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Mutu pelayanan kesehatan sangat dipengaruhi oleh waktu tunggu pasien, yang merupakan indikator penting dari kepuasan pasien. Peraturan Menteri Kesehatan No. 129 menetapkan waktu tunggu maksimal 60 menit untuk pelayanan rawat jalan. RSUD Pasar Minggu telah menerapkan reservasi online untuk mengurangi waktu tunggu, namun waktu tunggu di klinik rehabilitasi medik masih tinggi. Oleh karena itu, penelitian ini menggunakan pendekatan Lean untuk mengidentifikasi dan mengurangi pemborosan dalam proses pelayanan. Metodologi : Penelitian ini menggunakan desain action-research dengan pendekatan kualitatif, 24 pasien BPJS klinik rehabilitasi medik yang mendaftar melalui online akan dijadikan sampel sebagai data observasi waktu tunggu dengan metode time-motion Hasil : Hasil penelitian dengan pendekatan Lean berhasil mengidentifikasi waste waiting pada tahap pelayanan dokter sebagai waste tertinggi, akar masalah yang ditemukan pada waktu tunggu pelayanan dokter yang lama teridentifikasi metode fishbone analysis mencakup kurangnya SDM, tata letak ruangan, serta belum adanya SPO pada pelayanan pasien pendaftaran online. Intervensi dilakukan mengikuti prinsip Lean yaitu standardized work dan visual management. Berdasarkan perhitungan future state map secara simulatif dapat menurunkan lead time dari 2 jam 28 menit menjadi 1 jam 46 menit dengan penurunan persentase aktivitas non value added (¯28%). Ksesimpulan : kombinasi penerapan prinsip Lean yang dibutuhkan mencakup prinsip heijunka, standardized work, visual management, dan 5S dapat waste (NVA) dari 2 jam menjadi 1 jam 16 menit (¯63%).
The quality of healthcare services is significantly influenced by patient waiting times, which are a crucial indicator of patient satisfaction. The Ministry of Health Regulation No. 129 sets a maximum waiting time of 60 minutes for outpatient services. RSUD Pasar Minggu has implemented online reservations to reduce waiting times; however, waiting times at the medical rehabilitation clinic remain high. Therefore, this study uses a Lean approach to identify and reduce inefficiencies in the service process. Methodology : This study uses an action-research design qualitative approaches, employing probability sampling to select a sample of 24 BPJS patients who registered online at the medical rehabilitation clinic. Results : The Lean approach identified "waiting" waste at the doctor service stage as the highest waste. The root cause analysis using the fishbone method identified long doctor service waiting times caused by the shortage of human resources, inefficient room layout, and the absence of Standard Operating Procedures (SPO) for online registration patients. Interventions were implemented following Lean principles, including standardized work and visual management. A future state map simulation showed that lead time could be reduced from 2 hours 28 minutes to 1 hour 46 minutes, with a 28% reduction in non-value-added activities. Conclusion : The combination of Lean principles needed includes heijunka, standardized work, visual management, and 5S. These principles successfully reduced non-value-added activities from 2 hours to 1 hour 16 minutes, a 63% decrease.
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
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
Waiting time is one indicator of health services. The increase in waiting time in the Emergency Department (ED) has an impact on longer treatment days, increased mortality and reduced patient satisfaction. The purpose of this study was to determine the length of stay for services at the emergency department of the Tangerang General Hospital using lean method to determine waste at each stage of activity. This research method is operational research with qualitative and quantitative approaches, primary data sources taken from direct observation using time motion study techniques and in-depth interviews. The waiting time at the ER at the Tangerang Regency General Hospital is 852.92 minutes for inpatients and 564.24 minutes for outpatients. The length of time for each service is as follows: triage is 11.83 minutes, waiting time for an emergency room doctor examination is 32.25 minutes, drug administration time and action is 22.33 minutes, waiting time for laboratory examination is 106.07 minutes, waiting time for examination radiology 140.15 minutes, waiting time for specialist doctor consultation 146.54 minutes, waiting time for inpatient registration 164.8 minutes, waiting time for inpatient admission 58.5 minutes, patient administration time going home 89.6 minutes. The largest nonvalued added activity is waiting for specialist consultations. Found 2 types of waste, namely waiting (93.3%) and motion (6.7%). After conducting an analysis using the 5 why method, the root of the problem was found in the number of nurses, not yet maximally carrying out tupoksi, hospital information system applications that are less user friendly, specialist doctors are not standby and consultation SOPs are not optimally run, lack of clinical experience of doctors ER, as well as the unavailability of the ward. The conclusion, t the waiting time in the ER at the Tangerang General Hospital exceeds the standard time (4 hours). The lean approach is appropriate to look for waste in health service activities so that problem solving efforts can be obtained to improve service waiting times in the IGD RSU Tangerang Gneral Hospital
ABSTRAK Nama : Nikensari Koesrindartia ProgramStudi : Kajian Administrasi RumahSakit Judul : EVALUASI SISTEM ANTRIAN PENDAFTARAN ONLINE TERJADWAL WAKTU LAYANAN BAGI RUJUKAN BPJS DI POLIKLINIK RAWAT JALAN RSUD BUDHI ASIH TAHUN 2016 – 2017 Penelitian ini adalah Studi Kasus dilakukan dengan pendekatan kualitatif eksploratif yang secara umum bertujuan mengevaluasi Kebijakan Sistem Antrian Pendaftaran Online Terjadwal Waktu Layanan yang selanjutnya disebut sebagai (SI ALI JADUL) pada pasien rujukan BPJS di Poliklinik Rawat Jalan RSUD Budhi Asih Jakarta Timur. Penelitian dilakukan selama Bulan April – Mei 2017. Data kualitatif (primer) berupa FGD dan wawancara mendalam, dilengkapi data kuantitatif (sekunder) berupa dokumen data sampel penelitian Bulan September 2016 - April 2017 serta observasi lapangan. Hasil penelitian menunjukkan pemanfaatan SI ALI JADUL selama 8 bulan implementasi sebesar 70,14%. Distribusi pendaftaran pasien berasal dari poliklinik sebesar 59,07%, loket penjadwalan sebesar 15,10%, ,kontrol rawat inap sebesar 9,32%, pre-operasi sebesar 4,57%, Sistem Penjadwalan Rujukan Online ( SPRO) dari puskesmas sebesar 9,32% dan Web/Android sebesar 3,69%. Pada evaluasi kinerja, capaian efektifitas SI ALI JADUL, yaitu ketepatan waktu kehadiran pasien. Jumlah pasien terbanyak pada Kategori Hadir Tepat Waktu sebesar 73,08%, yaitu hadir di masa cetak SEP 30 menit sebelum slot penjadwalan jam layanan, Dan jumlah pasien paling sedikit pada Kategori Hadir Mendahului Waktu 240 menit atau lebih sebesar (0,06%) sebelum slot penjadwalan jam layanan. Capaian efisiensi SI ALI JADUL yaitu ketepatan waktu tunggu mendapatkan layanan. Peringkat pertama jumlah pasien terbanyak pada Kategori Waktu Tunggu Layanan (60-120 menit) sebesar 28,78% . Sedangkan Kategori Waktu Tunggu Layanan Tepat Waktu, sesuai SPM Rawat Jalan (≤ 60 menit) berada di peringkat keempat sebesar 16,13%. Identifikasi Critical Factor Succes SI ALI JADUL, didapatkan kategori High Priority sebesar 75%, kategori Medium Priority sebesar 20 % dan kategori Low Priorty sebsar 5 % . Kemudian dilakukan Analisa Fit/Gap SI ALI JADUL didapatkan Kategori Fit sebesar 45% , kategori Partial Fit sebesar 25 % dan kategori Gap sebesar 25%. Kata Kunci : CFS; Evaluasi ; Fit/Gap Analysis; Sistem Antrian Pendaftaran Online Terjadwal Waktu Layanan (SI ALI JADUL)
ABSTRACT Nama : Nikensari Koesrindartia Programme Study : Study of Hospital Administration Judul : EVALUATION OF ONLINE APPOINTMENT REGISTRATION SYSTEM WITH SCHEDULED SERVICING TIME FOR BPJS PATIENTS ON OUTPATIENT CLINICS AT RSUD BUDHI ASIH FOR 2016 - 2017 This research is a studied case that conducted with qualitative and explorative approachs with main objective is to evaluate a policy implementation of Online Appointment Registration System with Scheduled Servicing Time (SI ALI JADUL) for BPJS patients in outpatient Clinics at RSUD Budhi Asih East Jakarta for 2016 – 2017.This research has been conducted in 2 months (April-May 2017) and sampled data taken from RSUD Budhi Asih East Jakarta. Qualitative data taken from Focus Group Discussion and exhaustive interviewed. Equipped with Quantitative secondary data such as reviewed internal documentation and site observation. Result of this research is found that average utilization of SI ALI JADUL online system during 8 months implementation is 70,14%. Distribution of patients registration from polyclinic registration is 59,07%, Scheduled on-site registration is 15,10%, inpatient controlling registration is 9,32%, pre-operation registration is 4,57%.Online appointment source from government primary health care (Puskesmas) through Online Scheduled Appointment Patient System (SPRO) is 9,32% and data from web internet and android application is 3,69%. From performance evaluation of effectivity of SI ALI JADUL shown that patients who visit to hospital have 3 visiting time category i.e.: Advanced time, accurate time, and delayed time category. The most patients is accurate time category (73,08%), this category for patients who came in =<30 minutes before clinic servicing time. The less patients is advanced time category (0,06%), this category for patients who came in =<240 minutes before clinic servicing time. From performance evaluation of efficiency of SI ALI JADUL is accuracy of patients waiting time to be serviced.The first rank is waiting time category 60-120 min. (28,78%), The fourth rank is accurate time category =<60 min. (16,13%). Critical Factor Success for Successful of SI ALI JADUL online system have 3 category i.e.: High priority is 75%, Medium priority is 20%, and Low priority is 5%.Then from Fit/Gap analysis of SI ALI JADUL found that Fit category is 45%, Partial Fit category is 25% and Gap category is 25%. Key Words : CFS – Evaluation - Fit/GapAnalyze – Online Appointment Registration System With Scheduled Servicing Time
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.