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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).
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: Konsep Lean, Lean Thinking, Lean Hospital, Rawat jalan
One way to improve efficiency, improve service quality and improve patient safetyin the United States by using the concept of Lean Thinking is applied in hospitalsbecome Lean Hospital. This study analyzes the service flow in Outpatient ClinicSpecialists as the data for improvement in Hospital X which is a Class B PrivateHospital Education. Using the methodology of operational research studies,conducted in-depth observation and interviews show that the non-value addedactivities can be up to 80% and value added activity is only 20%. The data showsthat there has been a waste (waste) and the results of the analysis of the roots ofthe problem using Root Cause Analysis (RCA) demonstrates that there are severalfactors that cause inefficiencies in ambulatory care specialist clinic. the proposedimprovements to reduce waste is divided into three stages, including the short-term, medium-term and long-term is expected to improve outpatient care andpatient satisfaction.
Keywords: Concepts Lean, Lean Thinking, Lean Hospital, Outpatient
Latar Belakang : Waktu tunggu obat merupakan salah satu indikator rumah sakit untuk menilai kualitas pelayanan terhadap pasien. Waktu tunggu yang lama akan berdampak pada penurunan kepuasan pasien yang datang berobat ke rumah sakit. Standar pelayanan minimal waktu tunggu obat yang ditetapkan oleh Kemenkes yaitu kurang dari 60 menit untuk obat racikan dan kurang dari 30 menit untuk obat non racikan. Sepanjang tahun 2024 pencapaian data patient experience Mayapada Hospital Bogor untuk waktu tunggu obat racikan adalah 83% dan non racikan adalah 75%, masih dibawah target yang ditetapkan (>90%).
Tujuan : Menurunkan waktu tunggu obat racikan dan non racikan dengan menggunakan konsep Lean six sigma di Departemen Rawat Jalan Mayapada Hospital Bogor
Metode : Penelitian ini mempunyai desain operational research yang menggabungkan metode kuantitatif dan kualitatif. Peneliti melakukan observasi dengan time motion study. Teknik pengambilan sampel yang digunakan adalah stratified random sampling, dengan total sampel sebanyak 264 pasien yang berobat dan mendapat obat di rumah sakit. Pemilihan sampel didasarkan pada shift berobat, dan jenis penjaminan yang telah ditetapkan.
Hasil : Hasil penelitian dengan pendekatan lean six sigma berhasil mengidentifikasi lead time waktu tunggu obat non racikan di Mayapada Hospital Bogor yaitu sebesar 1 jam 10 menit 45 detik dimana 78% merupakan kegiatan non-value added yang didominasi oleh waste tipe waiting sebesar 49 menit 55 detik. Sedangkan waktu tunggu obat racikan sebesar 57 menit 56 detik dimana 60% merupakan kegiatan non-value added yang didominasi oleh waste tipe waiting sebesar 28 menit 23 detik. Akar masalah dari memanjangnya waktu tunggu obat berada di fase pembayaran obat pada kegiatan konfirmasi penjamin, tunggu bayar dan pada fase penginputan obat pada kegiatan input resep. Penerapan lean six sigma dalam proses waktu tunggu obat racikan di Mayapada Hospital Bogor berhasil mengurangi lead time sebesar 23% post intervensi dan 14% pada tahap kontrol, dari 57 menit 56 detik menjadi 38 menit 30 detik, sedangkan penurunan lead time waktu tunggu obat non racikan mengalami penurunan 25% post intervensi dan 27% pada tahap kontrol, dari 1 jam 10 menit 45 detik menjadi 38 menit 16 detik pada tahap kontrol. Pengurangan lead time ini diikuti dengan penurunan waste di seluruh tahapan waktu tunggu obat, dengan penurunan waste terbesar terjadi pada fase penginputan resep, yaitu sebesar 69%, dari 4 menit 39 detik menjadi 1 menit 58 detik detik untuk obat racikan. Pada fase pembayaran sebesar 63% dari 52 menit 23 detik menjadi 24 menit 35 detik untuk obat non racikan.
Kesimpulan : Terdapat penurunan waktu tunggu obat racikan dan non racikan di Mayapada Hospital Bogor setelah penerapan lean six sigma. Penurunan waktu tunggu obat masih diatas target standar pelayanan minimal yang ditetapkan oleh Mayapada Hospital.
Background : Drug waiting time is one of the hospital indicators to assess the quality of service to patients. Long waiting times will have an impact on reducing the satisfaction of patients who come to the hospital for treatment. The minimum service standard for drug waiting time set by the Ministry of Health is less than 60 minutes for compounding drugs and less than 30 minutes for non compounding drugs. Throughout 2024, the achievement of Mayapada Hospital Bogor's patient experience data for waiting time for compounding drugs was 83% and non- compounding was 75%, still below the set target (>90%) Objective: Reducing the waiting time for compounding and non compounding drugs by using the Lean six sigma concept in the Outpatient Department of Mayapada Hospital Bogor Methodology : This study employs an operational research design combining quantitative and qualitative methods. The researcher conducted observations using a time-motion study. The sampling technique used was stratified random sampling, with a total sample size of 264 patients who received treatment and medication at the hospital. Sample selection was based on the distribution of days, treatment shifts, and types of insurance coverage as defined. Results : The study using the Lean Six Sigma approach successfully identified the lead time for non-compounded medication waiting time at Mayapada Hospital Bogor as 1 hour, 10 minutes, and 45 seconds, with 78% being non-value-added activities dominated by waiting-type waste of 49 minutes and 55 seconds. Meanwhile, the waiting time for compounded medications was 57 minutes and 56 seconds, with 60% being non-value-added activities dominated by waiting-type waste amounting to 28 minutes and 23 seconds. The root cause of the prolonged waiting time for medications lies in the medication payment phase during the insurance confirmation and payment waiting activities, as well as in the medication input phase during the prescription input activities. The implementation of Lean Six Sigma in the waiting time process for compounded medications at Mayapada Hospital Bogor successfully reduced lead time by 23% post-intervention and 14% during the control phase, from 57 minutes and 56 seconds to 38 minutes and 30 seconds. Meanwhile, the reduction in lead time for non-compounded medications decreased by 25% post-intervention and 27% during the control phase, from 1 hour 10 minutes 45 seconds to 38 minutes 16 seconds during the control phase. This reduction in lead time was accompanied by a decrease in waste across all stages of medication waiting time, with the largest reduction in waste occurring during the prescription input phase, amounting to 69%, from 4 minutes 39 seconds to 1 minute 58 seconds for compounded medications. In the payment phase, there was a 63% reduction from 52 minutes 23 seconds to 24 minutes 35 seconds for non-compounded medications. Conclusion : There was a reduction in waiting time for compounded and non-compounded medications at Mayapada Hospital Bogor after the implementation of Lean Six Sigma. The reduction in medication waiting time remains above the minimum service standard target set by Mayapada Hospital.
Latar Belakang : Waktu tunggu sering kali dijadikan indikator untuk menilai kualitas pelayanan rumah sakit oleh pasien. Salah satu aspek yang menjadi perhatian adalah waktu tunggu untuk pemulangan pasien. Data RS Mitra Keluarga Bintaro tahun 2023 menunjukkan rata-rata waktu tunggu pasien adalah 87 menit dengan perbedaan yang cukup signifikan antara pasien dengan penjaminan pribadi (66 menit) dan penjaminan asuransi (121 menit). Data rata-rata waktu tunggu tersebut terhitung sejak dokter memberikan instruksi pulang hingga pasien melakukan billing akhir. Data tersebut belum terhitung hingga pasien meninggalkan ruang rawat inap. Standar pelayanan minimal waktu tunggu pemulangan pasien rawat inap yang ditetapkan oleh Kemenkes yaitu kurang dari 120 menit. Pencapaian waktu tunggu pasien yang keluar dalam waktu ≤ 2 jam tercatat sebesar 88%, meskipun masih belum memenuhi target korporat yang ditetapkan sebesar 100%.
Metode : Penelitian ini mengadopsi desain operational research yang mengintegrasikan metode kuantitatif dan kualitatif. Teknik pengambilan sampel yang digunakan adalah simple random sampling, dengan total sampel sebanyak 38 pasien yang pulang setelah menjalani rawat inap. Pemilihan sampel didasarkan pada distribusi hari, jam kepulangan, dan jenis metode penjaminan yang telah ditetapkan.
Hasil : Hasil penelitian dengan pendekatan lean six sigma berhasil mengidentifikasi lead time pemulangan pasien rawat inap di RS Mitra Keluarga Bintaro sebesar 5 jam 10 menit 54 detik dimana 69% merupakan kegiatan non value added yang didominasi oleh waste tipe waiting sebesar 3 jam 14 menit 23 detik. Akar masalah dari memanjangnya waktu tunggu pemulangan pasien rawat inap berada di fase III pada kegiatan menunggu pasien meninggalkan ruang rawat inap. Penerapan lean six sigma dalam proses pemulangan pasien rawat inap di RS Mitra Keluarga Bintaro berhasil mengurangi lead time sebesar 16%, dari 5 jam 10 menit 54 detik menjadi 4 jam 21 menit 25 detik. Pengurangan lead time ini diikuti dengan penurunan waste di seluruh tahapan pemulangan pasien, dengan penurunan waste terbesar terjadi pada fase I, yaitu sebesar 44%, dari 1 jam 3 menit 27 detik menjadi 35 menit 46 detik.
Kesimpulan : Terdapat penurunan waktu tunggu pemulangan pasien rawat inap di RS Mitra Keluarga Bintaro setelah penerapan lean six sigma. Penurunan waktu tunggu pemulangan pasien rawat inap masih diatas target standar pelayanan minimal yang ditetapkan oleh Kemenkes.
Background : Waiting time is often used as an indicator to assess the quality of hospital services by patients. One aspect of concern is the waiting time for patient discharge. Data from Mitra Keluarga Bintaro Hospital in 2023 showed that the average patient waiting time was 87 minutes with a significant difference between patients with personal guarantees (66 minutes) and insurance guarantees (121 minutes). The average waiting time data is calculated from when the doctor gives instructions to go home until the patient makes the final billing. The data does not include until the patient leaves the inpatient room. The minimum service standard for inpatient discharge waiting time set by the Ministry of Health is less than 120 minutes. The achievement of waiting time for patients who leave within ≤ 2 hours was recorded at 88%, although it still does not meet the corporate target set at 100%. Method : This study adopted an operational research design that integrates quantitative and qualitative methods. The sampling technique used was simple random sampling, with a total sample of 38 patients who returned home after undergoing inpatient care. Sample selection was based on the distribution of days, hours of discharge, and types of guarantee methods that had been determined. Hasil : The results of the study using the lean six sigma approach successfully identified the lead time for inpatient discharge at Mitra Keluarga Bintaro Hospital of 5 hours 10 minutes 54 seconds, where 69% were non-value added activities dominated by waiting type waste of 3 hours 14 minutes 23 seconds. The root of the problem of the long waiting time for inpatient discharge is in phase III in the activity of waiting for the patient to leave the inpatient room. The application of lean six sigma in the inpatient discharge process at Mitra Keluarga Bintaro Hospital successfully reduced the lead time by 16%, from 5 hours 10 minutes 54 seconds to 4 hours 21 minutes 25 seconds. This reduction in lead time was followed by a decrease in waste in all stages of patient discharge, with the largest decrease in waste occurring in phase I, which was 44%, from 1 hour 3 minutes 27 seconds to 35 minutes 46 seconds. Kesimpulan : There is a decrease in the waiting time for discharge of inpatients at Mitra Keluarga Bintaro Hospital after the implementation of lean six sigma. The decrease in the waiting time for discharge of inpatients is still above the minimum service standard target set by the Ministry of Health.