BLU (Public Service Agency) is one of the NPM (New Public Management) instruments which has the idea of ??adopting the private sector into the public sector. BLU has a goal to improve services to the community economically, effectively and efficiently by implementing sound business practices and reforming public management that is bureaucratic, inefficient and less service and performance oriented. The focus of this research was carried out at the Padang Pariaman District Health Center which had been inaugurated using PPK-BLUD since the issuance of Padang Pariaman Regent Regulation No. 39 of 2018 concerning Financial Management of Regional Public Service Agencies in December 2018. The purpose of this research is to find out the motives behind the parties involved in disclosing the determination of the status of BLU Puskesmas and to find out the organizational and cultural structure design practices after being designated as BLU Puskesmas. The primary data collection method uses research instruments in the form of field observations and interviews with informants. The results of the study found that the background to the formation of the BLUD puskesmas was due to pressure from the authorities where the puskesmas was sheltered, both internally and externally from the puskesmas, giving rise to various reactions of puskesmas innovations to fulfill better health services from various sides. (2) The form of organizational and cultural structure design practices after being designated as BLUD Puskesmas is the discovery of the concept of private culture for Puskesmas members consisting of professionalism and entrepreneurship, ease of management and financial realization which has an impact on continuity of activities and improvement of service quality as well as guidance and supervision from various parties towards the implementers of the BLUD Puskesmas. However, there are several obstacles, namely multiple positions, the incompatibility of the executor's character with the objectives of the BLU concept and activities that are only carried out for accreditation management formalities and after that are only adjusted.

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Highlights Endometriosis surgery decreased dyspareunia during 6 months follow up. No difference outcome between excision surgery and ablation surgery. Removal posterior nodules should be performed by experienced operators. The minimal requirement is knowledge about retroperitoneal anatomy.