Implementasi Kebijakan Kawasan Tanpa Rokok di RSU Mitra Medika Amplas

Abstract

Smoking is a leading cause of serious diseases such as lung cancer and heart disease. In North Sumatra, the prevalence of smokers reaches 26.28%, indicating a significant health challenge. Mitra Medika Amplas General Hospital, the only hospital in Medan Amplas District, has established a Smoke-Free Area (SFA) policy through Director’s Regulation Number 065/PER/DIR/RSMM/V/2022. However, violations of this policy frequently occur, especially in outdoor areas. This study utilizes the implementation theory by Ripley and Franklin to evaluate the SFA policy implementation based on three indicators: implementer compliance, routine smoothness and issues, and the desired performance and impact. This study employs a descriptive qualitative design. Data were collected through in-depth interviews with healthcare workers and visitors, observations of smoking behavior within the hospital environment, and analysis of policy documents. Informants included hospital staff responsible for overseeing the SFA policy, as outlined in the Director’s Decision Number 003/SK/DIR/RSMM/IV/2023 regarding the Assignment of SFA Policy Supervisors. Data were thematically analyzed using Ripley and Franklin’s theoretical framework. The findings indicate that compliance with the SFA policy inside the hospital building is relatively high, although violations are frequently observed in outdoor areas. Observations revealed cigarette butts in public areas of the hospital, indicating ineffective supervision. The hospital's operational routines remain smooth; however, the main challenges are inconsistent supervision and low awareness among visitors and staff. The impact of the policy on reducing the number of smokers within the hospital environment is beginning to be seen, though it is not yet significant. The implementation of the SFA policy at Mitra Medika Amplas General Hospital has not yet reached optimal levels. Strengthening supervision, increasing socialization efforts, and providing facilities such as a Smoking Cessation Clinic are recommended to enhance policy effectiveness. These steps are essential for achieving higher compliance and establishing a smoke-free hospital environment. Enhanced supervision and more intensive socialization efforts are needed to improve the effectiveness of the SFA policy implementation at Mitra Medika Amplas General Hospital. Keywords: General hospital, policy implementation, smoking