly in providing midwifery services.Midwivesat TPMB Purwakarta Regency understand that midwife performance management is an important process to improve the quality of midwifery services.This understanding can be seen from the midwife's answers in the in-depth interviews conducted.Midwives stated that midwife performance management can help midwives know the level of midwife performance achievement in achieving midwifery service standards, determine priorities for improving the quality of midwifery services, and monitor developments in the quality of midwifery services.Midwives also have a commitment to implementing optimal midwife performance management.This commitment can be seen from the various efforts made by midwives to implement midwife performance management, namely Participating in midwife performance management training organized by the Purwakarta Regency Health Service, Reading midwife performance management guidelines, Discussing the implementation of midwife performance management with fellow midwives.These efforts show that midwives in TPMB Purwakarta Regency have a high commitment to improving the quality of midwifery services through implementing midwife performance management. 11-13The following are several examples of midwives' statements regarding their understanding and commitment to the importance of midwife performance management: "Midwife performance management is important to know our performance in providing midwifery services.By knowing our performance, we can know which parts need to be improved" (Midwife A); "I am committed to implementing optimal midwife performance management.I want to provide quality midwifery services to patients" (Midwife B).Midwives' understanding and commitment to the importance of midwife performance management is an important factor that supports the successful implementation of midwife performance management.With high understanding and commitment, midwives will be more motivated to implement midwife performance management optimally.The Purwakarta Regency Health Service has provided support in implementing midwife performance management, such as providing training, facilities, and infrastructure, as well as budgeting.The Purwakarta Regency Health Service has provided midwife performance management training to midwives at TPMB.This training aims to improve midwives' understanding and skills in implementing midwife performance management.This training includes material on Understanding and objectives of midwife performance management, Elements of midwife performance assessment, Midwife performance assessment methods, and Midwife performance assessment techniques.The Purwakarta Regency Health Service has provided the necessary facilities and infrastructure to support the implementation of midwife performance management, such as a midwife performance assessment form, Stationery, and other equipment.The Purwakarta Regency Health Service has provided a budget for implementing midwife performance management.This budget is used to finance activities related to midwife performance management, such as Midwife performance management training, Provision of facilities and infrastructure, Data collection, and performance assessment of midwives.Support from the Purwakarta Regency Health Service in implementing midwife performance management has had a positive impact.This support has helped midwives to understand and implement midwife performance management optimally. 14-17The following are several examples of midwives' statements regarding support from the Purwakarta Regency Health Service in implementing midwife performance management: "The midwife performance management training organized by the Purwakarta Regency Health Service was very useful.I understand more about midwife performance management and how to implement it" (Midwife A); "The Purwakarta Regency Health Service has provided the necessary facilities and infrastructure to support the implementation of midwife performance management.This really helps us in implementing midwife performance management" (Midwife B).Support from the Purwakarta Regency Health Service is an important factor that supports the successful implementation of midwife performance management in the TPMB Purwakarta Regency.TPMB in Purwakarta Regency has adequate facilities and infrastructure to support the implementation of midwife performance management, such as comfortable and adequate work space; Equipment and supplies required for implementing midwife performance management, such as midwife performance assessment forms, stationery, and other equipment.These adequate facilities and infrastructure have made it easier for midwives to carry out midwife performance management.TPMB in Purwakarta Regency also has a sufficient budget for implementing midwife performance management.This budget is used to finance activities related to midwife performance management, such as Midwife performance management training, Provision of facilities and infrastructure, Data collection, and performance assessment of midwives.This adequate budget has supported the optimal implementation of midwife performance management.The availability of adequate facilities and infrastructure, as well as a sufficient budget, has had a positive impact on the implementation of midwife performance management in TPMB Purwakarta Regency.These positive impacts include: Midwives can implement midwife performance management optimally; Midwives can improve knowledge, skills, and attitudes in providing midwifery services; The clinical quality of midwifery services can be improved.The availability of adequate facilities and infrastructure, as well as a sufficient budget, are important factors that support the successful implementation of midwife performancemanagement.[18][19][20]