Waktu pemulangan pasien rawat inap merupakan indikator mutu penting dalam pelayanan rumah sakit. Di RS Universitas Indonesia (RSUI), target check-out time sebelum pukul 12 siang belum tercapai selama empat tahun terakhir, berdampak pada keterlambatan alur rawat inap dari IGD dan menurunnya efisiensi pemanfaatan tempat tidur. Proses discharge yang kompleks, melibatkan banyak unit, serta dominasi aktivitas non-value-added menjadi penyebab utama rendahnya capaian indicator mutu tersebut. Penelitian ini menggunakan pendekatan Lean Six Sigma dengan desain DMAIC (Define, Measure, Analyze, Improve, Control). Pengumpulan data dilakukan melalui observasi proses discharge dan wawancara mendalam terhadap tujuh informan kunci lintas profesi. Sampel terdiri atas 40 pasien jaminan BPJS Kesehatan. Analisis dilakukan untuk mengidentifikasi aktivitas value-added, non-value-added, waste, dan variasi proses. Rata-rata lead time discharge sebelum intervensi adalah 20 jam 35 menit dengan 86% aktivitas tergolong NVA. Empat aktivitas prioritas dengan waste tertinggi adalah discharge billing (43,75%), penyusunan resume keperawatan dan surat kontrol (13,62%), pengorderan resep obat pulang (9,95%), dan penyusunan resume medis (9,86%). Intervensi dilakukan melalui penempatan tenaga administrasi ruangan (ADRU), surat edaran kebijakan peresepan oleh DPJP, serta pelatihan Kaizen. Setelah intervensi, capaian check-out sebelum pukul 12.00 meningkat dari 45% menjadi 53%, meskipun total lead time meningkat menjadi 22 jam 40 menit. Namun, beberapa subprocess mengalami perbaikan signifikan, seperti edukasi dan pemberian obat (turun 29%), pasien keluar ruang (turun 40%), dan discharge billing (turun 40%). Intervensi Lean Six Sigma berhasil meningkatkan capaian check-out time <12.00 meskipun belum menurunkan total lead time secara keseluruhan. Perbaikan cenderung parsial dan menunjukkan perlunya intervensi lebih menyeluruh terhadap tahapan proses discharge yang belum optimal.

Inpatient discharge time is a key quality indicator in hospital services. At Universitas Indonesia Hospital (RSUI), the target check-out time before 12:00 PM has not been achieved over the past four years. This delay negatively impacts the inpatient admission flow from the emergency department and reduces the efficiency of bed utilization. The complexity of the discharge process, which involves multiple units and is dominated by non-value-added (NVA) activities, is a primary factor contributing to the low performance of this indicator. This study applied a Lean Six Sigma approach using the DMAIC (Define, Measure, Analyze, Improve, Control) framework. Data collection was conducted through direct observation of the discharge process and in-depth interviews with seven key informants from different professional backgrounds. The sample consisted of 40 inpatients covered by the national health insurance scheme (BPJS Kesehatan). The analysis focused on identifying value-added (VA) and non-value-added (NVA) activities, waste, and process variation. The average pre-intervention discharge lead time was 20 hours and 35 minutes, with 86% of activities categorized as NVA. Four priority activities contributing the most waste were: system-based discharge billing (43.75%), preparation of nursing discharge summaries and follow-up letters (13.62%), prescription of discharge medications (9.95%), and preparation of medical summaries (9.86%). Interventions included the deployment of room-based administrative staff (ADRU), a policy circular mandating discharge prescriptions by the attending physician, and Kaizen training for process owners. Post-intervention, the proportion of patients discharged before 12:00 PM increased from 45% to 53%, although the total lead time rose to 22 hours and 40 minutes. However, several subprocesses showed significant improvements, such as patient education and medication handover (reduced by 29%), patient exit from the ward (reduced by 40%), and discharge billing (reduced by 40%). The Lean Six Sigma intervention succeeded in improving the achievement of the <12:00 PM discharge time indicator, although it did not reduce the overall discharge lead time. The improvements were partial, indicating a need for more comprehensive interventions targeting other suboptimal discharge process components.