Latar Belakang: Waktu tunggu radioterapi merupakan salah satu indikator mutu penting dalam pelayanan onkologi karena keterlambatan memulai terapi dapat memengaruhi luaran klinis, pengalaman pasien, dan mutu layanan rumah sakit. RS Hermina Bekasi mengalami peningkatan kebutuhan layanan radioterapi yang tidak sepenuhnya diimbangi oleh kapasitas pelayanan sehingga menimbulkan antrean dan waktu tunggu yang panjang. Penelitian ini bertujuan menganalisis penerapan Lean Six Sigma dalam mengurangi waktu tunggu radiasi pertama di RS Hermina Bekasi. Metode: Penelitian menggunakan desain operational research dengan pendekatan mixed methods explanatory sequential. Pengumpulan data kuantitatif dilakukan melalui time-motion study terhadap pasien BPJS dengan seluruh diagnosis kanker yang menjalani pelayanan radioterapi sejak konsultasi dokter onkologi radiasi hingga radiasi pertama. Sampel terdiri atas 55 pasien periode pre-intervensi, 55 pasien periode post-intervensi, dan 50 pasien periode control. Data kualitatif diperoleh melalui observasi, telaah dokumen, wawancara, dan Focus Group Discussion. Analisis dilakukan menggunakan pendekatan Lean Six Sigma melalui tahapan DMAIC (Define, Measure, Analyze, Improve, Control), pemetaan alur proses, Value Stream Mapping, identifikasi aktivitas value added dan non-value added, analisis Pareto, Five Whys, serta Statistical Process Control. Hasil: Sebelum intervensi, total lead time pelayanan radioterapi mencapai 70,05 hari, dengan waktu terpanjang pada tahap konsultasi dokter onkologi radiasi hingga CT Simulator sebesar 61,44 hari. Aktivitas value added sebesar 5,87 hari (8,38%), sedangkan aktivitas non-value added sebesar 64,18 hari (91,62%). Waste dominan adalah waiting, terutama menunggu jadwal CT Simulator akibat keterbatasan kapasitas layanan dan ketersediaan slot LINAC. Intervensi yang dilakukan meliputi penambahan LINAC kedua, penambahan dokter spesialis onkologi radiasi, pengembangan dashboard monitoring antrean radioterapi terintegrasi SIMRS, perbaikan SPO penjadwalan pasca CT Simulator menggunakan kartu kontrol pasien, serta standarisasi pelaksanaan PSQA sebelum radiasi pertama. Setelah intervensi, total lead time menurun menjadi 31,05 hari, sedangkan pada tahap control menurun lebih lanjut menjadi 19,60 hari. Aktivitas value added meningkat menjadi 6,15 hari (19,81%) dan aktivitas non-value added menurun menjadi 24,88 hari (80,13%). Hasil control chart menunjukkan variasi proses yang lebih stabil dibandingkan sebelum intervensi. Kesimpulan: Penerapan Lean Six Sigma mampu mengurangi waktu tunggu radiasi pertama dan meningkatkan efisiensi alur pra-terapi radioterapi di RS Hermina Bekasi. Perbaikan terutama terjadi pada tahapan konsultasi hingga CT Simulator sebagai bottleneck utama pelayanan. Kombinasi peningkatan kapasitas, standarisasi proses, penguatan sistem monitoring, dan pengendalian berkelanjutan terbukti efektif dalam mendukung pencapaian indikator mutu prioritas rumah sakit berupa waktu tunggu radiasi pertama ≤30 hari.

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Background: Waiting time for radiotherapy is an important quality indicator in oncology services because delays in treatment initiation may adversely affect clinical outcomes, patient experience, and hospital service quality. Hermina Bekasi Hospital has experienced increasing demand for radiotherapy services that has not been fully matched by service capacity, resulting in long waiting lists and prolonged waiting times. This study aimed to analyze the implementation of Lean Six Sigma in reducing waiting time to first radiation treatment at Hermina Bekasi Hospital. Methods: An operational research design with a mixed-methods explanatory sequential approach was employed. Quantitative data were collected through a time-motion study involving BPJS-insured patients with all cancer diagnoses undergoing radiotherapy services from radiation oncology consultation to first radiation treatment. The study included 55 patients in the pre-intervention phase, 55 patients in the post-intervention phase, and 50 patients in the control phase. Qualitative data were obtained through observation, document review, interviews, and focus group discussions. Data were analyzed using the Lean Six Sigma DMAIC framework, process mapping, Value Stream Mapping, value-added and non-value-added analysis, Pareto analysis, Five Whys analysis, and Statistical Process Control. Results: Before the intervention, total radiotherapy service lead time was 70.05 days, with the longest delay occurring between radiation oncology consultation and CT simulation (61.44 days). Value-added activities accounted for 5.87 days (8.38%), while non-value-added activities accounted for 64.18 days (91.62%). The dominant waste was waiting, particularly for CT simulation scheduling, primarily caused by limited service capacity and LINAC slot availability. Interventions included the addition of a second LINAC, recruitment of an additional radiation oncologist, development of a radiotherapy queue monitoring dashboard integrated with the hospital information system, revision of post-CT simulation scheduling procedures using patient control cards, and standardization of PSQA implementation before first radiation treatment. Following the intervention, total lead time decreased to 31.05 days and further decreased to 19.60 days during the control phase. Value-added activities increased to 6.15 days (19.81%), while non-value-added activities decreased to 24.88 days (80.13%). Control chart analysis demonstrated improved process stability compared with the pre-intervention period. Conclusion: Lean Six Sigma implementation successfully reduced waiting time to first radiation treatment and improved the efficiency of the radiotherapy pre-treatment process at Hermina Bekasi Hospital. The most substantial improvement occurred in the consultation-to-CT simulation stage, which was identified as the primary service bottleneck. A combination of capacity expansion, process standardization, monitoring system enhancement, and continuous control proved effective in supporting the hospital’s priority quality indicator of maintaining waiting time to first radiation treatment within 30 days.