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Kata kunci : Waktu tunggu, Lean hospital, Value added, Non value added
Outpatient care is one of the mainstays for hospitals in increasing income for other units. The purpose of this research is to accelerate the outpatient service in Polyclinic Specialist Disease Inside Koja Hospital by knowing the lead time waiting time of outpatient service and knowing the cycle time (value added and non value added) in each stage of outpatient service and make simulation of Lean application Hospital to eliminate or minimize waste (waste). This research design is done by operational research through Lean Hospital approach. Outpatient service waiting time in Polyclinic Specialist of Internal Disease of Koja Hospital amounted to 71.18 minutes which means it still exceeds the standard set by Ministry of Health in Decree of Minister of Health Number 129 / Menkes / SK / II / 2008 regarding Minimum Service Standard of Hospital. Similarly, waiting time in the pharmacy unit is 256.8 minutes (racik drug) and 154.27 minutes (finished medicine). The waiting time in the laboratory service unit is in accordance with the Ministry of Health's standard of ≤ 140 minutes. Implementation of outpatient service improvement efforts in Polyclinic Specialist Disease In RSUD Koja is to eliminate waste waiting, defect / rework, transportation, overprocessing and overproduction in each stage of service. The conclusion of this research is to eliminate or minimize waste and make the design of service outpatient extension can reduce waiting time of outpatient service in Polyclinic Specialist of Disease in Koja Hospital.
Keywords: Wait Time, Lean Hospital, Value added, Non value added
Penelitian ini menggunakan metode penelitian kualitatif (analitik observasional) untuk melihat alur pelayanan resep obat dan mengidentifikasi pemborosan pelayanan resep obat. Dan didukung oleh penelitian kuantitatif (analisis deskriptif) untuk memperoleh data perhitungan waktu setiap tahapan proses pelayanan resep obat.
Berdasarkan hasil penelitian diketahui rata-rata waktu tunggu pelayanan resep obat non racikan selama 89.6 menit (88.17% kegiatan menunggu) dan 124.70 menit (82.10% kegiatan menunggu) pada pelayanan resep obat racikan.
Hasil penelitian mengidentifikasi bahwa terdapat 8 jenis pemborosan (DOWNTIME) pada pelayanan resep obat. Usulan perbaikan dengan metode lean diharapkan dapat menurunkan waktu tunggu menjadi 66.67% pada pelayanan resep obat non racikan dan 56.67% pada pelayanan resep obat racikan.
Kata kunci : farmasi; metode lean; pemborosan; waktu tunggu
Long waiting times on prescription services will reduce patient satisfaction and lead to inefficient services. Lean is one of the methodologies that can be used to deal with inefficiencies in health services. This study aims to analyze the application of lean method in reducing waiting time of outpatient prescription services at Pasar Minggu public hospital in 2017.
This study used qualitative research methods (observational analytics) to examine the flow and identify waste of prescription drug services. And also supported by quantitative research (descriptive analysis) to get the exact calculation of every step of prescription drug services.
Based on the result of the research, it is known that the average waiting time of medicine prescription services is 89.6 minutes (88.17% waiting activity) and 124.70 minutes (82.10% waiting activity) of personalized medicine prescription services.
The study identified that there were 8 types of waste (DOWNTIME) in prescription services. The future improvement by lean method is expected to reduce waiting time to 66.67% on medicine prescription services and 56.67% on personalized medicine prescription services.
Keywords : pharmacy; lean methode; waste; waiting times
Kata kunci: waktu tunggu, metode lean hospital, waste, value stream mapping, kegiatan value added, kegiatan non value added.
Waktu tunggu pelayanan di unit rawat jalan terutama pada poliklinik spesialis yang lebih dari waktu yang telah ditetapkan oleh pemerintah dalam Keputusan Menteri Kesehatan RI No. 129/Menkes/SK/II/2008 tentang Standar Pelayanan Minimal (SPM). Penelitian ini dilakukan secara kualitatif dan kuantitatif. Berdasarkan data penghitungan waktu tunggu didapat 6 poliklinik spesialis yang memiliki waktu tunggu pelayanan > 60 menit. Poliklinik tersebut adalah PD1 (107.6 menit), PD5 (168.7 menit), P2 (66 menit), PD2 (68 menit), PJ (60.6 menit), dan THT (62.1 menit) Permasalahan ini disebabkan oleh faktor - faktor seperti keterlambatan waktu dokter dalam memulai praktik, pola kedatangan pasien, jumlah pasien dan jadwal praktik, peralihan sistem informasi manajemen rumah sakit, sistem pendaftaran, serta lokasi yang kurang strategis antar unit pelayanan rawat jalan.
The waiting times in outpatient setting specifically for specialist polyclinics takes longer than it recommended by the goverment as stated in Ministry of Health Decision Letter No. 129/Menkes/SK/II/2008 about Minimum Standar of Hospital Services. This research are conducted by using a qualitative and quantitative method. According to the waiting time data countings there are 6 specialist have experiencing an patient waiting times more than 60 minutes. There are PD1 (107.6 minutes), PD5 (168.7 minutes), P2 (66 minutes), PD2 (68 minutes), PJ (60.6 menit) dan THT (62.1 menit). The issues are caused by the doctor lateness habits on starting practice, arrival pattern of patient, amount of pasien and unadequate practice schedule, alteration of hospital information sistem, hospital admission and registration sistem, futhermore the unstrategic location between units.
Hasil penelitian pada Curent State Map menunjukkan 90% waktu pelayanan rawat jalan poliklinik paru merupakan kegiatan yang tidak bernilai tambah (waste) dan hanya 10 % yang merupakan kegiatan bernilai tambah (value added). Usulan perbaikan dengan metode lean dituangkan dalam Future State Map dan diproyeksi dapat menurunkan kegiatan non value added menjadi 69,2% dan meningkatkan kegiatan value added menjadi 30,7%. Menurunkan waktu tunggu dari awalnya 279 menit menjadi 72 menit
Kata Kunci: Lean Hospital; Lean Thinking; Poliklinik Paru; Rawat Jalan; Waktu Tunggu.
Long waiting time on outpatient services will reduce customer satisfaction. From the employee side, not knowing the actual workload causes the employees to easily complain and ask to be held additional employees who may actually be unnecessary. In this study, the researcher observed the outpatient service process flow process and the time used by the patient to perform the treatment process at the Lung Polyclinic of RSUD Pasar Minggu and analyzed the work load and the calculation of the HR requirement of lung specialist doctor. From the results of observations conducted waste analysis and mapping Outstanding Output Value Stream Map.
The results of the research on the Curent State Map shows 90% of the outpatient service time of pulmonary polyclinic is an activity that is not value added (waste) and only 8% is a value added activity. Proposed improvement by lean method, set forth in the Future State Map is projected to reduce non value added activities to 69.2% and increase value added activities to 30.7% and reduce waiting time from 279 minutes to 72 minutes.
Key words: Ambulatory service; Lean Thinking, Lean Hospital; Waiting Time
Analysis of Outpatient Installation Pharmacy Waiting Time at Special Hospital of Drug Addiction Jakarta in 2023 Abstract Prescription services waiting time in outpatient installations is one of the indicators for evaluating the performance of pharmaceutical installations that affects the quality of hospital services. Hospitals need to effort that prescription services waiting time meet the Minimum Service Standards (SPM). Through the Lean method with the Value Stream Mapping approach, this study aims to determine the prescription service procedures at the outpatient installation of RSKO Jakarta, identify value added and non-value added and waste that occurs so that factors that cause waste can be analyzed which can be prevented through the strategy recommendations obtained. This is a qualitative research with data collection obtained through observing and recording the e-prescriptions services waiting time at the RSKO outpatient installation, extracting in-depth information from informants and reviewing documents. Observations were made on 20 concoction medicine recipes and 10 concoction medicine recipes. The selection of informants was carried out using a purposive sampling technique and interviews were conducted with patients to obtain value from the customer's perspective according to the principles of the Lean method. The data obtained is then analyzed to obtain the factors affecting the prescription services waiting time duration using a fishbone diagram then a scoring system is carried out by assessing the urgency, severity and growth aspects of the cause problem so that priority recommendations can be formulated. The results of research conducted in April-May 2023 found that the average waiting time for prescription drug services was 49.25 minutes (VAR 17.5%) and for concoction drugs 80.2 minutes (VAR 33%), which means that it still exceeds the SPM set by KMK No. 128 of 2009 (no concoction drug recipe < 30 minutes, concoction drug recipe < 60 minutes). Some of the factors that cause waste are inefficiency in human resources, pharmaceutical inventory systems that have not been automated, inadequate evaluation/monitoring of drug use, the absence of a separate system for emergency prescription services, prescription service SPO that has not been adjusted with the establishment of prescription response time quality standardsfor each process, networks information system that frequently down/loads repeatedly and patient’s interruption for asking information. It is hoped that in the future an improvement strategy can be carried out to improve the waiting time for prescription services; increasing HR efficiency through arrangements so that during peak hours pharmaceutical HR focuses on working on the duties and functions of prescription services, facilitating a pharmaceutical inventory system with an automated system, implementing an evaluation system for monitoring drug use more effectively so that procurement planning becomes more accurate, regulation separates prescription services from the emergency room, providing SPO in accordance with prescription service implementation, separate the information system network between patient services and office and providing reachable information for pastient (visual management).
Outpatient services as the leading unit which displays image of thehospital and the largest contributor to patient must be properly managed,one of which is improving wait-times. Wait-times is one of thedimensions of quality in health care. This research aims to analyze thewait-times in outpatient services at Rumah Sakit Ibu Dan Anak Aulia for2014. This research is using the qualitative and quantitative methods inoutpatient services, starts from registration, polyclinic, pharmacy, andcashier.The results showed that approximate time for registration is 8.77 minutesat peak hours and 7.37 minutes at non peak hours. The longest wait-timesis in the children's polyclinic with approximate wait-times about 63.82minutes at peak hours and 40.27 minutes at non peak hours. Theapproximate wait-times in pharmacy at peak hours is 21.39 minutes forgeneric medicine and 33.92 minutes for personalized medicine, whileapproximate wait times at non peak hours is 17.50 minutes for genericmedicine and 31.23 minutes for personalized medicine. At cashier, theapproximate wait times is 15.09 minutes in peak hours and 9.43 minutesin non peak hours.All wait times is already referred to Minimum standard of services forhospital according to Kepmenkes no. 129/2008 except for the polyclinic'swait times. Wait times is influenced by some factors, consists of man,material, method, machine, and money. At polyclinic, the long wait timesis mainly due to human resources factor, which is indiscipline doctor topractice hours, so the result of this research suggests the management tore-analyze and restore the agreement with the doctors to shorten the waittimes so the quality of service in the future will improve.
Penelitian ini bertujuan untuk mengetahui harapan dan tingkat kepuasan pasien terhadap mutu pelayanan dokter spesialis penyakit dalam pada poliklinik penyakit dalam instalasi rawat jalan RSUP Persahabatan di Jakarta, Indonesia. Jenis penelitian berupa kuantitatif dengan pendekatan cross sectional, sampel dipilih secara acak. Jumlah sampel sebanyak 198 pasien. Responden terdiri dari 63 kunjungan baru dan 135 kunjungan lama. Metode pengukuran kepuasan dengan menggunakan Importance Performance Analysis. Tingkat kepuasan responden umur tua (>= 55 tahun) lebih puas dibandingkan responden dengan umur muda ( < 55 tahun). Responden yang belum menikah kurang puas dibandingkan responden yang telah menikah. Responden yang tidak bekerja / non karyawan contoh lebih puas dibandingkan karyawan. Responden berjenis kelamin perempuan lebih puas dibandingkan responden berjenis kelamin laki-laki. Tingkat pendidikan SMP paling puas dibandingkan tingkat pendidikan SMA kebawah maupun D3/Perguruan tinggi. Responden dengan cara bayar tunai kurang puas dibandingkan dengan resonden cara bayar jaminan. Responden yang merupakan pengunjung lama lebih puas dibandingkan pengunjung baru. Responden dengan waktu tunggu lama (>= 60 menit) sangat tidak puas dibandingkan responden dengan waktu tunggu singkat (< 60 menit). Responden yang diperiksa dokter >= 15 mnt lebih puas dibandingkan responden yang diperiksa singkat < 15 menit. Untuk tingkat kesesuaian antara harapan dan kenyataan didapatkan hasil : untuk variabel kecepatan pelayanan kepuasan 38,4 %. Untuk variabel ketrampilan pelayanan kepuasan hanya 47,5 %. Untuk perhatian pelayanan, kepuasan hanya 44,4 %. Namun untuk penampilan pelayanan, kepuasan 58,6 %. Secara keseluruhan, tigkat kepuasan terhadap variabel pelayanan yang diteliti sebesar 37,4 %. Karakteristik responden yang merasa puas dengan pelayanan dokter spesialis penyakit dalam di instalasi rawat jalan RSUP Persahabatan adalah responden yang berumur tua, berjenis kelamin perempuan, kawin, bukan karyawan, pendidikan SMA, pengunjung lama, cara bayar jaminan, waktu tunggu yang singkat dan diperiksa lama oleh dokter. Dari sisi mutu pelayanan, kepuasan responden pada penampilan pelayanan. Secara keseluruhan, tingkat kepuasan responden terhadap mutu pelayanan dokter spesialis penyakit dalam masih sangat rendah.
The purpose of this research was to discover expectations and satisfaction levels of internist service quality at Persahabatan out-patient department. This is a cross sectional quantitative research in obtaining the instrument, through a random sampling, and involved 198 patients as samples. 63 patients were new patients and the rest of them were regular ones. The application of the Importance Performance Analysis, measurement of satisfaction is carried out. Satisfaction level of more or less than 55 years old patients were higher than the younger patients (less than 55 years old). Unmarried respondents have lower satisfaction levels than the married ones. Unemployed respondents, have higher satisfaction level than employed respondents. Female respondents were more satisfied than male respondents. High school graduated respondent were the most satisfied respondents than junior high school graduated respondents and also diploma graduated respondents. Fee for service patients were less satisfied than insured patients. Regular patient respondents have higher level of satisfaction than the new ones. Respondents with longer waiting period (more than 60 minutes) truly unsatisfied if they compared to respondents with shorter waiting period. Respondents with longer examination period (more or less than 15 minutes) were more satisfied than the shorter ones (less than 15 minutes). The result of suitability level between expectation and reality were: services skill variable was only 47.5%. For service attention was only 44.4% but for service packaging the satisfaction was reached 58.6%. Over all, satisfaction level against researched service variables was 37.4%. characteristics of satisfied respondents on internist service at outpatient department of Persahabatan Hospital were geriatrics, females, married, unemployed, high school graduated, regular patients, insured patients, short waiting period, and longer examination period. Based on service quality, highest satisfaction level was on service packaging. Generally, respondent satisfaction level against internist service quality was very poor/low.