Strategi Transformasi Tata Kelola Badan Layanan Umum Daerah dalam Meningkatkan Kinerja Rumah Sakit Umum Daerah di Sulawesi Tenggara

Abstract

The implementation of the Regional Public Service Agency financial management scheme grants managerial flexibility to public hospitals, yet this flexibility does not automatically translate into mature governance without a corresponding strengthening of internal oversight capacity. This study aims to analyse the gap between regulatory compliance and substantive governance capability, and to formulate a staged transformation strategy for Regional Public Service Agency hospitals in Southeast Sulawesi Province. A descriptive qualitative design combining case study and document analysis was employed, evaluating Southeast Sulawesi Governor Regulation Number 22 of 2023, official hospital performance reports, and evaluation reports from the Finance and Development Supervisory Agency. Data were analysed using thematic analysis integrated with internal-external factor mapping and SWOT-TOWS matrices. The findings show that regional regulation has provided adequate structural legitimacy and that service performance at RSUD Bahteramas has shown an improving trend from 2019 to 2023, yet strengthening internal oversight and risk management remains a strategic priority. These findings are juxtaposed with international empirical evidence indicating that hospital autonomy does not always translate proportionally into performance gains when managerial capability fails to develop in tandem, as well as evidence from Indonesian public sector governance linking weak internal control to accountability risk. The study recommends a staged transformation model that links short-term regulatory compliance with medium- and long-term development of adaptive organisational capability, serving as a policy basis for local governments and hospital management in designing more targeted BLUD governance strengthening programmes.