Pelayanan rawat jalan merupakan pintu masuk pelayanan rumah sakit yang menentukan mutu, kontinuitas, kepuasan pasien, dan kinerja operasional rumah sakit. Pada Rumah Sakit Tonggak Husada, pelayanan rawat jalan menunjukkan indikasi belum efisien, ditandai oleh penurunan kunjungan pasien, waktu tunggu pelayanan yang panjang, serta peningkatan biaya operasional yang tidak sebanding dengan pendapatan. Kondisi tersebut memerlukan pendekatan sistemik untuk mengidentifikasi kendala utama yang membatasi kinerja pelayanan. Penelitian ini bertujuan mengidentifikasi constraint dengan Theory of Constraints untuk meningkatkan efisiensi pelayanan unit rawat jalan Rumah Sakit Tonggak Husada tahun 2026. Penelitian menggunakan desain explanatory sequential dengan pendekatan mixed methods. Data kuantitatif diperoleh melalui telaah dokumen jumlah kunjungan rawat jalan periode Januari–Mei 2026, observasi waktu pelayanan bulan Mei 2026, serta telaah data pendapatan dan biaya operasional periode Januari–Mei 2026. Data kualitatif diperoleh melalui wawancara mendalam dengan manajemen dan petugas yang terlibat dalam pelayanan rawat jalan. Analisis dilakukan berdasarkan indikator Theory of Constraints, yaitu throughput, inventory, dan operating expenses, kemudian dilanjutkan dengan thinking process untuk mengidentifikasi root causes, konflik, dan alternatif solusi atau injection. Hasil penelitian menunjukkan bahwa jumlah kunjungan pasien rawat jalan cenderung menurun pada beberapa poli spesialis. Poli IPD relatif stabil, sedangkan Poli Bedah 1, Poli Obgyn 1, dan Poli Anak mengalami penurunan kunjungan sebelum pelayanan dihentikan sementara akibat dokter spesialis mengundurkan diri, penurunan jumlah kunjungan juga diiringi dengan penurunan pendapatan sekitar 37,6% dari bulan Januari hingga Mei 2026. Pada aspek waktu tunggu, hambatan utama ditemukan pada tahapan menunggu dokter dan pelayanan farmasi. Median waktu menunggu dokter tertinggi terdapat pada Poli Bedah sebesar 55 menit dengan maksimum 360 menit, disusul Poli Obgyn sebesar 26 menit dengan maksimum 100 menit, sedangkan Poli Penyakit Dalam memiliki nilai median menunggu dokter 5 menit tetapi waktu pengambilan obat mencapai median 10 menit dengan maksimum 120 menit. Hal ini seiring dengan meningkatnya rata-rata waktu keterlambatan dokter terutama pada poli Bedah dan poli Obgyn. Dari aspek keuangan, biaya operasional meningkat pada Maret 2026 dan kembali menurun di bulan April dan Mei. Namun biaya operasional perpasien yang dilihat dari unit cost terus meningkat karena penurunan jumlah kunjungan tidak diikuti dengan penurunan beban operasional secara proporsional. Constraint utama pelayanan rawat jalan berada pada aspek sumber daya manusia, terutama ketidakstabilan ketersediaan dan kedisiplinan dokter spesialis, yang berdampak pada waktu tunggu, kontinuitas layanan, penurunan kunjungan, dan penurunan profitabilitas. Root causes yang ditemukan meliputi komunikasi efektif yang belum merata, kepatuhan dokter terhadap jadwal praktek belum optimal, ketersediaan dokter spesialis belum stabil, dukungan fasilitas penunjang yang belum maksimal dan ketersediaan obat yang belum optimal serta verifikasi resep pasien asuransi yang masih memanjang. Tidak ditemukan konflik bermakna yang bersifat politis, kebijakan, atau etika. Solusi yang diusulkan mencakup peningkatan kualitas komunikasi, monitoring ketepatan waktu dokter spesialis, strategi menjaga ketersediaan dokter spesialias, penguatan layanan penunjang, serta perbaikan pelayanan farmasi. Efisiensi pelayanan rawat jalan Rumah Sakit Tonggak Husada belum optimal karena terdapat ketidakseimbangan antara throughput yang menurun, inventory berupa waktu tunggu yang masih tinggi, dan operating expenses yang meningkat. Perbaikan perlu difokuskan pada penguatan tata kelola sumber daya dokter spesialis, koordinasi antarunit, farmasi, fasilitas penunjang, dan komunikasi pelayanan.

Outpatient services are the entry point to hospital care and play an important role in determining service quality, continuity of care, patient satisfaction, and hospital operational performance. At Tonggak Husada Hospital, outpatient services showed indications of inefficiency, as reflected in declining patient visits, prolonged waiting times, and increasing operating expenses that were not proportional to revenue. This condition requires a systemic approach to identify the main constraints limiting service performance. This study aimed to identify constraints using the Theory of Constraints to improve the efficiency of outpatient services at Tonggak Husada Hospital in 2026. This study used an explanatory sequential design with a mixed methods approach. Quantitative data were obtained through document review of outpatient visit data from January to May 2026, observation of service times in May 2026, and review of revenue and operating expense data from January to May 2026. Qualitative data were obtained through in-depth interviews with management and staff involved in outpatient services. The analysis was conducted based on the Theory of Constraints indicators, namely throughput, inventory, and operating expenses, followed by the thinking process to identify root causes, conflicts, and alternative solutions or injections. The results showed that outpatient visits tended to decline in several specialist clinics. The Internal Medicine Clinic remained relatively stable, while Surgery Clinic 1, Obstetrics and Gynecology Clinic 1, and the Pediatric Clinic experienced declining visits before services were temporarily suspended due to the resignation of specialist doctors. The decline in visits was also accompanied by an approximately 37.6% decrease in revenue from January to May 2026. In terms of waiting time, the main bottlenecks were found in the stages of waiting for doctors and pharmacy services. The highest median waiting time for doctors was found in the Surgery Clinic at 55 minutes, with a maximum of 360 minutes, followed by the Obstetrics and Gynecology Clinic at 26 minutes, with a maximum of 100 minutes. Meanwhile, the Internal Medicine Clinic had a median waiting time for doctors of 5 minutes, but the median waiting time for medication collection reached 10 minutes, with a maximum of 120 minutes. This finding was consistent with the increasing average delay in doctor arrival, particularly in the Surgery and Obstetrics and Gynecology clinics. From the financial aspect, operating expenses increased in March 2026 and decreased again in April and May. However, operating expenses per patient, as reflected in unit cost, continued to increase because the decline in patient visits was not followed by a proportional decrease in operating expenses. The main constraint in outpatient services was found in the human resource aspect, particularly the instability in the availability and punctuality of specialist doctors, which affected waiting time, service continuity, patient visits, and profitability. The root causes identified included uneven understanding of effective communication, suboptimal compliance of doctors with practice schedules, unstable availability of specialist doctors, inadequate supporting facilities, suboptimal drug availability, and prolonged insurance prescription verification. No significant political, policy-related, or ethical conflicts were found. The proposed solutions include improving communication quality, strengthening monitoring of specialist doctors’ punctuality, maintaining the availability of specialist doctors, strengthening supporting services, and improving pharmacy services. Outpatient service efficiency at Tonggak Husada Hospital has not been optimal due to an imbalance between declining throughput, inventory in the form of prolonged waiting time, and increasing operating expenses. Improvement efforts should focus on strengthening the governance of specialist doctor resources, interunit coordination, pharmacy services, supporting facilities, and service communication.