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Quick and Accurate Fast Online Outpatient Registration
System (Si Palin Ceria) Tuban District General Hospital
Moch. Amriza1, Bintoro Wardiyanto2, Antun Mardiyanta3
1, 2, 3 Airlangga University
1 moch.amriza-2017@fisip.unair.ac.id, 2 bintoro.wardiyanto@fisip.unair.ac.id, 3 antun.mardiyanta@fisip.unair.ac.id
Abstract: Public service is a benchmark of the most visible performance of the government. The
community can directly assess the performance of the government based on the service it receives. For
this reason, the quality of public services in all ministries / institutions is a fundamental matter that must
be immediately improved. Good and quality public services are citizens' rights as well as the
constitutional obligations of the state. The thought of public service innovation is inseparable from the
still slow improvement of public quality as a manifestation of bureaucratic reform, while the ongoing
process of bureaucratic reform is carried out by the Government that aspires to World Class Government
(World Class Government) expected to be achieved in 2025 the public should ideally grow out of
organizational culture, because it is expected to develop and sustainably encourage accelerating the
improvement of the quality of public services.Public service innovation should reach a broader goal,
which is to accelerate the improvement of the quality of public services. RSUD Tuban Regency issued
Innovation with "Si Palin Ceria" application (Quick and Accurate Fast Online Outpatient Registration
System), with this application patients can register from home for D-7 days until D-day service. Patients
can go directly to a special window without queuing. This application has been bridging with the
Population Administration Information System (SIAK) of the Population and Civil Registry Office of
Tuban Regency and the Hospital Management Information System (SIMRS). Application is expected to
facilitate the public in enjoying health services.
Keywords: innovation, government, public service, Si Palin Ceria, hospital
Introduction
The public sector is a sector that is characterized by non-commercial, public-oriented, based on
legitimate authority, and the relationship of accountability and transition between citizens (the people) as
mandates with the state or the government as executors of society. On the other hand, the public sector
with all its rigidity also corrects a wave of change, to be more flexible, better able to respond to
challenges, changes and dynamics that occur in the midst of society. Increased awareness of citizens of
their rights, as well as the level of education, literacy, health, welfare and other socio-economic aspects
have increased the public sector to keep pace with policies and service quality that is in accordance with
the capacity of its citizens.
Public administration must always modernize itself, find more precise strategies and approaches and
continue to strive to update theories and instrumentation so that they are not increasingly left behind with
the advancement of time. In this case, one of the major trends that must be integrated into the discipline of
public administration is innovation. Today, innovation has become a real practice that makes
governments everywhere have far better performance. This means that innovation becomes the most
rational choice to prevent a country from various forms of failure. In fact, innovation is no longer a
choice, but rather the obligations and needs of government officials at all levels and all levels.
If we talk about innovation, the fundamental question that is very important to ponder is why to
innovate? This question certainly has thousands of answers, there can be the same and can also be
different. The reason for the public sector to innovate is more because of the demands for accountability,
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transparency and various good governance principles that lead to higher-performing public organizations.
In the context of national development, innovation in the public sector becomes absolute because our
country needs acceleration or acceleration in advancing the economy and people's welfare. Our
competitiveness with other countries, even if only at the regional level is still quite alarming. Difficulties
arise from the discipline of public administration in adapting to environmental changes. The difficulty of
adapting to environmental changes is seemingly unresolved and a problem that for decades has tended to
be ignored. Innovation is needed to get the best solution of the various problems faced, both by the
community, business people, and government.
The importance of developing innovation for public sector organizations, such as local government
innovation in this study, is a serious concern of Mulgan and Albury (2003: 2). This can be seen in the
statement as follows; “Innovation should be a core activity of the public sector: it helps public services to
improve performance and increase public value: respond to the expectations of citizens and adapt to the
needs of users; increase service efficiency and minimize costs."
The meaning of what was stated by Mulgan and Albury above, that innovation should be the core of
all activities in the public sector. Innovation can help improve service performance and public values.
Innovation means increasing responsiveness to the expectations of citizens and the needs of service users.
Also innovation can grow efficiency and reduce costs. Mulgan and Albury (2003) also mentioned several
reasons why the public sector must innovate. Some of these reasons include: (1) innovations are carried
out to respond more effectively to changes in the increasing needs and expectations of the public; (2) to
include cost elements and to improve efficiency; (3) to improve the delivery of public services, including
those in the past which have made little progress; (4) to capitalize on the full use of ICT, as this has been
proven to increase efficiency and effectiveness in service delivery.
The guarantee that the Law on Public Services does not appear to be sufficient, the implementation of
Law No. 25/2009 on Public Services is more important, with many people still not getting public services
that are not in line with their expectations. The community acknowledged that there was an increase in
public services, but the increase was not in line with their expectations.
Therefore the implementation of public services now and in the future in order to achieve World Class
Government in 2025 (Bureaucratic Reform Design, 2014), is not an ordinary job, but must be an
extraordinary job by accelerating through various new breakthroughs . The improvement in public
services today compared to the expectations of the community is illustrated between the arithmetic and
the geometric progression. The progress of public services that runs like a series of counts will be further
behind the expectations of people who jump like a series of measurements. Public service innovation is
accelerating to make a breakthrough breakthrough to become a solution to improve the quality of public
services that is closer to the expectations of the community.
Public service innovation thinking cannot be separated from the still slow increase in public quality as
a form of bureaucratic reform, meanwhile the process of bureaucratic reform that is currently being
carried out by the Government of Indonesia which aspires World Class Government is expected to be
achieved in 2025. Innovation Public services should ideally grow from organizational culture, because
they are expected to develop and continue to encourage the acceleration of improving the quality of
public services. For the first time, the Ministry of Administrative Reform and Bureaucratic Reform of the
Republic "forced" the public service innovation to continue to grow as an organizational culture through
the implementation of the "One Agency, One Innovation" policy, which is that each Ministry / Institution
and Local Government must create at least 1 (one) Public Service Innovation every year in line with the
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obligation to bring up "Quick Wins" as a requirement for implementing bureaucratic reforms within the
Ministry / Agency and Regional Government.
There is no harm if the Leaders of Ministries / Institutions and Regional Governments continue to
implement the "One Agency, One Innovation" policy with instructions from Ministers / Institutional
Leaders, Governors and Regents / Mayors, requiring the leaders of work units to be at the echelon II level
in their programs to create innovations in public services. . Then the creativity that led to the innovation
was made as one of the indicators of performance evaluation in question. This action if done consistently
will greatly help accelerate innovation into an organizational culture.
In accordance with Regulation of the Minister of Health of the Republic of Indonesia Number 129
Year 2008 regarding Minimum Service Standards for Hospitals, Hospitals are required to provide health
services in accordance with Minimum Service Standards.
Regent Regulation Number 25 Year 2017 concerning Main Performance Indicators in the Government
of Tuban Regency in 2016 - 2021, that the Main Performance Indicators in the District Hospital of Tuban
consist of 7 Main Performance Indicators. In the final report for 2017, 4 indicators were achieved in
accordance with the target set, but there are still 3 indicators that have not been achieved. One indicator
that has not yet been reached is the percentage of hospital Minimum Service Standards achievement.
Evaluation of achievement of Minimum Service Standards that were not achieved in 2017 there were 7
installations / units out of 18 installations / units. One of the installations / units in RSUD Dr. R Koesma
Tuban that has not been achieved by the target service performance indicators according to the Minimum
Service Standards in 2017 is outpatient installation. Minimum Service Standards Indicators that are not
achieved according to the target there are 2 out of 7 targets, namely: indicators of service providers in
specialist polyclinics and indicators of customer satisfaction.
Achievements for indicators of physician service providers in specialist polyclinics reached 94.24% of
the target of 100%. The reason for not achieving these targets is the lack of information for specialists
who are unable to practice. So that patients who come served by a substitute doctor (general practitioner).
Indicators of customer satisfaction are assessed by conducting internal and external surveys to patients
with the Community Satisfaction Index. In the 2017 internal survey the achievements of the Community
Satisfaction Index in outpatient agencies were not achieved. Achievement of the Community Satisfaction
Index was achieved 79% of the target of 90%. And external surveys reached 75.25%. One of the causes
of customer dissatisfaction is the high queues at both outpatient registration and queuing at outpatient
clinics. Even though the waiting time of the service has been reached the target, but in reality patients
scramble to queue at the same hours, namely at 07.00 to 09.00 am. Long queues make patients sometimes
do not get a seat in the waiting room. Because the number of seats in the waiting room is limited and
makes the patient uncomfortable.
Of all the causes and conditions in the analysis of the problems mentioned above, the strategy for
solving the problem is by adding an online-based outpatient registration or website. Therefore the Tuban
District General Hospital innovated the application "SIPALIN CERIA" (Online, Fast, Quick, and
Accurate Outpatient Registration System).
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Conceptual / Theoretical Framework
Figure 1. Concept Framework Scheme
Public service
Principles of Service according to LAN (2003), namely simplicity, reliability, responsibility of service
officers, skills of service officers, approach to customers and ease of customer contact with officers,
friendliness, openness, communication between officers and customers, credibility, clarity and certainty,
security, understand what customers expect, reality, efficient, and economical.
Services can basically be defined as the activities of a person, group and or organization, both directly
and indirectly to meet the needs (Pasolong, 2007: 128). Moenir stated that service is a process of fulfilling
needs through other people's activities directly. While the Minister of Administrative Reforms, said that
services are all forms of service activities in the form of goods or services in the framework of efforts to
meet the needs of the community (Pasolong, 2007: 128). Meanwhile, the term public comes from public
English which means general, community and state. The word public has actually been accepted as
Standard Indonesian to be Public, which means general, multitude, crowded. Inu Kencana defines the
public is a number of people who have together thought, feelings, hopes, attitudes and actions that are
right and good based on the norm values that feel they have.
Therefore, public service is defined as every activity carried out by the government to a number of
people who have every beneficial activity in a collection or unity, and offer satisfaction even though the
results are not tied to a product physically (Sinambela, 2007: 5).
Kurniawan (2005) said that public service is the provision of services (serving) the needs of other
people or people who have interests in the organization in accordance with the basic rules and procedures
that have been set.
Meanwhile, the definition of public service according to the Decree of the Minister of Administrative
Reform and Bureaucratic Reform No. 25/2004 is all service activities carried out by public service
providers as an effort to meet the needs of service recipients, as well as in the context of implementing the
provisions of the legislation (Sinambela, 2007: 5). Thus, public service is an effort to fulfill the desires
and needs of the community by the government apparatus in the framework of implementing the
applicable laws and regulations.
Best Practice
Criteria According
to UN
Health
services
Health
Service
Innovatio
n
Application of
Si Palin Ceria
Tuban
General
Hospital
Factors inhibiting
innovation
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Innovation Strategy in Government
Innovation strategies in government are also explained in the book Innovative Government by
Sangkala (2013), namely:
1.
Integrated services, where the public sector offers an increase in a number of services, residents have
not simple expectations where citizens request the services provided along with comfort.
2.
Decentralization, service delivery and monitoring are closer to the community and usually establish
certainty for high levels of demand thereby increasing the satisfaction of the public or business people.
3.
Utilization of cooperation, means as an innovative government to meet increased fulfillment to be more
efficient in the delivery of public services, more collaborative between organizations and also
collaboration between public and private.
4.
Citizen involvement, Innovative government authority must realize the role of its important role by
encouraging the role of citizens to participate in driving change.
5.
Utilization of communication and information technology.
Best Practice
Best practice is defined as an idea or way that is considered successful and has a high level of
efficiency and effectiveness. Best practice is the best practice carried out by an authority that usually
exists in government or management, depending on the situation. Best practice is also an example to be
practiced elsewhere.
The UN Habitat assessment of best practice, quoted from Sangkala (2013), also defines best practice
in the context of the urban environment as an initiative that has produced outstanding contributions in
improving the quality of life both in cities and other general public. The best practices criteria according
to the UN (in Sangkala, 2014: 8) consist of:
1. Impact, a must show a positive and tangible impact in improving the living conditions of the
community, especially the poor and disadvantaged.
2. Partnership, must be based on a partnership between the actors involved, involving at least two
parties.
3. Sustainability
4. Leadership and community empowerment
5. Gender equality and social inclusion
6. Innovation within local content and transferability
Discussion
Public service innovation should reach a broader goal, namely to accelerate the improvement of the
quality of public services. The development of public service innovation in the form of replication and
transfer of knowledge as well as the institutionalization of public service innovation is an important step
that needs to be done so that public service innovation can encourage the acceleration and continuous
improvement of the quality of public services.
Behind the low quality of public services that are often perceived by the public, Indonesia has in fact
gained the most prestigious international achievement, namely gaining a respected place in the
international public service competition organized by the United Nations called the United Nations Public
Service Award (UNPSA). Since 2005, Indonesian public service institutions / institutions have been
nominated to participate in UNPSA. Only in 2014 obtained a count from the international competition
agency by placing 5 finalists. Achievements were made again in 2015 by placing 2 Indonesian public
service innovations, namely Strengthening the Partnership between TBAs and Paramedic Workers:
Reducing the Death of Children and Mothers giving birth to Aceh Singkil District and the Integrated
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Services for Poverty Alleviation of Sragen Regency respectively as Runner-up in the Category "
Improving the delivery of Public Services "and the" Promoting Whole of Government Approaches in the
Information Age "Category. Achievements in the last 2 years can not be separated from the role of the
Ministry of PANRB in collaboration with development partner institutions in Indonesia starting from
mentoring and candidacy.
This news can certainly make the Indonesian Government somewhat "confident" while opening the
eyes of the international community that Indonesian public services are counted internationally. Doubts
both the domestic community and the international community caused by Indonesia's bad report cards in
the international survey numbers are gradually expected to turn around.
The question is whether Indonesian public service innovation can be said as a model of change in
public services in Indonesia? One of the criteria for innovative public services is to provide results and
benefits for the community. The results of tangible changes improve service fundamentally not just
patchwork. Then giving benefits (outcome) meant that public service innovation has a good and broader
influence on the environment, both on the performance of the work unit as well as on the Ministries /
Institutions or Local Governments.
Quick and Accurate Fast Online Outpatient Registration System ("Si Palin Ceria")
The application "Si Palin Ceria"is an Online, Fast, Compact and Accurate Outpatient Registration
System. Patients or family of patients with this application can do outpatient registration 7 (seven) days
before the service. Patients do not need to leave early to register, because it can be done by using a
cellphone / gadget by accessing this system application.
The objectives to be achieved in "Si Palin Ceria"are: the availability of alternative outpatient
registration options for the people of Tuban District online; reduce waiting time in the outpatient
registration queue so that customer satisfaction indicators can be achieved in the Minimum Service
Standards (SPM) in 2019 outpatient installations.
Targets to be achieved in "Si Palin Ceria" internally: to improve service standard procedures in the
outpatient registration process and to facilitate the effective and efficient implementation of outpatient
registration and queues,
In this innovation simple but able to solve problems in new ways and different from existing methods
before. This is because:
1.
Easy
The application "Si Palin Ceria" can be accessed very easily. It can be with the google play store
application or without an application (by directly http://registrasi.rsudkoesma.id)
2.
Bridging
This application has been bridging with the Population Administration Information System (SIAK) of
the Civil Registry Population Service and has also been bridging with the Hospital Management
Information System (SIMRS)
3.
Integrated
This application has been integrated with the Siranap Ministry of Health and the Smart City of Tuban
Regency Government
4.
Light weight
This application is very light, the Google Play Store only has a capacity of 1.2 Mb. And on the Hello
doctor's menu, the recording is very light, with good quality.
The "Si Palin Ceria" application socialization was conducted to: (1) medical record officer; (2) all
hospital employees; (3) hospital patients and visitors; (4) Head of Puskesmas; (5) Distribution of
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brochures, banners and pamphlets; (6) Radio Broadcasts; (7) Health BPJS; and (8) Socialization on Print
and Online Media. Application launching is held on April 25, 2018.
Monitoring and Evaluation
Since the beginning of the application, the number of patients / people who have used and used this
application has been monitored. The indicators used in monitoring the use of "Si Palin Ceria" are: (1)
evaluation of the monthly "Sipalin Ceria" account development; (2) evaluation of the percentage of
outpatients per month
While indicators for impact evaluation are used 9 indicators in the Community Satisfaction Survey in
accordance with RB Regulation No. 14 of 2017 concerning Guidelines for the Preparation of Public
Satisfaction Survey Public Service Provider Units, namely: (1) requirements; (2) systems, mechanisms
and procedures; (3) completion time; (4) costs / rates; (5) product specification type services; (6)
implementing competencies; (7) implementing behavior; (8) handling complaints, suggestions and input;
and (9) facilities and infrastructure
The results of monitoring the use of this application are: (1) evaluation of the development of the
"Sipalin Cheers" account registered until February 2019 with a total of 2268 people, each month a new
account is registered with an average of 241 people; (2) evaluation of the percentage of outpatients.
Comparison of outpatients using cheerful sipalin with those who register manually every month the trend
is increasing. The percentage in February is 20%.
While the results of the impact evaluation in the Community Satisfaction Survey (SKM) are an
increase in the value of internal or external surveys: (1) internal assessment, in 2018 there was an increase
of 80.78% compared to 2017 which was 79.17%; (2) external assessment in 2018 there was an increase of
82.25% compared to 2017 which amounted to 75.25%
Graph 1. Evaluation of the SIPALIN CERIA Account Development
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Graph 2. Evaluate Percentage of Outpatients
Graph 3. Evaluation of Community Satisfaction Surveys
Constraints and Solutions
Constraints that occur in this innovation include:
1.
At the beginning of implementation, the number of users is still small. Efforts to resolve it by
increasing the socialization of the use of this application. Among other things, direct socialization to
visitors by scheduling officers at the front office / information service every day.
2.
There is a slow application access process. The solution is by changing the design, changing the size
of the image, and simplifying access.
3.
The existence of proposals and needs of patients related to other information.
4.
The solution to this problem is by developing the application into "Si Palin CeriaKoesma Plus" but it
remains light. Ie we add a new menu of information "all in one" this is:
5.
Doctor's schedule information at the outpatient clinic,
6.
Availability of inpatient rooms,
7.
Complaint service, MantapMas (Cellular Inter Patient Services Safe and Safe Cheap) and
8.
Hello Doctor's Documentation.
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The application "Si Palin Ceria Koesmaplus" which is available "all in one" is an improvement in
governance and improvement in the area of public service quality. So that public satisfaction with
outpatient installations in 2019 can be achieved. In this application another benefit is to improve service
satisfaction in medical record installations by accelerating the preparation of medical record documents.
And also can reduce the queue of motorized parking.
Impact before and after innovation
This innovation has been carried out monitoring and evaluation of its impact on improving public
service governance at the Tuban District General Hospital. Monitoring is carried out routinely every
month by the internal hospital team. Impact assessments are carried out by internal and external teams to
assess the level of community satisfaction using the Community Satisfaction Survey (SKM) method.
The target community groups surveyed were visitors to the RSUD in a population of 150 people. An
external survey was carried out by the Tuban District Government Organization in collaboration with
Mitra Karsa Utama Consultants in December 2018. The following is an illustration before and after the
Innovation:
Number
Before Innovation
After Innovation
1
Outpatient registration is only manual
Manual and online outpatient registration
2
Not available Leave doctor schedule
information
Available doctor leave schedule information
3
Bridging is not available with SIAK of the
Population and Civil Registry Office of Tuban
Regency
Bridging is available with SIAK of the Population
and Civil Registry Office of Tuban Regency
4
The complaints service is not yet application
based
Complaints service is application based
5
Great Information is only available manually
Great information is available manually and
online
6
Inpatient information is only available on the
website
Inpatient information is available on the website
and is also integrated in the application
7
No documentation available Hello Doctor
Documentation is available Hello Doctor
8
2017 Community Satisfaction Survey
(Internal surveyor) of 79.17
Community Satisfaction Index 2018 (Internal
Surveyor) Of 80.78
9
2018 Community Satisfaction Index (Internal
Surveyor) Of 80.78
2018 Community Satisfaction Index (external
surveyor)
of 82.25
This innovation has been guaranteed to be sustainable due to the full support of the Tuban District
Government, Hospital Director, internal stakeholders, and external stakeholders. And also there is
adequate budget support. And positive responses from patients, visitors, and the community. Evidenced
by an increase in the number of new accounts and total application user accounts and the percentage of
users is increasing. This innovation is also guaranteed to be sustainable because of the legal aspects of
Team Decree available and the existence of guidelines for its use.
This is also because it has benefits from social, and economic aspects both in society and also for
institutions. The perceived social benefits to the community are the ease of gaining access to services to
the hospital, as well as the ease of getting educational information about health and other diseases.
Economic benefits to the community include cost efficiency due to the time efficiency of faster
outpatient registration. The social benefit at the hospital institution is the achievement of the Hospital's
service performance.
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In general, in implementing the program for public service innovation in "Sipalin Ceria" (Quick and
Accurate Fast Online Outpatient Registration System) Tuban District General Hospital is measured in
best practice according to the UN as follows:
1.
Impact (impact),can show a positive and tangible impact in improving the living conditions of the
community, especially health service users.
2.
Partnership (partnership), the development of this program has been implemented with the support of
the collaboration partner of the Population and Civil Registry Office of Tuban Regency, and has
provided benefits for the Regional General Hospital of Tuban Regency and the community in the
Tangerang Regency environment in general.
The external survey was conducted by the Tuban District Government Organization in collaboration
with Mitra Karsa Utama Consultants.
This has shown that innovation is based on a partnership between the actors involved. At least it
involves more than two parties.
3.
Sustainability (sustainability),
4.
This innovation has been guaranteed to be sustainable due to the existence of full support from the
Tuban District Government, hospital directors, internal stakeholders, and external stakeholders. And
also there is adequate budget support. And positive responses from patients, visitors, and the
community. Evidenced by an increase in the number of new accounts and total application user
accounts and the percentage of users is increasing. This innovation is also guaranteed to be sustainable
because of the legal aspects of Team Decree available and the existence of guidelines for its use.
5.
Leadership and community empowerment (leadership and community empowerment), leadership that
inspires action and change, including changes in public policy, community empowerment,
neighborhood harmony and other communities and integration of contributions made by the
community, acceptance and responsibility with respect to social and cultural differences, the
possibility of transferability of further development and replication, appropriate to local conditions
and levels of development.
6.
Gender equality and social exclusion (gender equality & social inclusion), initiatives have been
accepted by all parties and are a response to social and cultural differences; promote equality and
social justice on the basis of income, sex, age and physical / mental condition; and recognizes and
assigns values to different abilities.
7.
Innovation in a local context and can be transferred (innovation within local context &
transferability), in this innovation that is simple but can be carried out all parties and other parties can
learn or benefit from the initiative, as well as the ways used to share and transfer knowledge.
Recommendation
From the implementation of these innovations, short-term targets can be achieved. However,
continuous implementation must continue to be carried out according to a predetermined plan, so that the
goals, objectives and benefits to be achieved can be realized. Some of the recommendations we submit
are:
1. There needs to be an increase in continuous outreach activities to increase the number of citizens who
use this application.
2. Need to improve communication and coordination with stakeholders related to this application to
ensure the application goes well.
3. Efforts should be continued to improve and develop this application to make it easier and better.
4. It is necessary to propose to adequately facilities and infrastructure of the queue per polyclinic in the
future.
5. It is necessary to develop this application in adequate budget planning.
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