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An alignment between two or more aspect in hospitals could have an impact on efficiency. The results of a preliminary study at 9 regional general hospitals showed an inefficient 66.67% in 2015-2016, and there was a decrease in efficiency 33.33% of the inefficient hospital. The purpose of this paper is to analyze the contribution of alignment between the costs of quality improvement activities and quality achievements on efficiency in hospital. This study is an observational analytic research with survey method. The population of this study is general hospitals (government and private) class B and C in East Java of 150 units with a sample of 30 hospitals. Respondents for the alignment assessment are 432 people, while for the efficiency measurement are 118 people. Analysis to determine the contribution of alignment on efficiency using linear regression statistical test. The results showed that most hospitals were in an align between the cost of quality improvement activities with quality achievement of 70%, most of the hospitals were in the efficient of 60%, and the contribution of alignment between the costs of quality improvement activities and quality achievement on efficiency (RoS /CoS ratio) of 4.1% with a value of R² = 0.041.

An alignment between two or more things in an organization (including hospitals) could have an impact on the organization performance. The alignment between two aspects (eg between processes and outputs) in the health sector, especially in the hospital is necessary. The alignment between processes and outputs is needed such as the alignment between the costs of quality improvement programs (processes) and the quality achievements (outputs). This alignment could be deployed as an evaluation parameter for the cost control and the quality control carried out in the hospital. The purpose of this paper is to systematically review evidence of the assessment instrument for the alignment between the cost and the quality or the alignment of other aspects. This study was a systematic review of articles on the assessment instruments for the alignment between the cost and the quality or the alignment of other aspects. The inclusion criteria that were used were the assessment or the measurement instrument of the alignment, the assessment or the measurement instrument, the alignment between the cost and the quality, or other alignments. The initial identification process based on the search found 774.139 articles.

The prevalence of chronic pain ranges from 30-50% in patients with cancer undergoing active therapy. Kynurenic acid, xanthurenic acid, and quinolinic acid are significant biomarkers for assessing pain objectively. This study aims to investigate the scientific evidence of the effect of serum kynurenic acid levels on the severity and duration of chronic cancer pain. It is a cross-sectional study with 80 subjects consisting of 19 male and 61 female patients in the palliative outpatient clinic of Dr Soetomo Hospital. The pain assessment was performed using the NRS, and the biochemical analysis of serum kynurenic acid was assessed using the ELISA method. Of the total of 80 subjects, 26 patients had pelvic organ cancer (33.7%), 24 patients had respiratory organ cancer (30.1%), 17 patients had breast cancer (21.7%), 9 patients had abdominal organ cancer (9.6%), 3 patients had malignant melanoma (3.6%), and 1 patient had sternal bone cancer (1.2%). Kynurenic acid significantly correlated with the severity of pain (p = 0.043), with (r) of -0.218. However, kynurenic acid showed no significant correlation with the duration of pain (p = 0.052). Kynurenic acid affected the severity of pain but did not affect the duration of pain in chronic cancer pain patients.