ANALYSIS OF THE IMPLEMENTATION OF ENVIRONMENTAL COSTS

CASE STUDY AT BANJARMASIN ISLAMIC HOSPITAL

Fatmawati Bakri Noor1

Padlah Riyadi, 2
Masters Program in Accounting, Faculty of Economics and Business, Lambung Mangkurat University, Banjarmasin,
Indonesia

Corresponding Author : padlah.riyadi@gmail.com

ABSTRACT

This study aims to uncover waste management activities and environmental costs of environmental cost reporting at
the Islamic Hospital of Banjarmasin. This researcher uses a qualitative paradigm with a case study design. The
research scope is the Unit of Environmental Health Sanitation with the accounting process of environmental
management, hospital waste management's data focus, and expenditures for waste costs. Primary data were
collected through in-depth interviews and observations; secondary data, through documentation. The results
revealed that environmental management accounting systems in 2019 and 2020 found hidden environmental costs
from waste management cost reports in the Financial Statements. For example, the environmental cost report
applied to the SKL Unit revealed Rp. 677,646,500 and Rp. 459,521,600 not presented as an environmental cost in
2019 and 2020. The implementation of environmental cost accounting through environmental cost reporting at the
Islamic Hospital of Banjarmasin revealed that special reports in environmental management accounting could be
used as information by the management of the Islamic Hospital of Banjarmasin in planning and controlling
environmental responsibility activities. The study results also revealed that the environmental cost report facilitated
the direction of the Islamic Hospital of Banjarmasin in making decisions related to environmental costs and
provided information for stakeholders that the hospital had been responsible for maintaining environmental health.

Keywords:
Environmental management accounting, environmental costs, environmental cost reports.

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A. INTRODUCTION existence of a hospital (RS) is very important

A hospital is a health service institution that to provide health services to the community.
provides complete individual health services, Based on data from the Ministry of Health of
providing inpatient, outpatient and the Republic of Indonesia in 2020, the
emergency services. Regulation of the number of hospitals in Indonesia from 2015-
Minister of Health of the Republic of 2019 increased by 13.52%. In 2015 the
Indonesia Number 7 of 2019 concerning number of hospitals was 2,488, increasing to
Hospital Environmental Health Articles 1b 2,877 in 2019. The number of hospitals in
and 1c, states that hospital environmental Indonesia as of 2019 consisted of 2,344
health aims to protect hospital human General Hospitals (RSU) and 533 Special
resources, patients, visitors and the Hospitals (RSK). The South Kalimantan
community around the hospital from Province region as one of the provinces in
environmental risk factors and create a Indonesia has 45 hospitals spread across
home environmentally friendly sick several city districts. A total of 11 hospitals or
(www.healthenvironment.com, 2019). around 24.4% are in Banjarmasin City which
will certainly have an impact on the amount
Law Number 32 of 2009 concerning of waste produced
Environmental Protection and Management (https://pusdatin.kemkes.go.id, 2020).
in Article 2 also regulates that environmental
protection and management is carried out Hospital waste is all waste produced from
based on participatory principles and local hospital activities in the form of solid, liquid,
wisdom. This means that the law states that paste (gel) or gas which can contain
we are ordered to maintain, protect and care infectious pathogenic microorganisms, toxic
for the surrounding environment, including chemicals that can affect human health
hospitals as health service institutions. As (Indrawati and Rini, 2018). One One type of
the population grows, the need for health hospital waste is medical waste. It is very
services continues to increase. The important for medical waste to be managed
properly, this is because medical waste is costs, and hospitals gain more trust from
included in the category of hazardous and stakeholders.
toxic waste. Some medical waste is included
in the hazardous waste category and some The background regarding the phenomenon
is included in the infectious category. There of the importance of waste management and
are still many hazardous medical wastes in environmental costs arising from the waste
the form of chemical waste, pharmaceutical management process as well as the high
waste, heavy metals, genotoxic waste and amount of costs incurred by the Banjarmasin
pressurized containers that have not been Islamic Hospital to manage hospital waste
managed properly. Meanwhile, infectious motivates research on environmental costs
waste is waste that can be a source of with the title "Analysis of the Implementation
disease spread to staff, patients, visitors or of Environmental Costs in Case Studies in
the community around the hospital Islamic Hospitals Banjarmasin”.
environment. Infectious waste usually
consists of patient body tissue, syringes, Research Problems
blood, bandages, other cultures that are Based on the above background, the research
thought to be contaminated by the patient's problem is stated as follows:
disease. a. How have waste management
activities as a form of environmental
Activities arising from environmental responsibility been carried out by the
management will give rise to environmental management of the Banjarmasin
costs. As with other business activities, the Islamic Hospital?
responsibility imposed on hospitals for b. Do waste management activities as
environmental problems, such as waste a form of environmental
management activities resulting from responsibility at the Banjarmasin
operational activities, of course incurs Islamic Hospital result in
environmental costs. According to Ikhsan environmental costs in the
(2009), environmental costs are impacts, Banjarmasin Islamic Hospital's
both monetary and non-monetary, that must Financial Report?
be borne as a result of activities that affect
environmental quality. Meanwhile, according Research purposes
to Hansen and Mowen (2017), The main objectives of this research are:
environmental costs can be called a. To reveal and analyze the
environmental quality costs. Environmental implementation of environmental
costs are costs that occur because the responsibility carried out by the
quality of the environment is poor or poor Banjarmasin Islamic Hospital
environmental quality may occur. Thus, through hospital waste management
environmental costs relate to the creation, activities.
detection, improvement, and prevention of b. To reveal the implementation of
environmental degradation. hospital waste management activity
costs and analyze the environmental
Hospital environmental costs are costs that costs incurred for preparing
arise due to hospital operational activities environmental cost reports at the
which can reduce the quality of the Banjarmasin Islamic Hospital.
surrounding environment, namely hospital
waste. The efforts made are not only B. LITERATURE REVIEW
expressed in the form of activities, but are 1. Environmental Ethics Theory
also implemented in the accounting system One theoretical view regarding
so that they can be implemented in a environmental ethics is the theory of
sustainable manner (Swastyakso and ecocentrism. Ecocentrism theory offers
Widodo (2016). Meanwhile, according to an increasingly adequate understanding
Anam and Ramlah (2020), environmental of the environment. Moral concern is
cost reports are very important for expanded to include the entire ecological
environmental cost management for every community, both living and non-living.
company that produces hazardous waste, Ecocentrism is increasingly expanded in
especially in a hospital environment, also deep ecology and ecosophy, which
provides benefits such as good greatly arouses human understanding of
environmental cost management, more the interests of the entire ecological
accurate charging, minimizing environmental community. Deep ecology demands a
new ethic that is not centered on
 humans, but is centered on the whole of environmental functions and prevent
life with efforts to overcome environmental pollution and/or
environmental problems (Ernawan, damage which includes planning,
2007). utilization, control, maintenance,
2. Takeholders (Stakeholder Theory) supervision and law enforcement.
Stakeholders are all parties, internal and c. Sustainable development is a
external, who can influence or be conscious and planned effort that
influenced by the company either directly combines environmental, social and
or indirectly. The success of a economic aspects into development
company's business is determined by strategies to ensure the integrity of
company management which is the environment as well as the
successful in fostering relationships safety, capabilities, welfare and
between the company and its quality of life of present and future
stakeholders. Stakeholder theory states generations.
that companies have a responsibility to According to Law Number 32 of
stakeholders, by carrying out social 2009, Article 13 states that
disclosures (Hadi, 2011). controlling environmental pollution
3. Environment and/or damage consists of 3 things,
According to ISO 14001, the namely, prevention, overcoming and
environment is the surrounding restoration of the environment by
conditions in which an organization applying various instruments,
operates, including air, water, land, namely Strategic Environmental
natural resources, flora, fauna, humans Studies (KLHS), spatial planning,
and their interactions. The environment standards. environmental quality,
in Indonesia is often called the living AMDAL, UKL-UPL, licensing,
environment. Regulations for environmental-based laws and
implementing the environment are regulations, environmental audits,
contained in Law of the Republic of and other instruments in accordance
Indonesia number 32 of 2009 with scientific needs and/or
concerning Environmental Protection developments.
and Management.
4. The Role of AMDAL, UKL & UPL in
According to Law number 32 of 2009 Environmental Management
concerning Environmental Protection AMDAL is the abbreviation of
and Management, the definition of the Environmental Impact Analysis. The
environment is the unity of space with all definition of AMDAL according to the
objects, forces, conditions and living Regulation of the Minister of
creatures, including humans and their Environment of the Republic of
behavior, which influence the continuity Indonesia Number 16 of 2015
of life and the welfare of humans and concerning Guidelines for Preparing
other living creatures. Environmental Environmental Documents, article 1
impact is any change that occurs in the paragraph 1, states that AMDAL is a
environment, whether detrimental or study of large and important impacts for
beneficial, which is wholly or partly decision making of a planned business
caused by the environment and the or activity on the environment which is
organization. necessary for the process. making
decisions regarding the implementation
Some excerpts from the contents of Law of business or activities.
number 32 of 2009 on the environment
include: Some of the functions of AMDAL are as
a. The living environment is the unity of follows:
space with all objects, conditions 1. Regional development planning
and living things. Including humans materials
and their behavior which influences 2. Help processtaking decision
the continuity of life and the welfare to environmental
of humans and other living feasibility of business plans
creatures. and/or activities
b. Environmental protection and 3. Provide input in the preparation
management is a systematic and of detailed technical designs for
integrated effort to preserve business plans and/or activities
 4. Provide input in the preparation processes, systems or facilities important for
of environmental management better management decision making. The
and monitoring plans goal of cost acquisition is how to reduce
5. Providing information to the environmental costs, increase income and
public regarding the impacts improve environmental performance by
resulting from a business plan paying attention to the current situation, the
and/or activity future and potential management costs
(Ikhsan, 2009).
6. The first stage of
recommendations regarding 7. Identify Environmental Costs
business permits Environmental cost quality is an industry
7. Providing Scientific Documents standard technique for evaluating trends in
and Legal Documents full costs in guaranteeing each end product
8. Environmental feasibility permit and customizing services beyond customer
desires (Ikhsan, 2009). Identification of
Benefits of AMDAL for society: environmental costs can be classified into 4
1. Know from the start the impact categories (Hansen Mowen, 2017):
of an activity 1) Prevention costs are costs for activities
2. Implement and enforce controls carried out to prevent the production of
3. Involved in the decision making waste and/or waste that causes
process environmental damage.
2) Detection costs are costs for activities
5. Environmental Management Accounting carried out in determining whether
Environmental management accounting is a products, processes and other activities
sub-system of environmental accounting that in the company meet applicable
explains a number of issues regarding the environmental standards or not.
issue of quantifying a company's business 3) Internal failure costs are costs for
impacts into a number of monetary units. activities carried out due to the
Environmental management accounting can production of waste and rubbish, but not
also be used as a benchmark for disposed of into the external
environmental performance. The USEPA environment.
(1995) definition explains environmental 4) External failure costs are costs for
management accounting as a "process of activities carried out after releasing
identifying, collecting and analyzing waste or rubbish into the environment.
information about costs and performance to External failure costs can be further
assist organizational decision making" divided into realized and unrealized
(Ikhsan, 2009). categories.
5) Realized external failure costs are costs
6. Environmental Costs experienced and paid by the company.
Environmental costs are impacts, both Unrealized external failure costs or
monetary and non-monetary, that occur as a social costs are caused by the company,
result of company activities that affect but are experienced and paid for by
environmental quality. Environmental costs parties outside the company.
basically relate to the costs of products,
 Table 1
Environmental Cost Categories and Activity List
Prevention Activities Internal Failure Activity
 Carry out environmental studies  Maintain pollution equipment
 Recycle products  Obtain a facility license to
produce waste
 Designing processes  Recycle leftover materials
 Audit environmental risks  Process and dispose of toxic waste
 Developenvironmenta  Operatepollution
l management control equipment
system
 Evaluate and select tools to
control pollution
 Evaluate and choose
 supplier External Failure Activity
Detection Activity  Loss of jobs due to pollution (S)

Inspect products and processes  Loss of the benefits of

the lake as a recreation
area (S)
 Verify environmental performance  Loss of sales due to poor
 from the supplier environmental reputation
 Audit environmental activities  Cleaning polluted lakes
 Develop environmental  Clean up spilled oil
performance measures
 Testing for contamination  Cleaning polluted land
 Measuring the level of pollution  Receiving medical
treatment due to air
pollution (S)
 Using raw materials and electricity
 inefficiently
 Resolving personal accident claims
(related to the environment)
 Restoring land to its natural state
 Damage to the ecosystem
due to dumping of solid
waste (S)
Source. Hansen and Mowen, 2017

information regarding the company's

8. Environmental Cost Report profitability and information regarding the
Hansen and Mowen (2017), stated that relative amounts and costs spent for each
environmental cost reports are information category.
related to the relative distribution of
environmental costs which is useful for According to Hansen and Mowen (2017),
improving and controlling environmental environmental cost reporting is important if
performance. A good environmental costs an organization is serious about improving
report provides a breakdown of its environmental performance and
environmental costs by category. Reporting controlling its environmental costs. A good
environmental costs by category will provide first step is a report that provides a
important information for companies, namely breakdown of environmental costs by
information regarding the impact of category. Reporting environmental costs by
environmental costs which provides category provides 2 important results:
1. The impact of environmental costs on
company profitability, and An illustrative example of an environmental
2. The relative amount spent on each cost report at Thamus Corporation can be
category. seen in Table 2 below:

Table 2
Environmental cost report illustration
Thamus Corporation
Environmental Cost Report
for the Year Ended December 31, 2008

Percentag
Environmental Costs eof Cost
Operational
Prevention costs:
- Employee training $600,000
- Product design 1,800,000
- Equipment selection 400,000 $2,800,000 1.40%

Detection cost:

- Process checker $2,400,000

- Size development 800,000 3,200,000 1.60%

Internal failure costs:

- Equipment operation $4,000,000

- Pollution
- Equipment maintenance 2,000,000 6,000,000 3.00%
- Pollution

External failure costs:

- Lake cleaning $9,000,000

- Land restoration $5,000,000
- Claim settlement 4,000,000 18,000,000 9.00 %
- property damage
Total $30,000,000 15.00 %

The Thamus report in the image above hospital is a health service institution
underlines the importance of that provides comprehensive individual
environmental costs by stating them as a health services providing inpatient,
percentage of total operational costs. In outpatient and emergency services" (http
this report, environmental costs are 15 ://hukor.kemkes.go.id, 2019).
percent of total operational costs. This
number seems quite significant. From a According to Law no. 44 of 2009, the
practical standpoint, environmental costs functions of hospitals are:
will receive managerial attention only if 1) Providing treatment and health
they are significant. Hospitals as Health recovery services in accordance with
Service Entities hospital service standards.
2) Maintaining and improving individual
The definition of a hospital based on the health through comprehensive
Regulation of the Minister of Health of second and third level health
the Republic of Indonesia Number 30 of services according to medical
2019 concerning Classification and needs.
Licensing of Hospitals states that: "A
 3) Organizing education and training eutrophication and taste from organic
for human resources in order to chemicals.
increase capabilities in providing 2) Property damage can be caused by
health services. dissolved salts (corrosive, rust), muddy
4) Carrying out research and water and so on which can reduce the
development as well as screening of quality of buildings around the hospital.
technology in the health sector in the 3) Disturbance/damage to plants and
context of improving health services animals can be caused by viruses,
by paying attention to the ethics of nitrate compounds, chemicals,
science in the health sector. pesticides, certain nutrient metals and
phosphorus.
It can be concluded based on the 4) Disturbances to human health can be
definition above, hospitals provide caused by various types of bacteria,
several types of services including viruses, chemical compounds,
medical services, medical support pesticides, and metals such as Hg, Pb,
services, care services, rehabilitation and Cd which come from dentistry.
services, prevention and improvement of 5) Genetic and reproductive disorders.
health, as places for medical education Although the mechanism of interference
and/or training, as places for research is not fully known with certainty, several
and development of science and compounds
technology in the health sector, general 6) can cause disruption or damage to
administration and finance, as well as to genetics and the human reproductive
avoid risks and health problems as system, for example pesticides,
intended, so it is necessary to organize a radioactive materials.
hospital environmental health in
accordance with health requirements Based on RI Minister of Health Regulation
(http://bprs.kemkes.go.id, 2009). No. 7 of 2019 also states that waste
management officers must use personal
9. Hospital Waste protective equipment consisting of
According to Government Regulation (PP) hats/helmets, masks, eye protection, long
no. 12 of 1995, waste is leftover material clothing, industrial aprons, boots and special
from an activity and/or production process. gloves. The influence of hospital waste on
Meanwhile, hospital waste according to the environmental quality and health can cause
Republic of Indonesia Minister of Health various problems (Permenkes RI No. 7,
Regulation Number 7 of 2019 concerning 2019:
Hospital Environmental Health is all waste 1) Comfort and aesthetic disturbances, in
produced from hospital activities in solid, the form of colors originating from
liquid and gas form (RI Minister of Health sediments, solutions, phenol odors,
Regulation, 2019). eutrophication and tastes from organic
chemicals, which cause environmental
10. Characteristics of Hospital Waste aesthetics to become unsightly
Hospital waste is all waste produced by 2) Property damage can be caused by
hospital activities and other supporting dissolved salts (corrosive and rust),
activities. When compared with the activities muddy water and so on which can
of other agencies, it can be said that the reduce the quality of buildings around
types of hospital waste can be categorized the hospital.
as complex. In general, hospital waste is 3) Disturbance/damage to plants and
divided into two large groups, namely animals can be caused by viruses,
medical and non-medical waste, both solid nitrate compounds, chemicals,
and liquid (Permenkes RI, 2019). pesticides, certain nutrient metals and
phosphorus.
11. The Effect of Hospital Waste on the 4) Disturbances to human health can be
Environment and Health caused by bacteria, viruses, chemical
The influence of hospital waste on compounds, pesticides, and heavy
environmental quality and health can cause metals such as Hg, Pb, and Cd which
various problems such as (Silfa, 2013): come from dentistry.
1) Comfort and aesthetic disturbances, in 5) Genetic and reproductive disorders
the form of color originating from 6) Poor hospital waste management will
sediment, solutions, phenol odor, become a good place for disease
vectors such as flies and mice
 7) Work accidents to workers or the public The primary data collection method used in
due to spilled syringes or other sharp this research is:
objects 1) Interview: According to Bungin (2017),
8) The incidence of dengue fever is an interview is often referred to as an
increasing because the disease vector interview, which means obtaining
lives and reproduces in used cans or information for research purposes by
standing water conducting questions and answers face
9) The process of decomposing waste by to face between the interviewer and the
microorganisms will produce certain respondent. In this research, interviews
gases that cause a foul smell as a data collection tool were carried out
10) The presence of flying dust particles will using the in-depth interview method,
interfere with breathing, causing air namely interviews with informants in
pollution which causes disease germs to depth to gather information about data
contaminate medical equipment and related to waste management and costs
hospital food. incurred by the SKL Unit of Banjarmasin
11) If unsanitary hospital waste is burned, Islamic Hospital.
the smoke will disrupt breathing, vision 2) Observation
and reduce air quality. Observation is a data collection method
used to collect research data through
C. RESEARCH METHODOLOGY observation and sensing (Bungin, 2017).
This research is a qualitative descriptive In this research, the researcher used
study. According to Bungin (2017), unstructured observation, that is,
descriptive research is research that observation was carried out without
describes, summarizes various conditions, using an observation guide, that is, there
various situations or various variables that was no need to understand theoretically
arise in society which are problems, then the research object first. Data collected
draws them to the surface as a characteristic using unstructured observation includes
or description of the conditions of certain direct observations related to waste
situations or variables. Qualitative type management at the Banjarmasin Islamic
descriptive research is where data is Hospital.
expressed in the form of words or sentences 3) Documentation
as well as descriptions. Secondary data collection was carried
The research paradigm uses an alternative out by means of manual documentation
approach. The qualitative research design in the SKL Unit environmental cost
used is a case study approach. The expenditure data archive.
qualitative descriptive format of case studies
does not have characteristics like water 2. Research Instrument
(spreading on the surface), but focuses on a According to Bungin (2017) states that the
particular unit of various phenomena. The qualitative research instrument is the
descriptive qualitative case study format is researcher himself so that the reliability,
exploratory research and plays a very validity of measurements and measuring
important role in creating understanding and tools. Reliability and validity are aimed at the
is more appropriate when used to research feasibility and credibility of the researcher.
problems that require in-depth study Measurements and measuring tools in
(Bungin, 2017). qualitative research are respondents and a
list of questions in interviews. Bungin (2017)
1. Method of collecting data also stated that the research instrument is
Data collection is the initial activity carried the researcher himself so he does not need
out by researchers in the field. Researchers a lot of tools. In this research, the researcher
begin conducting research with observations will be the research instrument, namely so
or interviews. According to Bungin (2017), an that the results of the interview can be
important issue in data collection that must recorded properly and the researcher has
be considered is "how it can be ensured or evidence of having conducted interviews
believed that the sample determined is with respondents, supporting instruments are
representative". In collecting data, needed in the form of a recording device and
researchers must be sure that the data photo camera, in this case the researcher
obtained can strengthen the research uses a cellphone.
results. 3. Research subject
The research subjects are informants, that
is, they provide information regarding the
 required data. Research information in 2017). In this research, researchers used a
qualitative research is related to the steps purposive procedure technique. According to
taken by researchers so that data or Bungin (2017), purposive procedures are
information can be obtained (Bungin, 2017). one of the most common strategies for
Research subjects consist of parties involved determining informants in qualitative
in the research. research, namely determining the group of
Determining informants can be done by participants who become informants
researchers if the researcher understands according to selected criteria that are
the general research problem and also relevant to a particular research problem. An
understands the anatomy of the community example of using this procedure is using a
where the research is carried out (Bungin, Key Informant.

Table 3
Key Informant
No Name Gender Position Information
1 Novita Dewi P Kanit. SKL Key
Informant1
2 Bustani L Head of Key
Finance Informant2
3 Siti Adawiah P Inhabitant Key
Informant3
4 Arum Apriliyanti P Inhabitant Key
Informant4
5 Halima P Inhabitant Key
Informant5
Source: Processed by researchers, 2021

The basic key to using this procedure is mastery researchers choose subjects who are involved in
of information from informants and logically, key supporting additional information regarding data
figures in the social process always directly that is considered lacking. The supporting
control the information that occurs in the social informants in this research are:
process. Meanwhile, for Supporting Informants,

Table 4.
Supporting Informant

No Name Gender Positi Information

on
1 Wahyu Hardi L Head of Division Supporting
Cahyono Supervision of Informants1
DLH Banjarmasin
City
2 Irwan Tunija L Head of Supporting
Subdivision. Informants2
Accountancy,
Budget & Finance
3 Djalaluddin L Docto Supporting
r Informants3
4 Fauziah Rezqi P KatimAl Biruni Supporting
Nursing Informants4
5 Mila Patma P Kanit. Training Supporting
Khairina Informants5
6 Humaidi L SKL Unit Staff Supporting
Informants6
7 Sumiati P Al Biruni Supporting
staff Informants7
8 Fahmi H L Janitor Supporting
Informants8
 9 M. Aspihani L Head of RT.15 Supporting
Informants9
10 Ahmad Yasir L Former Chairman of Supporting
RT.15 Informants10
Source: Processed by researchers, 2021
focusing on important relevant things, so
4. Data analysis method that it will be easier to present the data.
Data analysis in qualitative research is 3) Data Display (Data Presentation)
carried out during data collection and after After the data has been reduced, the
data collection has been completed within a next step is to display the data. In
certain period. At the time of the interview, qualitative research, data presentation
the researcher had carried out an analysis of can be done in the form of brief
the interviewee's answers (Sugiyono, 2018). descriptions, charts, relationships
In this research, data analysis uses Miles between categories,
and Huberman in Sugiyono (2018) where flowcharts and the like. The most
activities in qualitative data analysis are frequently used presentation of data in
carried out interactively and continue qualitative research is narrative text. By
continuously until completion, so that the displaying data, it will be easier to
data is saturated. Data analysis activities understand what happened, plan further
carried out include: work based on what has been
1) Data Collection (Data Collection) understood. In this step the researcher
The main activity in every research is tries to compile relevant data so that it
collecting data. In qualitative research, becomes information that can be
data is collected using observation, in- concluded and has written meaning.
depth interviews, and documentation or 4) Conclusion Drawing/Verification
a combination of the three The fourth step in qualitative data
(triangulation). Researchers conducted analysis is drawing conclusions and
direct observations and interviews to verifying. The initial conclusions put
obtain and collect data in the form of forward are still temporary, and will
data regarding the environmental change if strong supporting evidence is
management of the SKL unit of Islamic not found at the next stage of data
Hospital Banjarmasin such as records or collection. However, if the conclusions
expenditure documents related to put forward at the initial stage are
environmental management activities, supported by valid and consistent
SOPs for waste management activities, evidence when the researcher returns to
waste management processes, training the field to collect data, then the
assignment letters, several related conclusions put forward are credible
documents. permits from the conclusions. Conclusions in qualitative
Banjarmasin City Environmental Service, research are new findings that have not
laboratory results reports from the South previously existed. Findings can be in
Kalimantan Provincial Health Laboratory the form of a description or picture of an
and financial reports from the object that was previously dim or dark so
Banjarmasin Islamic Hospital. As well as that after examination it becomes clear.
data related to the impact caused by
Banjarmasin Islamic Hospital waste on D. General Description of Research Locations
the surrounding environment. Islamic Hospital Located in JI. S. Parman
2) Data Reduction (Data Reduction) No. 88 RT. 24, Banjarmasin City, South
Data obtained from the field needs to be Kalimantan. The Banjarmasin Islamic
analyzed through data reduction. Hospital has territorial boundaries, to the
Reducing data means summarizing, north of Jl. S. Parman, to the east of
selecting and sorting the main things, people's houses, to the west of people's
focusing on the important things, looking houses and to the south of Banjarmasin
for themes and patterns. In this way, the Muhammadiyah University. The land area is
data that will be reduced is in approximately 11,350 m2. The 25th regional
accordance with the research problem meeting of the Muhammadiyah leadership of
formulation, and makes it easier for South Kalimantan which was held in Nagara,
researchers to carry out further data Hulu Sungai Selatan Regency which took
collection, and search for it if necessary place on 15-17 April 1968 was a milestone in
so that it will provide a clearer picture in the history of the Banjarmasin Islamic
 Hospital which was established to develop Banjarmasin Islamic Hospital was accredited
the charity business of the association. at the "Prime" Hospital level (KARS) on April
Banjarmasin Islamic Hospital was originally a 20 2017 with the Accreditation Commission
maternity clinic called "Siti Khadijah accreditation certificate number
Maternity Clinic". Based on Notary Bachtiar's KARSSERT/384/V/2017, Islamic Hospital
deed dated 1 March 1972 Number 1/1972, type C. On January 4 2018, Banjarmasin
the Banjarmasin Islamic Hospital is under Islamic Hospital collaborated and provided
the Banjarmasin Islamic Hospital services to patients participating in BPJS
Foundation. In 2005 the Banjarmasin Islamic Health with 4 (four) basic services, namely
Hospital Foundation ended and was directly Internal Medicine, General Surgery,
under the Regional Leadership of Gynecology and Obstetrics, and Children.
Muhammadiyah South Kalimantan.
1. Organizational Structure of Banjarmasin
The Banjarmasin Islamic Hospital last Islamic Hospital
received permission from the Banjarmasin Banjarmasin Islamic Hospital is led by a
City Health Service dated January 22 2018 Director who is assisted by two Deputy
number 503/524/SIOT/RSUS-I/Il-18-DISKES Medical Directors. During the course of the
concerning Permanent Operational Permits Banjarmasin Islamic Hospital in its service,
for Private Public Hospitals, Head of the the position of director underwent several
Banjarmasin City Health Service. changes, namely as follows
Table 5.
Banjarmasin Islamic Hospital Staffing
No. Name Length of
service
1 Dr. H. Abu Hanifah, MPH 1974-1984
2 Dr. H. Mochlan Aham DTMH 1984-1994
3 Drg. H. Muhammad Asj'ari 1994-2001
4 Dr. H. Abimayu, Sp. PD., 2001-2003
KGEH
5 Dr. H. Hasan Zain, Sp. P 2004-2009
6 Dr. H. Mohamad Isa, Sp. 2009-2014
7 Dr. Hj. Rafiqoh 2014-2019
8 Drg. Hj. Eva Ariyani 2019-Present
Source.Banjaramasin Islamic Hospital in 2021

The owner of the Banjarmasin Islamic Hospital is specialist service facilities. As shown in the
the Regional Leader of Muhammadiyah South following table:
Kalimantan. Built by Drg. Hj. Eva Ariyani Director
of Banjarmasin Islamic Hospital.

2. Vision, Mission and Motto

The vision is to realize the Banjarmasin
Islamic Hospital as a professional, high-
quality hospital that is the choice and pride of
the community.
The mission, namely the Banjarmasin
Islamic Hospital, was established to provide
public health services, helping patients to
obtain physical and spiritual health as well as
serving as a medium for Islamic preaching.
Motto "CINTA" C: Fast in service I: Islamic in
service N: Comfortable for customers T:
Right in action A: Safe and high quality

3. Types of Services at Banjarmasin Islamic

Hospital
So far, Banjarmasin Islamic Hospital
provides various types of services consisting
of general service facilities, general service
facilities, supporting service facilities and
 Table 6
Types of services at the Banjarmasin Islamic Hospital
No. Service Kind of service
a. General
b. Tooth
c. Other Specialists
1) Pediatric Specialist
1 Outpatient Facilities 2) Lung Specialist
3) ENT Specialist
4) Obstetrics and Gynecology Specialist
5) Urology Specialist
6) Neurologist
7) Internal Medicine Specialist
8) Skin and Venereology Specialist
9) General Surgery Specialist
10) Physical and Rehabilitation Specialist
a. Pediatric Specialist
2 BPJS Service b. Obstetrics and Gynecology Specialist
Specialist
c. Internal Medicine Specialist
d. General Surgery Specialist

a. Surgeon Specialist
b. Internal Medicine Specialist
c. Pediatrician
d. Ob-gyn specialist
e. Radiology Specialist Doctor
f. Anaesthesiologist
g. Clinical Pathology Specialist Doctor
3 Specialist Inpatient
Services
h. Psychiatric Specialist
i. Ophthalmologist
j. ENT Specialist Doctor
k. Skin and Venereology Specialist
l. Cardiology Specialist Doctor
m. Lung Specialist Doctor
n. Neurologist
o. Neurosurgeon Specialist
p. Orthopedic Surgeon Specialist
q. Orology Specialist Doctor
r. Medical Rehabilitation Specialist
Doctor, Anatomical Pathology
Specialist Doctor
Source.Banjarmasin Islamic Hospital in 2021

4. General Description of Accounting and The development of hospital dynamics, the

Financial Reporting Activities at Banjarmasin very rapid development of medical
Islamic Hospital technology, changes in payment pattern
policies from fee for service to pre-payment
and demands for quality health services
require that hospitals can always provide The aim of preparing this guidebook is that it
evidence of high performance accountability can be used as a reference and
to stakeholders so that resource implemented well by the Banjarmasin
management is needed effectively. Islamic Hospital in financial management, so
transparent, effective and efficient in that the financial management pattern at the
accordance with the principles of good Banjarmasin Islamic Hospital can be
corporate governance. As a form of managed by applying the principles of
accountability for the management of healthy, standardized, productive practices
managed resources, hospitals must create and reporting can be done. consolidated
financial management guidelines to ensure down to the central level by the
the level of soundness and reliability of associations.
financial reports prepared by the Financial reports must disclose all
Muhammadiyah and Aisyiyah Health components that are material enough to
Business Charities. One effort to increase influence management evaluations or
accountability in hospital financial decisions. Financial reports must be clear
management is by creating comprehensive and understandable, based on accounting
guidelines and standards. For this reason, policies. The accounting policies at
the Muhammadiyah Central Leadership Banjarmasin Islamic Hospital are:
Community Health Development Council 1) Policy on cash and cash equivalents
(MPKU) collaborated with the UMY MMR 2) Policy on trade receivables
Team to prepare Hospital Financial 3) Policy on other receivables
Management Guidelines, namely Guidebook 4) Policy on down payments
6 concerning Accounting Policies and 5) Inventory policy
Hospital Financial Reports. 6) Corporate tax/income installment policy
7) Environmental Health Sanitation Unit at the
8) Fee policy is paid in advance Banjarmasin Islamic Hospital as Key
9) Income policy that will still be accepted Informant 1 regarding operational waste
10) Fixed asset policy produced by the Banjarmasin Islamic
11) Deferred load policy Hospital. Following are some excerpts from
12) Fixed asset policy under construction the interview:
13) Inventory policies don't work
14) Security deposit policy "The waste produced at this Islamic hospital
15) Current liability policy is solid waste and liquid waste. Well, solid
16) Long-term liability policy waste is in solid form while liquid waste is in
17) Equity policy liquid form. There is solid waste, both
18) Deferred and current tax policies medical and non-medical. "Medical solid
19) Income policy waste comes from medical activities, for
20) Expense policy example infectious waste, sharp objects and
needles, pharmaceuticals, chemicals" (Key
21) The financial reports of the Banjarmasin Informant 1).
Islamic Hospital consist of business
results reports, balance sheets, changes “…while non-medical solid waste is a type of
in equity reports, cash flow reports, waste generated from hospital services.
explanatory notes to financial reports. Non-medical solid waste is further divided
into organic waste and non-organic waste.
Structurally, the owner is Muhammadiyah. "For example, leaves, paper, plastic waste,
For financial reporting, it continues to the rice wrappers or leftover food from visitors
owner through the central representative of or kitchen activities" (Key Informant 1).
the Muhammadiyah Regional Leadership
(PWM) and the representative of the “…infectious waste is waste that is
Muhammadiyah Regional Leadership is the contaminated with pathogenic organisms
Daily Executive Board (BPH). Description of that can infect other people
operational waste at the Banjarmasin need receptacle special in
Islamic Hospital. Results of in-depth management" (Key Informant 1).
interviews with the Head of the
"... sharps and needle waste comes from all 2. Non-medical solid waste is a type of
medical activities in the hospital" (Key waste generated from hospital services.
Informant 1). Non-medical solid waste includes
organic waste and non-organic waste.
"...pharmaceutical waste means waste from For example, leaves, paper, plastic
medicines that are no longer used, for waste, rice wrappers or leftover food
example expired medicines and it could also from visitors or kitchen activities.
be that the medicine has been opened in 3. Liquid waste is liquid waste that is
packaging so it is contaminated and can no included in the infectious waste
longer be used, so it is waste" (Key category, such as blood waste
Informant 1). originating from laboratory activities or
pathology waste, surgical activities,
"... chemical waste is from the use of delivery rooms that are in contact with
chemicals in medical and laboratory patients that contain bacteria or viruses.
procedures, heavy metal means waste from Liquid waste which is included in the
metals used in chemical management from domestic waste category comes from
laboratories for medical purposes" (Key household waste such as from washing
Informant 1). curtains, bolster pillowcases, bed
sheets, used washing water.
"... for liquid waste, some are included in the hands and water from the bathroom
infectious waste category, such as blood containing soap. Liquid waste needs
waste originating from laboratory activities special handling because it can cause
or pathology waste, surgical activities, an unpleasant odor and quickly spread
delivery rooms that are in contact with disease, especially if it is not treated
patients that contain bacteria or viruses" first, it can endanger the surrounding
(Key Informant 1). community.

“…it could also be liquid waste from water According to the Republic of Indonesia
used for washing hands, water from Minister of Health Regulation no. 7 of 2019
bathrooms, water from laundry such as cloth explains that hospital waste is all waste
from the hospital environment such as produced from hospital activities in solid,
curtains, bolster pillowcases, bed sheets liquid and gas form.
and others. "Liquid waste can also damage Results of in-depth interviews with cleaning
the environment because it contains soap staff at the Banjarmasin Islamic Hospital as
and substances that are not good for the supporting informant 8 regarding solid waste
environment" (Key Informant 1). management. The following are excerpts
from the interview:
“…liquid waste needs to be handled "There has never been any special
specifically because it can cause an housekeeping training for hospitals, taught
unpleasant odor and quickly spread only from the SKL unit" (supporting
disease, especially if it is not treated first, it informant 8)
can endanger the surrounding community.
"At the Islamic Hospital there is a Waste “…here we work in 3 shifts, namely morning,
Water Treatment Plant or IPAL facility to afternoon and evening shifts. "For our duties
neutralize liquid waste" (Key Informant 1). here we clean the hospital environment, for
example cleaning patient rooms, rooms,
Based on the results of in-depth interviews gardens, pools and collecting waste"
with the Head of the Environmental Health (supporting informant 8)
Sanitation Unit as Key Informant 1, the
waste generated from operational activities “...the waste location varies according to the
of Banjarmasin Islamic Hospital is: type. Medical waste is yellow and non-
1. Medical and non-medical solid waste. medical waste is black" (supporting
Medical solid waste is waste generated informant 8)
from medical activities. Examples of
medical solid waste are: Results of observations and interviews with
employee staff at Banjarmasin Islamic
Hospital as supporting informants 7. The hope that there will be some kind of banner
following are excerpts from the interview: related to the SOP posted so that it can be
"I have worked as a nurse assistant for 17 seen by many people" (supporting informant
years, my daily job is to maintain patient 4)
hygiene" (supporting informant 7) "This was coordinated by the SKL unit with
"...there is, usually it's pampers waste, used us (supporting informant 4)"
sanitary napkins from patients after giving
birth" (supporting informant 7) "I once took part in training related to liquid
waste such as blood dripping, so I used a
"...it is differentiated, there are special tool called a skillkit, even though the tool
places, for example the waste used by was complete with procedures for using and
patients after giving birth is placed in the handling it, but at the time of the incident
yellow bag infectious waste area, if there is here, there was blood dripping in the
no blood it is just put in the normal rubbish patient's room, instead the cleaners were
bin" (supporting informant 7) called" (supporting informant 4)

"...no, because it's guaranteed, because the Based on the results of observations,
waste is differentiated according to the type interviews and documentation related to the
of waste" (supporting informant 7) medical solid waste management process at
the Banjarmasin Islamic Hospital, it is in
"...there is, when you want to get accordance with applicable regulations,
accreditation, you are always reminded to namely the Republic of Indonesia Minister of
separate the waste" (supporting informant 7) Health Regulation Number 7 of 2019
concerning hospital environmental health
The results of an in-depth interview with an which explains that every hospital must
official doctor who works at the Banjarmasin manage and supervise medical waste
Islamic Hospital as a supporting informant 3. starting from collection. , transportation and
The following are excerpts from the destruction must undergo certification from
interview: the competent authority
"There is no SOP related to waste
management. I know that yellow bags are However, non-medical solid waste is still not
for medical waste and black bags are for optimal because it is not in accordance with
non-medical waste. It is very important for the Republic of Indonesia Minister of Health
there to be an SOP related to waste Regulation Number 7 of 2019 concerning
management because so far there have hospital environmental health. This is proven
been none" (supporting informant 3). by several findings, namely:
1) For the container stage, there are
This is also in line with the results of an in- several trash cans for non-medical
depth interview with a Head of the Nursing waste containing black bags that don't
Team working at the Banjarmasin Islamic have lids and are left open, even though
Hospital as a supporting informant 4. Here based on Minister of Health Regulation
are some excerpts from the interview: Number 7 of 2019 Chapter III, it is stated
"Regarding waste management, especially that damaged trash cans must be
waste products, both medical solid waste replaced with trash cans that meet the
and non-medical solid waste, it is usually requirements.
communicated to us from the SKL Unit, but 2) For the storage stage at the TPS, it was
the SOP itself has never been seen also found that not all domestic solid
displayed in hospitals or posted. waste was wrapped in black plastic bags
In my opinion, the SOP regarding waste but was scattered at the bottom of the
products from activities in the hospital is TPS floor because based on Minister of
very important, because I have found Health Regulation Number 7
visitors throwing non-medical waste into the 3) In 2019, CHAPTER III explained that
medical waste bin, we often remind them. domestic solid waste that had been
Usually there are also doctors who throw placed in TPS was guaranteed to
away things incorrectly, for example remain wrapped in black plastic bags
throwing away handscoons to brokers. "I
 and the contents were prohibited from parameters does not exceed the
being disassembled. specified quality standard thresholds.
4) And for sorting efforts, it was also found 5) The wastewater disposal permit expired
that there were organic solid waste and in 2019 and there has been no
inorganic solid waste that were not extension until now. This is also not in
sorted in accordance with Minister of accordance with the Regulation of the
Health Regulation Number 7 of 2019 Governor of South Kalimantan Number
CHAPTER III which explains that sorting 36 of 2008. Seventh Point concerning
is carried out by separating organic and Amendments to the Regulation of the
inorganic waste types. Governor of South Kalimantan Number
04 of 2007 concerning Liquid Waste
Meanwhile, for liquid waste there are also Quality Standards for industrial, hotel,
several findings such as: restaurant, hospital, domestic and
mining activities, namely stating that the
1) The availability of Waste Water period The waste water disposal permit
Management Installation (IPAL) facilities is valid for 1 year.
is available but does not yet meet the
requirements set by the Indonesian 5. Description of operational cost data for
Ministry of Health in 2011 concerning environmental management at Banjarmasin
Technical Guidelines for Waste Water Islamic Hospital.
Treatment Installations Chapter 1, Based on a preliminary study conducted
namely the technical requirements for previously, operational cost data for
waste water treatment installations with environmental management of the SKL unit
anaerobic aerobic biofilter systems in at Banjarmasin Islamic Hospital is as
health service facilities including follows:
planning. , building layout, operational The results of a manual documentation
and maintenance systems in wastewater study by researchers on archival data on
treatment installations, anaerobic environmental management costs turned out
aerobic biofilter systems in health to be greater than the data during the
service facilities. Meanwhile, what the preliminary study, this is because the
Banjarmasin Islamic Hospital currently payment for workers for environmental
owns is a domestic IPAL, not a medical management such as SKL unit employees
IPAL. and cleaners is included in the salary
2) Lack of coordination between related expense account and for training activities
units, especially waste producers and carried out. has been followed by SKL unit
waste managers. employees into the general administration
3) The unavailability of special personnel to expense account. Revealed environmental
maintain the IPAL means that when cost data from the results of manual
damage occurs to the IPAL, no one can documentation studies is presented in the
repair it except through consultant following table:
services for the IPAL.
4) Laboratory results show that the quality Results of in-depth interviews with Head of
standard value exceeds the Subdivision. Accounting, Budget and
environmental quality standard value Finance of Banjarmasin Islamic Hospital as
threshold. This means that it is not in supporting informant 2. The following is an
accordance with South Kalimantan excerpt from the interview:
Governor Regulation Number 36 of "We include the salaries of environmental
2008. Third Point Concerning management workers, such as the salaries
Amendments to South Kalimantan of SKL unit employees and cleaning officers,
Governor Regulation Number 04 of into the salary expense and cleaning
2007 concerning Liquid Waste Quality expense accounts" (supporting informant 2)
Standards for industrial activities, hotels,
restaurants, hospitals, domestic and "...and the costs incurred by SKL unit
mining which states that water waste employees related to training on
that comes out of the IPAL point for environmental management are included in
the administrative and general expense classified as some that are environmental
account" (supporting informant 2) and some that are not. Among the types of
environmental costs that are potentially
Based on the results of in-depth interviews hidden from managers, such as direct labor
with the Head of Subdivision. Accounting, costs related to the environment and
Budgeting and Finance can be concluded administrative costs, are piled on general
that information on costs related to the and hidden costs, such as monitoring,
environment is often hidden in indirect costs reporting and training costs related to
such as what happened at Banjarmasin environmental management.
Islamic Hospital, namely included in salary
expenses, cleaning expenses and general Identify environmental costs in the
administration expenses. According to operational costs report for the SKL Unit at
Ikhsan (2009), the limitations of conventional Banjarmasin Islamic Hospital
management accounting systems and
practices make it more difficult to effectively Environmental cost report in the
collect and evaluate data related to the environmental cost report at the SKL Unit of
environment. Cost information related to the Banjarmasin Islamic Hospital
environment is often hidden in indirect costs. The results of the interview with the Head of
There are many potentially important Finance as Key Informant 2, below are
examples related to the allocation of excerpts from the interview:
environmental costs. These costs are often
carelessly hidden in accounting records. "The environmental costs incurred by the
SKL unit have so far been included in the
There is careless withholding of information asset maintenance expenses group, in the
regarding environmental costs that is financial reports they are in the SHU report.
misplaced on indirect costs rather than So so far there has never been a special
directly on the processes or products that report for environmental costs" (Key
create the costs. This practice can create Informant 2).
problems if a manager does not know where
to look for the necessary cost information so The environmental cost report applied for
that it can obscure fixed costs that are 2019 and 2020 as an internal report at the
difficult to reduce and variable costs that can SKL Unit of Banjarmasin Islamic Hospital
be reduced or prevented by environmental based on Hansen and Mowen's (2017)
management (Ikhsan, 2009). According to environmental cost theory is expressed as
Ikhsan (2009) also explains that some costs follows:
are included in the gray zone or may be
 Table 6
Environmental Cost Report for Banjarmasin Islamic Hospital 2019 SKL Unit
Banjarmasin Islamic Hospital
Environmental Cost Report
for the Year Ended December 31, 2019

Percentage
Environmental of
Costs Operational
Costs
Prevention Costs:
Labor costs for waste management 457,180,000
Costs of purchasing materials for waste 1,322,500
management
UKL UPL environmental document costs 10,000,000
Cost of purchasing live flowers 150,000
Waste training costs 64,000
Pool cleaning costs 1,024,000
Park cleaning and tree removal costs 390,000
Amount of Prevention Costs 470,130,500 40
.2
4
%
Detection Cost:
Wastewater and RO HD sample inspection 7,834,000
fees
Air emission test inspection costs 9,557,000
Cost of hospital eye examination 17,370,000
Amount of Detection Costs 34,761,000 2.
9
7
%
Internal Failure Costs:
Non-medical waste transportation costs 30,250,000
Costs for transporting and destroying 633,189,000
medical waste
Total Internal Failure Costs 663,439,000 56
.7
9
%
External Failure Costs:
Total External Failure Costs 0
Total Environmental Costs 1,168,330,500 10
0.0
0%
(Data processed by researchers, 2021)
 Table 7
Environmental Cost Report for Banjarmasin Islamic Hospital 2020 SKL Unit
Banjarmasin Islamic Hospital
Environmental Cost Report
for the Year Ended December 31, 2020

Percentage
Environmental of
Costs Operatin
g costs
Prevention Costs:
Labor costs for waste management 459,724,500
Costs of purchasing materials for waste 4,430,000
management
Waste training costs 96,000
Credential test training costs 300,000
Pool cleaning costs 250,000
Park cleaning fees 490,000
Amount of Prevention Costs 465,290,500 34.77%
Detection Cost:
Wastewater and RO HD sample inspection fees 8,824,000
Costs for laboratory health analysis and 5,330,000
sampling
Cost of hospital eye examination 6,838,000
Amount of Detection Costs 20,992,000 1.57%
Internal Failure Costs:
Non-medical waste transportation costs 39,150,000
Costs of purchasing IPS goods for 1,120,000
repair and maintenance
Cost of purchasing goods for the WWTP 2,826,300
flowmeter
Costs for transporting and destroying medical 808,746,600
waste
Total Internal Failure Costs 851,842,900 63.66%
External Failure Costs:
Total External Failure Costs 0
 Total Environmental Costs 1,338,125,400 100.00%
(Data processed by researchers, 2021)

In both reports, researchers have grouped increase in costs was due to the
each cost according to its activity. It can Banjarmasin Islamic Hospital receiving
be seen that the total environmental costs Covid patients during the 2020 pandemic
incurred by the Banjarmasin Islamic so that the waste produced from the
Hospital in 2019 amounted to IDR Covid room, whether medical or non-
1,168,330,500,- and in 2020 it amounted medical waste, was treated. as covid
to IDR 1,338,125,400,-. waste. Furthermore, there are costs
The costs with the highest level of incurred for prevention and detection
expenditure are found in internal failure activities. It was recorded that the total
activities. It was recorded that in 2019, the costs incurred for prevention activities
total prevention costs for the Banjarmasi were IDR 470,130,500 in 2019 and IDR
Islamic Hospital were IDR 663,439,000,- 465,290,600 in 2020. Meanwhile,
and in 2020 it was recorded at IDR detection activities amounted to IDR
851,842,900,-. There was an increase in 34,761,000 for 2019 and IDR 20,992,000
internal failure costs of IDR 188,403,900,- for 2020. Finally, the recorded external
in 2020 compared to 2019. failure costs incurred were nil due to the
absence of activities or events that could
Results of interviews with the Head of the be categorized as external failures.
Environmental Health Sanitation Unit as
Key Informant 1 and the Head of Finance Relative Distribution of Environmental
as Key Informant 2, below are excerpts Costs at the Banjarmasin Islamic Hospital
from the interview: Based on Islamic Hospital environmental
"In 2020, during the pandemic, the cost report data
amount of waste increased because our Banjarmasin which researchers have
hospital received Covid patients, previously made, a comparison of the
regulations in state hospitals were relative distribution between the
overloaded so that private hospitals, like it environmental costs of the Banjarmasin
or not, had to provide inpatient care for Islamic Hospital in 2019 and 2020 can be
Covid patients" (Key Informant 1) made.
The definition of relative distribution is a
"If it is in the Covid room, both medical percentage number that explains the
and non-medical waste is still treated as amount of data in a particular group.
Covid waste Comparisons will be made according to
cost activities.
Based on the results of interviews with the The following is a table that presents the
Head of the Environmental Health relative distribution of environmental costs
Sanitation Unit and the Head of Finance at the Banjarmasin Islamic Hospital:
at the Banjarmasin Islamic Hospital, the
Table 8
Relative Distribution of Environmental Costs at Banjarmasin Islamic
Hospital
Cost Activity % Towards Environmental Costs
2019 2020
Prevention 40.24 34.77
% %
Detection 2.97% 1.57%
Internal Failure 56.79 63.66
% %
External Failure 0% 0%
Total 100% 100%
(Data processed by researchers, 2021)
Relative Distribution of Environmental 1) Theoretically, hospitals as institutions
Costs in 2019 Describes the relative or institutions operating in the health
distribution of environmental costs in 2019 sector have a fairly large and
according to cost activities. The total significant role in protecting the
environmental costs incurred by the environment. If medical waste
Banjarmasin Islamic Hospital in 2019 produced by hospitals is not managed
were IDR 1,168,330,500,- consisting of: properly, it can result in a polluted
1) Prevention costs with a ratio of environment. In its activities, every
40.24% of total environmental costs. hospital produces waste which is
The costs incurred for this prevention classified as hazardous waste,
cost are IDR 470,130,500.-. especially medical waste. It cannot be
2) Detection costs with a relative denied that hospitals really need to
distribution ratio are 2.97% of total implement good environmental
environmental costs. The costs management. Environmental
incurred for detection costs were IDR management accounting is
34,761,000. predominantly related to providing
3) Internal failure costs with a relative information for internal decision
distribution ratio are 56.79% of total making. The application of
environmental costs. The costs environmental costs according to
incurred for internal failure costs were Hansen and Mowen's theory is based
IDR 663,439,000. on 4 categories of activity costs,
4) External failure costs with a relative namely, prevention costs, detection
distribution ratio of 0% of total costs, internal failure costs, external
environmental costs. There are no failure costs, which can be applied in
costs incurred for these two costs. agencies. Hospitals, especially the
5) Internal failure costs with a relative Banjarmasin Islamic Hospital.
distribution ratio are 63.66% of total 2) Practically, the results of this research
environmental costs. The costs are used as input for hospital
incurred for internal failure costs agencies that reporting environmental
amounted to IDR 851,842,900.-. costs can provide an overview of the
6) External failure costs with a relative costs incurred as a result of
distribution ratio of 0% of total environmental management activities
environmental costs. There are no so that the information conveyed,
costs incurred for these two costs. especially expenditures in the SKL
unit of Banjarmasin Islamic Hospital,
Based on this information, it is hoped that can be clearly seen for convenience.
it can reduce the impact of environmental in the managerial decision making
damage (waste). This is in line with the process at Banjarmasin Islamic
application of the expanded theory of Hospital.
ecocentrism in deep ecology which
demands a new ethic that is not centered Research Limitations
on humans, but is centered on the whole This research was carried out in
of life with efforts to overcome accordance with ethical research
environmental problems and the considerations, however, in its
importance of harmony between the implementation there were limitations,
surrounding environment and the namely:
activities of an agency in this research, 1. The financial report for the
namely hospitals. .Implications of Banjarmasin Islamic Hospital cannot
Research Results be presented in this research
because the report is internal and
Based on the results of this research, the confidential. So researchers can only
following theoretical and practical present details of the environmental
implications can be stated: costs at the Banjarmasin Islamic
Hospital.
 2. The focus of the research data is only 3. Repair damaged IPAL because the
2019 and 2020, and waste quality standard value has exceeded the
management data in 2021 during the environmental quality standard threshold
Covid-19 pandemic has not been set by the Indonesian Ministry of Health
included. because if it is not immediately repaired
the liquid waste management process
E. CLOSING will be disrupted and could endanger the
Conclusion surrounding environment and change
the system from a domestic IPAL to a
Based on the results of the research and wastewater treatment plant specifically
analysis that researchers have carried out, for B3 waste because It is true that
several conclusions have been drawn as health service facilities, especially
follows: hospitals, must use medical IPAL.
1. Waste management activities as a form 4. Extending the waste water disposal
of environmental responsibility carried permit because by extending the permit,
out by the management of the Islamic Hospital as a business entity has
Banjarmasin Islamic Hospital in the form implemented the principles of obedience
of non-medical solid waste are still not and compliance with environmental
optimally carried out, likewise liquid management.
waste management in terms of Waste 5. Additional SKL unit staff with a minimum
Water Management Installation (IPAL) educational background of DIII
equipment does not meet the Environmental Health and additional
predetermined requirements, namely it staff specifically for environmental
does not have Special medical engineering personnel for maintenance
wastewater treatment plant with an of the IPAL, so that if damage occurs it
anaerobic aerobic biofilter system but can be immediately repaired because
only domestic wastewater treatment the IPAL is a Hospital Asset that must
plant. be maintained.
2. Environmental costs arising from waste
management activities in the financial
reports of the Banjarmasin Islamic
Hospital found that there were
environmental costs hidden from the
actual environmental costs in the
financial reports.
Suggestion
Based on the conclusions that researchers
have summarized, suggestions that
researchers can give:
1. Banjarmasin Islamic Hospital should
apply environmental costs according to
the theory of Hansen and Mowen (2017)
with four categories of activity costs
because it is very easy to apply in
hospital institutions.
2. Management of non-medical solid waste
in terms of containerization, storage and
separation must refer to Minister of
Health Regulation No. 7 of 2019
concerning the health of the Hospital
Environment.
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