Abstrak: Proses pelayanan pasien lama rawat jalan umum di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita berkaitan dengan waktu tunggu pemeriksaan pasien poliklinik, belum mencapai target standar pelayanan minimal rumah sakit kurang dari 60 Menit. Hal ini mengakibatkan pelayanan menjadi tidak efisien. Metode Lean merupakan suatu metode yang diharapkan dapat meningkatkan efisiensi pada proses pelayanan pasien lama rawat jalan umum. Penelitan kualitatif dengan menggunakan prinsip Lean Thinking untuk menggambarkan alur proses pelayanan pasien lama rawat jalan umum, menghitung Cycle Time dan Lead Time dan menganalisai Waste yang terjadi. Hasil penelitian digambarkan dalam current state value stream mapping menunjukkan bahwa 12% total waktu yang dibutuhkan untuk kegiatan value added sedangkan 88% total waktu layanan merupakan waktu yang digunakan untuk kegiatan non value added (Waste). Usulan perbaikan dengan metode Lean dapat menurunkan presentasi non value added activity.
Kata Kunci : Lean; Non Value Added; Proses pelayanan; Value Added; Waste.

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The service process of old patient at outpatient poly services in Rumah Sakit Jantung Dan Pembuluh Darah Harapan Kita related to waiting time examination of the patients, it has not reached the target of minimum service standards for hospital less than 60 minutes. This resulted in services being inefficient. Lean method is a method that is expected to improve efficiency in service process on old patients at outpatient general services. Qualitative research by using the principles of Lean Thinking to illustrate the process flow patient service on old patients at outpatient general services, calculated cycle time and lead time and analyzed waste that occurs. The results of the study are described in the current state value stream mapping showed that 12% of the total time required for value added activities, while 88 % of total service time is the time spent on non-value added activities (Waste). Proposed improvements with Lean methods can reduce non-value added activity presentation.
Keywords: Lean; Non Value Added; Process service; Value Added; Waste

Abstrak: Fenomena tingginya angka rujukan pasien yang diterima oleh rumah sakit di eraJaminan Kesehatan Nasional mengakibatkan penumpukan pasien yang berobat ke rumahsakit. Salah satu konsep yang dapat digunakan di era JKN untuk dapat memberikan kualitaspelayanan bagi pasien rujukan agar lebih efektif dan optimal, melakukan efisiensi biaya danjuga berorientasi kepada nilai walaupun dengan keterbatasan anggaran dan sumber daya yangdihadapi rumah sakit adalah dengan mengaplikasikan konsep Lean dalam pelayanankesehatan.Penelitian ini menunjukkan bahwa faktor penentu belum optimalnya pelayanan pasienrujukan JKN di poliklinik disebabkan oleh waktu tunggu berkas rekam medik lama, waktutunggu dokter spesialis lama, serta pasien yang menumpuk dan berkerumun menungguantrian. Berdasarkan Karakteristik Sistem Rujukan WHO, kurangnya SDM rekam medik,profesionalitas dokter, kurangnya kerjasama dan komunikasi pra rujukan, kelengkapanfasilitas sarana prasarana dan sumber daya pendukung yang kurang memadai, serta belumsempurnanya aplikasi SIMRS juga menyebabkan belum optimalnya pelayanan pasienrujukan JKN di poliklinik. Berdasarkan Current State Value Stream Mapping didapatkanaktivitas value added pada proses pelayanan hanya 7,32 % sampai 17,75 %, sedangkanaktivitas non value added mencapai 82,25 % sampai 92,6 %. Dengan memotong alurpelayanan, mengeliminasi waste yang ditemukan, dan implementasi tools Lean 5S, VisualManagement, Eror Proofing, dan Heijunka diharapkan pada Estimate Future State ValueStream Mapping akan menghasilkan penurunan waktu pelayanan sampai 87 menit, danmeningkatkan aktivitas value added sampai 34,95%.
Kata kunci : Pasien rujukan JKN, optimalisasi pelayanan, konsep lean, waktu tunggu.

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The phenomenon of high rates of referral of patients received by the hospital in theera of National Health Insurance resulted in a buildup of patients treated at the hospital . Oneconcept that can be used in the era JKN to be able to provide quality care for the patientsreferral to be more effective and optimal, cost efficiency and also oriented to value althoughwith limited budgets and resources faced by hospitals is to apply the concept of Lean inhealthcare.This study shows that the decisive factor is not optimal patient care referral JKN inpolyclinic are caused by long waiting time for medical record file, long waiting timespecialist doctors, and patients who accumulate and clump waiting queue. Based ReferralSystem Characteristics WHO, lack of human resources in medical records, physicianprofessionalism, lack of cooperation and communication pre references, completeinfrastructure facilities and supporting resources are inadequate, and incomplete applicationSIMRS also lead to non-optimal patient care referral JKN in polyclinic. Based on the CurrentState Value Stream Mapping, value added activities in the service only 7.32 % to 17.75 %,while the non-value added activity reached 82.25 % to 92.6 %. By cutting the service flow,eliminate waste were found, and implementation tools of Lean 5S, Visual Management, ErrorProofing , and Heijunka expected at Estimate Future State Value Stream Mapping will resultin reduced service time to 87 minutes , and increase value added activities until 34.95 % .
Key word : referral patient of JKN, optimization services, lean concept, waiting time.

Abstrak: Keterlambatan pengajuan klaim BPJS berakibat pada turunnya cashflow rumahsakit. Proses klaim saat ini berjalan tidak efisien dan efektif. Tujuan daripenelitian ini adalah mendapatkan hasil analisis dan usulan perbaikan alur prosesdokumen klaim BPJS pasien rawat jalan dengan menerapkan konsep LeanHospital. Penelitian dengan pendekatan kuantitatif dan kualitatif inimengobservasi waktu yang dibutuhkan untuk menyelesaikan dokumen klaimsebelum diberikan kepada verifikator BPJS serta melakukan wawancaramendalam, observasi proses, dan telaah dokumen. Hasil penelitian menunjukkanterjadi waste terbesar di unit mobilisasi dana yaitu selama 32,5 hari 18,8 menitdalam penyelesaian dokumen klaim. Jenis waste terbanyak adalah waiting dantransportation. Berdasarkan VSM diketahui Lead Time dari proses klaim saat iniadalah 33,9 hari. Usulan perbaikan yang diberikan dari penelitian ini adalahdengan optimalisasi tim Casemix yang baru saja dibentuk, sehingga lead timepengerjaan klaim yang dibutuhkan menjadi 6,44 menit. Standardisasi kerja danpenilaian kinerja berupa KPI, IKI, dan IKU dinilai perlu diterapkan agar kinerjapetugas menjadi optimal.
Kata Kunci: Lean Thinking, BPJS, klaim, value added activity, non value addedactivity, waste

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Delay in the submission of BPJS claims resulted in decreasing hospital cash flow. The currentclaim process is not efficient and effective.The objective of this reseach is to analize and proposeimprovement in the claim process by applying Lean Hospital concept. This research usedquantitative and qualitative approaches to observed the time required to complete the claimprocess before submitted to the BPJS verificator and also have an in-depth interview, observe theprocess, and document review. The result showed most waste happened in mobilisasi dana unitfor 32.5 days 18.8 minutes in the settlement BPJS document claims. Based on Value StreamMapping, Lead Time of the claim process at this time is 33.9 day. Most types of waste arewaiting and transportation. Proposed improvement provided from the study is to optimizing thecasemix team which newly formed. By optimizing the casemix team, Lead Time required tocomplete the claims process is 6.44 minutes. Standardize work and performance appraisal (KPI,IKI, and IKU) consider to apply to reach employee best performance.
Keywords: Lean Thinking, BPJS, claim, value added activity, non value added activity, waste

Abstrak: Penundaan pada proses pemulangan pasien berkaitan dengan ketersediaan jumlahtempat tidur pada pasien yang akan masuk dirawat inap. Hal ini mengakibatkanpelayanan menjadi tidak efisien. Metode Lean merupakan suatu metode yangdiharapkan dapat meningkatkan efisiensi pada proses pemulangan pasien rawatinap. Penelitian kualitatif dengan menggunakan prinsip Lean thinking untukmenggambarkan alur proses pemulangan pasien, menghitung Lead time dan CycleTime, dan menganalisis waste yang terjadi.

Hasil penelitian menunjukkan wakturata-rata yang diperlukan untuk pasien metode pembayaran BPJS sebesar 153,5menit, Cash sebesar 127 menit , dan asuransi sebesar 264 menit. Total persentasenon value added activity pada proses pemulangan pasien dengan metodepembayaran BPJS sebesar 76,4%, cash sebesar 72,4%, dan asuransi sebesar84,1%.

Usulan perbaikan dengan metode Lean dapat menurunka persentase nonvalue added activity menjadi sebesar 56,6% untuk pasien BPJS, 46,6% untukpasien cash, dan 56,8% untuk pasien asuransi.

Kata kunci: pemulangan pasien; Lean; Value Added; Non value added; waste

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Delays in the process of discharge related to the availability of the number of bedsfor patients who are going to be hospitalized. This resulted inefficiency ofservices. Lean method is a method that is expected to improve efficiency in theprocess of discharge process. A qualitative study using the principles of leanthinking to describe the process of discharge flow, calculate the lead time andcycle time, and analyze the waste that occurs.

The results show the average timerequired for patient used BPJS payment method is 153.5 minutes, cash is 127minutes, and insurance is 264 minutes. The total percentage of non-value addedactivity in the process of discharge process with BPJS payment method is 76.4%,cash is 72.4%, and insurance is 84.1%.

Suggestions for improvements with leanmethods can reduce the percentage of non-value added activity by 56.6% forBPJS patients, 46.6% for cash patients, and 56.8% for insured patients.

Keywords: discharge process; lean; value added; non-value added; waste

Abstrak:

Patient satisfaction is one of indicators to measure efficacy of hospital service and giving feedback for the side of management, because service satisfaction will give positive effect of hospital promotion. Background of this research is the existence of trend increasing customer complain both indirect and direct (suggestion box) which are collected by marketing department during 2005 until one semester of 2007 and the existence of trend lowering amount of outpatient where their medical costs is given by company based on data which is collected by medical record department during 2005 until 2007 and also lowering amount of new outpatient during 2006 until 2007 at Coroner and Venous Hospital of Harapan Kita (RSJPD). Purpose of this research is finding te-exploiting enthusiasm of outpatient unit by patient which is evaluated of satisfaction factor at the place of patient acceptance, satisfaction at the place of patient Service, satisfaction at the place of cashier and service cost factor.

Abstrak: Peningkatan mutu dan keselmatan pasien merupakan dua hal yang tidak bisadipisaahkan dan harus berkesinambungan. Upaya peningkatan mutu dan keselamatanpasien di Instalasi Farmasi Rumah Sakit Pusat Otak Nasional Prof. DR. dr. MaharMardjono digambarkan melalui capaian indicator pelayanan menurut Standar PelayananMinimal Rumah Sakit yang belum mencapai standar. Penelitian ini dilakukan untukmenganalisis waktu tunggu pelayanan obat jadi pasien JKN dan aktivitas risikoterjadinaya medication error dengan prinsip lean thinking dan swiss cheese model. Jenispenelitian ini adalah operational research dengan pendekatan kualitatif dan kuantitatif.Data kualitatif diperoleh melalui proses observasi dan telaah dokumen, sedangkankuantitatif berdasarkan data waktu tunggu dari electronic health record dan waktutunggu hasil observasi. Hasil penelitian menunjukan waktu tunggu adalah 1 jam 3 menit11 detik, dengan waktu tunggu terlama adalah pada proses penerimaan resep (30 menit42 detik). Kegiatan VA (79%) yaitu 13 menit 13 detik. Aktivitas NVA (21%) denganwaktu 49 menit 21 detik. Waste terbanyak adalah pada kegiatan waiting denganpresentasi waktu 92% dari waktu NVA. Bottleneck pada penelitian ini diambil dariproses waktu tunggu terlama dan hasil analisis swiss chesse model pada tahapanpengkajian dan pemeriksaan sediaan obat.Usulan perbaikan berdasarkan hasil analisisproses pengkajian dan pelayanan resep obat jadi ini adalah perlu adanya penyusunanregulasi pengkajian dan pelayanan obat sesuai standar pelayanan kefarmasian, telaahprofil indicator waktu tunggu obat jadi sesuai SPM rumah sakit, perlu adanya analisisbeban kerja, dan monitoring supervise kajian pelayanan resep obat. Usulan perbaikandigambarkan dalam future state map dengan mereduksi aktivitas NVA yang dapatsecara langsung dihapuskan tanpa dilakukan intervensi.
Kata kunci: lean thinking, , medication error, swiss chesse model waktu tunggupelayanan

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Quality improvement and patient safety are two things that cannot separated and mustbe continuous. Effort to improve quality and patient safety at Outpatient PharmacyPusat Otak Nasional Prof. DR.dr. Mahar Mardjono Hospital is described through theachievement of service indicators according to the hospital minimum service standardsthet have not resched the standard. This study was conducted to analyze the waitingtime for JKN patient medication services and risk activities of medication errors usingprinciples of lean thinking and the swiss cheese model. This type of research isoperational research with qualitative and quantitative approaches. Qualitative data isobtained through the process of observation and document review, while quantitativedata is based on waiting time data from electronic health records and waiting time forobservations. The result showed that the waiting time was 1 hour 3 minutes 11 seconds,with the longest waiting time was in the process of receiving the recipe (30 minutes 42seconds). Value_added activity (79%) was 13 minutes 13 seconds, non value addedactivity (21%) for 49 minutes 21 second. Most of waste is in waiting activities with apresentation time of 92% of the time for non value added. The bottleneck in this studywas taken from the longest waiting time process and the result of the swiss cheesemodel analysis at the assessment and examination stage of drug preparations.Reviewing the waiting time indicator profile for the finished medicine according to theSPM of the hospital. There is a need for workload analysis, and monitoring of thereview of prescription services. Proposed improvements are described in a future statemap by reducing non value added activity which can be directly eliminated withoutintervention.
Key words: lean thinking, medication error, swiss chesse model, medication error,service waiting time.

Abstrak:

Kinerja rumah sakit menxpakan suatu dimensi utama dari mutu pelayanan rumah sakit. Peningkatkan rnutu pelayanan rumah sakit merupakan hal yang sangat penting oleh karena rumah sakit memberikan pelayanan yang paling kxitis dan berbahaya dalam sistem pelayanan. Hal tersebut dikarenakan yang menjadi sasaran kegiatan adalah jiwa manusia, Balanced Scorecard (BSC) merupakan metode yang dapat digunakan untuk menilai kinexja rumah sakit dan rnengukur strategi secara komprehensif dengan pola manajemen strategis. Tujuan penelitian ini adalah untuk memperoleh garnbaran pengukuran kinerja rumah sakit secara komprehensitl akurat dan obyektif sesuai pendekatan Balanced Scorecard Penelilian ini menxpakan penelitian dcskriptif anaiitik yang menggunakan pendekatan kualitatif dan kuantitatif. Penclitian dilakukan di Rumah Sakit Harapan Kita. Hasil penclitian ini mcnunjukkan bahwa pengembangan Rumah Sakit Harapan Kita sudah diarahkan menuju pencapaian visi dan misi. Dalam Perspektif Keuangan, beberapa pencapaian indikator keuangan seperti Relurn on lnvesrrnenr (Roi) dan cash ratio menunjukkan adanya peningkatan dibanding dengan keadaan sebelum menjadi PPK-BLU. Dari sisi perspektif pelanggan, telah texjadi kecenderungan peningkatan kunjungan pasien. Beberapa indikator yang mcwakili proses bisnis intemal juga menunjukkan hasil yang positifi Terdapat peningkatan jumlah tindaknn bedah. Disamping itu, beberapa indikator pelayanan, sepeni BOR dan TOI berada di daerah ideal. Texkait dengan perspektif pertumbuhan dan pembelajaran, rumah sakit telah mengirimkan beberapa staf ke luar negeri. Rumah Sakit juga mengadakan pertemuan rutin antara komite medis, tenaga dokter, dan paramedis untuk memantau penampilan pelayanan yang dibexikan. Dilakukan pula evaluasi terhadap pelaksanaan kegiatan. Penelitian ini menghasilkan saran perlunya pelatihan/supegvisi khusus dari Departemen Kesehatan untuk pelaporan dengan penekanan terhadap analisa rasio keuangan untuk mengetahui nilai pertumbuhan ekonomis, penguatan stratcgi pemulihan layanan, kesamaan persepsi mengenai defmisi beberapa indikator kinexja rumah sakit, pembenahan sarana dan prasarana, penguatan sistem infommasi ketenagaan di rumah sakit.

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Hospital performance is the main dimension of hospital service quality. The Improvement of hospital services quality is very important, because hospital provides most critical and dangerous services in health services system since it targeted human life as the object of services. Balanced Scorecard (BSC) can be used to assess hospital performance and examined the stratc gy comprehensively in strategic management framework. The objective of this study is to get the description of hospital performance assessment eomprehensiveiy, accurately, and objectively according to Balanced Scorecard. This study is descriptive-analytical study which using qualitative and quantitative technique. The study located at I-Iarapan Kita Hospital in Jakarta. The results of this study show that the Harapan Kita Hospital activities have been directed to the achievement of its vision and mission. In financial perspective, some of financial indicators, such as Retum on Investment (Rol) and cash ratio have been improved. In customer perspective side, there is an increasing trend of patient visit. Some of indicators which representing of intemal business process, also shown positive results, such as increasing of the number of operative activities. Hospital’s bed occupancy rate and tum over interval are in ideal position. In learn and growth perspective, hospital has sent some ol' its staff to study abroad. Hospital also conducting regular meeting between medical committee, doctors, and paramedics to evaluate the services which have been given. This study recommend that there should be special training or supervision from Ministry of Health for reporting purpose especially in analyzing financial ratio to observe economical growth value, strengthening of services recovery, equalizing perception regarding of some hospital performance indicators definition, improving hospital facilities, Strenghening of human resource infomation system, and comprehensive evaluation including input, process and output components by Ministry of Health as the owner.

Abstrak: Abstrak
Tesis ini membahas kajian Penerapan Sistem Remunerasi Dan Kinerja Pelayanan bedah Jantung Dewasa Di Rumah Sakit Jantung Dan Pembuluh Darah Harapan Kita (RSJPDHK). Penelitian ini menggunakan pendekatan mixed method dengan melakukan kajian deskriftif data sekunder dan data primer dengan kuesioner self assessment dari responden terpilih, dilanjutkan Focus Group Disscusion dari informan terpilih. 
Hasil penelitian menunjukkan sebagian besar SMF dan perawat tidak puas dengan beberapa hal dalam penerapan sistem remunerasi. Namun ternyata ketidakpuasan tersebut terjadi karena kekurangpahaman terhadap isi dari Keputusan Menteri Keuangan Republik Indonesia Nomor 165 Tahun 2008. Pada penelitian ini juga terlihat kinerja pelayanan bedah jantung dewasa tetap mengalami kenaikan setiap tahunnya sebelum dan sesudah penerapan sistem remunerasi.

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This thesis studied of implementation of Remuneration System and Performance of adult cardiac surgery services in Harapan Kita Cardiovascular Hospital. This research used a mixed method approach by conducting detailed descriptive study of secondary data and primary data with self assessment questioner from selected respondent, continued with Focus Group Discussion from selected informant. 
The result of the research showed that almost of functional medical staff dan nurse unsatisfied with several things in implementation of Remuneration system. However the unsatisfied due to not well informed with the content of Keputusan Menteri Keuangan Republik Indonesia No. 165/2008. But performance of adult cardiac surgery services increased for every year, before and after implementation of Remuneration System. 
The researcher suggest that Ministry of Health facilitates RSJPD Harapan Kita to have remuneration system formulation that more appropriate with the present condition. RSJPD Harapan Kita make remuneration system that appropriate with regulation and the present condition that continued with a good socialization and evaluated regularly.

Abstrak:

Latar belakang: Pelaporan Insiden Keselamatan Pasien (IKP) penting untuk memahami penyebab insiden dan meningkatkan keselamatan pasien. Tingkat pelaporan IKP oleh perawat di RSJPDHK tahun 2023 hanya 15,9%, menunjukkan masih banyak insiden yang tidak dilaporkan dan akan melemahkan kapasitas sistem pelaporan untuk mendorong pembelajaran. Penelitian terdahulu (2014-2023) mengidentifikasi bahwa faktor individu, psikologis, dan organisasi sebagai determinan penerapan pelaporan IKP.
Tujuan: Mengetahui determinan individu, psikologis, dan organisasi yang berkaitan dengan penerapan pelaporan IKP oleh perawat di RSJPDHK tahun 2024.
Metode: Penelitian kualitatif dengan desain studi kasus dilakukan pada bulan Juli – Oktober 2024. Penelitian ini melibatkan lima orang kepala unit kerja dan dua orang dari Komite Mutu melalui wawancara mendalam dan telaah dokumen.
Hasil: Penerapan pelaporan IKP meningkat pada tahun 2022-2024, namun belum merata di seluruh unit kerja. Perawat yang rutin melaporkan IKP menunjukkan pengetahuan yang lebih baik dan motivasi yang lebih tinggi. Hambatan psikologis lebih sedikit dirasakan pada perawat yang aktif melapor. Determinan organisasi yang paling banyak mendapat respon negatif meliputi supervisi kepala unit, pelatihan, dan dukungan manajemen berupa champion keselamatan pasien.
Kesimpulan: Akar permasalahan belum meratanya penerapan pelaporan IKP di RSJPDHK yaitu pelatihan yang belum efektif dan ketiadaan instrumen yang merinci pelaksanaan supervisi kepala unit dan uraian aktivitas champion keselamatan pasien.

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Background: Patient Safety Incident (PSI) reporting is crucial for understanding the causes of incidents, which serve as a basis for improving patient safety. The PSI reporting rate by nurses at National Cardiovascular Center Harapan Kita (NCCHK) in 2023 was 15,9%, indicating that many incidents remain unreported, which weakens the reporting system’s capacity to drive learning. Previous research (2014-2023) identified individual, psychological, and organizational factors as determinants of PSI reporting implementation. Objective: To identify individual, psychological, and organizational determinants related to the implementation of PSI reporting by nurses at NCCHK in 2024.  Method: A qualitative study with a case study design was conducted from July-October 2024. The study involved five units head and two members from the Quality Committee through in-depth interviews and document reviews. Results: The implementation of PSI reporting increased from 2022-2024 but remains inconsistent across all units. Nurses who regularly report PSI demonstrated better knowledge and higher motivation. Psychological barriers were less prominent among nurses who actively reported incidents. Organizational determinants receiving the most negative responses included unit head supervision, training, and patient safety champions. Conclusion: The root causes are ineffective training, the absence of detailed instruments outlining unit head supervision and specific activities for patient safety champions.

Abstrak: Pelayanan Farmasi merupakan pelayanan yang tidak dapat dipisahkan dari pelayanan rumah sakit. Lamanya waktu tunggu di farmasi akan memengaruhi mutu layanan di rumah sakit secara menyeluruh. Demikian juga di RSU Bali Royal, didapatkan waktu tunggu diatas dari standar pelayanan minimal rumah sakit. Lamanya waktu tunggu di farmasi rawat jalan disebabkan belum berjalannya manajemen mutu yang baik di RSU Bali Royal. Peneitian ini akan melihat bagaimana proses pelayanan farmasi rawat jalan dengan menggunakan metode lean, di tahun 2017 dengan observational action process research, dengan melakukan observasi terhadap 15 pasien dari bulan oktober 2017 sampai dengan Januari 2018 di farmasi rawat jalan RSU Bali Royal, dengan melihat waste yang ada. Ditemukan kegiatan yang bersifat value added sebesar 45,65% dan kegiatan non value added (waste) sebesar 54,28%. Waste yang banyak ditemukan adalah waste waiting dan waste defect. Eliminasi waste yang sudah ditemukan dengan implementasi intervensi antara lain: memindahkan konter kasir, merubah lay out farmasi, membuat loket antara konter farmasi dengan ruang pengerjaan obat mengunci pintu ruang farmasi dan merubah alur layanan farmasi rawat jalan, sehingga kegiatan non value added dapat di eliminasi menjadi 18,28% dan kegiatan value added menjadi 81,72%. Dari segi outcome dapat dilihat adanya perbaikan waktu tunggu, perbaikan kepuasan pelanggan, peningkatan kunjungan dan peningkatan omset di farmasi. Peneitian ini menyimpulkan adanya peningkatan mutu layanan setelah dilakukan perbaikan proses pelayanan farmasi rawat jalan dengan menggunakan metode lean.
Kata kunci : Mutu; Lean; Farmasi

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Pharmaceutical Services is a service that cannot be separated from hospital services. The length of waiting time in the pharmacy will satisfy the overall quality of hospital services. Currently the waiting time in Bali Royal Hospital pharmacy for out patient is still above the standard waiting time, which is not in accordance with the hospital guidelines. The standard waiting time for outpatient pharmacy cannot be achieved due to lack of quality management at RSU Bali Royal. This study will look at how the process of outpatient pharmacy service using lean method, in 2017 with observational action process research, by observing 15 patients from October 2017 to January 2018 at outpatient pharmaceutical RSU Bali Royal, by looking at the waste. It is founded that there are 45.65% value added activities and non-value added activities (vaste) of 54.28%. Most of the wastes that are found are waste waiting and waste defect. Elimination of waste that has been done by the implementation of intervention, among others: moving cashier counters, changing the lay out of pharmacy, making counter between the pharmaceutical counter with space lock pharmaceutical door lock and change in outpatient pharmacy service, so that non value added activities can be eliminated to 18.28% and value added activities to 81.72%. In terms of outcome can be seen the improvement of waiting time, improvement of customer satisfaction, increased visits and increased turnover in pharmacy. This study concludes that there is a significant improvement of service quality after the refinement of outpatient pharmacy service process using lean method.
Keyword : Quality; Lean; Pharmacy