Instalasi Rawat inap Utama RSMH Palembang yang berpotensi sebagai unit bisnis strategis dengan sasaran masyarakat segmen ekonomi menengah ke atas masih menghadapi berbagai masalah yaitu rendahnya tingkat hunian karena ketidak puasan pasien terhadap pelayanan, rendahnya tanggung jawab karyawan terhadap pekerjaan dan secara finansial belum melakukan perhitungan biaya satuan sebagai dasar penentuan tarif sehingga belum diketahui secara pasti recovery pendapatan terhadap biaya. Penelitian ini bertujuan untuk mengetahui pencapaian kinerja IRNA Utama dengan pendekatan Balanced Scorecard yang secara komphrehensif dapat menelusuri harapan pelanggan, memotivasi pegawai, mengukur pencapaian kinerja keuangan dan membuat tujuan strategis untuk melakukan suatu perubahan yang diukur dari perspektif pertumbuhan dan pembelajaran, bisnis internal, pelanggan dan finansial (Lynch dan Cross, 1993 dalam Yuwono, 2002). Perspektif pelanggan dinilai melalui kepuasan pasien, harapan pasien terhadap pelayanan dengan analisis kuantitatif Inovasi dan bisnis tingkat strategis digali dari manajer puncak dan manajer tengah dengan analisis kualitatif, dan dari tingkat pengguna ditelusuri dari pelanggan dengan analisis kualitatif Pertumbuhan dan pembelajaran diketahui dari keikutsertaan karyawan dalam pendidikan dan latihan serta perencanaan. Dilakukan juga studi kepuasan karyawan secara kuantitatif. Finansial diketahui dengan menghitung biaya satuan dan Cost Recovery Rate dengan metode Activity Based Costing (Tunggal, 2001 & Mulyadi, 2003) dan analisis titik impas (Gani, 1996). Visi dan Misi belum mengacu kepada indikator kesejahteraan karyawan dan keuangan. Kinerja keseluruhan belum mengarah kepada pencapaian Visi dan Misi. Kinerja pertumbuhan dan pembelajaran menunjukkan 67,7% karyawan pemah ikut diktat, 23,8% pemah membuat perencanaan. Total karyawan yang puas 49,2%. Harapan karyawan yang belum terpenuhi adalah penghargaan atas prestasi yang dicapai. Inovasi dan manajemen mutu layanan belum ada, inovasi dan proses operasional termasuk kategori sehat berdasarkan standar Depkes, BOR dan TGI tahun 2003 dalam Grafik Barber-Johson tidak efisien. Pelanggan memilih IRNA Mama karena harga 37,6%, fasilitas 30, 83%, dokter 5,83% dan fasilitas/dokter 15,83%. Pasien 99,17% menyatakan peralatan biasa saja, 89,17% setuju diadakan alat canggih dengan biaya mahal. Pasien yang puas 48,3% dengan unsur yang belum dapat memenuhi harapan dan belum mendapat perhatian manajemen adalah pelayanan dokter dan perawat tepat waktu, rumah sakit mampu memberikan pertolongan dengan cepat dan tepat, gangguan nyamuk selama dirawat dan kebesihan alat makan. Cost Recovery Rate biaya satuan Musi Elok Super VIP 232,4%, Musi Elok VIP 139,4%, Ogan Permai 160,6%, Komering Cindo 88,3%, Enim Indah 62,6% dan Lematang Indah 95,3% dengan Total Cost Recovery Rate 70,20%. Disarankan untuk meninjau ulang Visi dan Misi, meningkatkan pelatihan customer service bagi karyawan , memberikan apresiasi terhadap karyawan berprestasi berwujud bonus,sertifikat, tur dan merealisasikan pengadaan dokter jaga serta pengadaan kendaraan antar jemput. Perlu perhatian tehadap ketepatan dokter/perawat memberikan pelayanan dengan memberikan pelatihan customer service secara intensif kepada perawat.

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The Mohammad Hoesin's Main Inpatient Services Department that is potential to become a strategic business unit with upper middle class economical stratum mark faces some problems. Those are inferiority of occupancy because of patients' disappointment to services, inferiority of employee responsible to their job, and financially, the department hasn't yet done unit cost accounting as the basic to decide the tariff, therefore the income recovery to cost is not known yet.

This research intend to get the numbers of department performance achievement with Balance Scorecard that comprehensively is able to delve customers expectation, to motivate the employee, to measure financial performance achievement, and to make a strategic goal to do some innovations that are measured from growing and learning, internal business, customers, and finances perspective (Lynch and Cross, 1993 in Yuwono, 2002).

Customers perspective is evaluated by patient satisfaction, patient expectation to services with quantities analysis. Innovation and strategic level business is delved from top manager and middle manager with qualities analysis. Growing and learning is known from employee participation in education, training, and also planning. Furthermore, Employee satisfactions studying are also done quantitatively. Finances are known by unit cost accounting and Cost Recovery Rate using Activity Based Costing method (Tunggal, 2001 and MuIyadi, 2003) and break-even point analysis (Gani, 1996).

Growing and learning performance indicates that 67,7% of employee have ever followed training, 23,8% have ever made a planning. The total numbers of satisfied employee are 49,2%. Employee expectation that hasn't been fulfilled is about achievement awareness. There are not innovation and quality service management yet. Furthermore, innovation and operational process included health category based on Health Ministry standard, BOR, and TOI at 2003 in Barber-Johnson Graphic get inefficient evaluation.

Customers prefer Main Inpatient Services because of price is amount 37,6%; facility is amount 30,83%, doctor 5,83%, and facility/doctor 15,83%. As amount of 99,17% patients declare that the equipment is ordinary, 89,17% agree about sophisticated and expensive equipment supply. As amount of 48,3% patients are satisfied with unexpected factors and management uncontrolled are about doctor services and on-time nurse services, hospital can give a service fastly and exactly, mosquito disturbance along nursery and dinning equipment cleanliness. Cost Recovery Rate of unit cost of Musi Elok Super VIP 232,4%, Musi Elok VIP 139,4%, Ogan Permai 160,6%, Komering Cindo 88,3%, Enim Indah 62,6%, and Lematang Indah 95,3% with Total Cost Recovery Rate is amount 70,20%.

Increasing of customer service training for employee is suggested aside from to appreciate high achievement employee with bonus giving, certificate, tour, and to actualize stand by doctor shift and also transportation supply. Doctor/nurse on-time shifting must be attended, especially in giving services by the customer service training and workshop program to nurse intensively.