Latar Belakang: Waktu tunggu radioterapi merupakan salah satu indikator mutu penting dalam pelayanan onkologi karena keterlambatan memulai terapi dapat memengaruhi luaran klinis, pengalaman pasien, dan mutu layanan rumah sakit. RS Hermina Bekasi mengalami peningkatan kebutuhan layanan radioterapi yang tidak sepenuhnya diimbangi oleh kapasitas pelayanan sehingga menimbulkan antrean dan waktu tunggu yang panjang. Penelitian ini bertujuan menganalisis penerapan Lean Six Sigma dalam mengurangi waktu tunggu radiasi pertama di RS Hermina Bekasi. Metode: Penelitian menggunakan desain operational research dengan pendekatan mixed methods explanatory sequential. Pengumpulan data kuantitatif dilakukan melalui time-motion study terhadap pasien BPJS dengan seluruh diagnosis kanker yang menjalani pelayanan radioterapi sejak konsultasi dokter onkologi radiasi hingga radiasi pertama. Sampel terdiri atas 55 pasien periode pre-intervensi, 55 pasien periode post-intervensi, dan 50 pasien periode control. Data kualitatif diperoleh melalui observasi, telaah dokumen, wawancara, dan Focus Group Discussion. Analisis dilakukan menggunakan pendekatan Lean Six Sigma melalui tahapan DMAIC (Define, Measure, Analyze, Improve, Control), pemetaan alur proses, Value Stream Mapping, identifikasi aktivitas value added dan non-value added, analisis Pareto, Five Whys, serta Statistical Process Control. Hasil: Sebelum intervensi, total lead time pelayanan radioterapi mencapai 70,05 hari, dengan waktu terpanjang pada tahap konsultasi dokter onkologi radiasi hingga CT Simulator sebesar 61,44 hari. Aktivitas value added sebesar 5,87 hari (8,38%), sedangkan aktivitas non-value added sebesar 64,18 hari (91,62%). Waste dominan adalah waiting, terutama menunggu jadwal CT Simulator akibat keterbatasan kapasitas layanan dan ketersediaan slot LINAC. Intervensi yang dilakukan meliputi penambahan LINAC kedua, penambahan dokter spesialis onkologi radiasi, pengembangan dashboard monitoring antrean radioterapi terintegrasi SIMRS, perbaikan SPO penjadwalan pasca CT Simulator menggunakan kartu kontrol pasien, serta standarisasi pelaksanaan PSQA sebelum radiasi pertama. Setelah intervensi, total lead time menurun menjadi 31,05 hari, sedangkan pada tahap control menurun lebih lanjut menjadi 19,60 hari. Aktivitas value added meningkat menjadi 6,15 hari (19,81%) dan aktivitas non-value added menurun menjadi 24,88 hari (80,13%). Hasil control chart menunjukkan variasi proses yang lebih stabil dibandingkan sebelum intervensi. Kesimpulan: Penerapan Lean Six Sigma mampu mengurangi waktu tunggu radiasi pertama dan meningkatkan efisiensi alur pra-terapi radioterapi di RS Hermina Bekasi. Perbaikan terutama terjadi pada tahapan konsultasi hingga CT Simulator sebagai bottleneck utama pelayanan. Kombinasi peningkatan kapasitas, standarisasi proses, penguatan sistem monitoring, dan pengendalian berkelanjutan terbukti efektif dalam mendukung pencapaian indikator mutu prioritas rumah sakit berupa waktu tunggu radiasi pertama ≤30 hari.

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Background: Waiting time for radiotherapy is an important quality indicator in oncology services because delays in treatment initiation may adversely affect clinical outcomes, patient experience, and hospital service quality. Hermina Bekasi Hospital has experienced increasing demand for radiotherapy services that has not been fully matched by service capacity, resulting in long waiting lists and prolonged waiting times. This study aimed to analyze the implementation of Lean Six Sigma in reducing waiting time to first radiation treatment at Hermina Bekasi Hospital. Methods: An operational research design with a mixed-methods explanatory sequential approach was employed. Quantitative data were collected through a time-motion study involving BPJS-insured patients with all cancer diagnoses undergoing radiotherapy services from radiation oncology consultation to first radiation treatment. The study included 55 patients in the pre-intervention phase, 55 patients in the post-intervention phase, and 50 patients in the control phase. Qualitative data were obtained through observation, document review, interviews, and focus group discussions. Data were analyzed using the Lean Six Sigma DMAIC framework, process mapping, Value Stream Mapping, value-added and non-value-added analysis, Pareto analysis, Five Whys analysis, and Statistical Process Control. Results: Before the intervention, total radiotherapy service lead time was 70.05 days, with the longest delay occurring between radiation oncology consultation and CT simulation (61.44 days). Value-added activities accounted for 5.87 days (8.38%), while non-value-added activities accounted for 64.18 days (91.62%). The dominant waste was waiting, particularly for CT simulation scheduling, primarily caused by limited service capacity and LINAC slot availability. Interventions included the addition of a second LINAC, recruitment of an additional radiation oncologist, development of a radiotherapy queue monitoring dashboard integrated with the hospital information system, revision of post-CT simulation scheduling procedures using patient control cards, and standardization of PSQA implementation before first radiation treatment. Following the intervention, total lead time decreased to 31.05 days and further decreased to 19.60 days during the control phase. Value-added activities increased to 6.15 days (19.81%), while non-value-added activities decreased to 24.88 days (80.13%). Control chart analysis demonstrated improved process stability compared with the pre-intervention period. Conclusion: Lean Six Sigma implementation successfully reduced waiting time to first radiation treatment and improved the efficiency of the radiotherapy pre-treatment process at Hermina Bekasi Hospital. The most substantial improvement occurred in the consultation-to-CT simulation stage, which was identified as the primary service bottleneck. A combination of capacity expansion, process standardization, monitoring system enhancement, and continuous control proved effective in supporting the hospital’s priority quality indicator of maintaining waiting time to first radiation treatment within 30 days.

Rumah sakit perlu menjaga mutu layanan yang diberikan kepada pasien. Waktu tunggu rawat jalan merupakan salah satu indikator mutu yang diukur oleh rumah sakit. Rerata waktu tunggu di Klinik Penyakit Dalam Charitas Hospital Palembang yang mencapai target hanya sebesar 54%. Penelitian ini merupakan penelitian operasional eksperimental untuk melihat bagaimana upaya perbaikan dengan penerapan Metode Lean Six Sigma (LSS) dapat mereduksi waktu tunggu pasien rawat jalan. Upaya perbaikan berupa penerapan sistem perjanjian dan simplifikasi alur pasien rawat jalan sesuai future state map dilakukan rumah sakit pada April 2021 sampai dengan Januari 2022. Data waktu tunggu pasien rawat jalan sebelum upaya perbaikan diambil dari sistem informasi dan manajemen rumah sakit (SIMRS) pada Maret 2021, sedangkan data sesudah upaya perbaikan diambil dari Februari sampai Maret 2022, dengan 222 subjek pada masingmasing kelompok. Terdapat reduksi waktu tunggu pasien rawat jalan sesudah upaya perbaikan, yaitu secara keseluruhan subjek sebesar 11% dari 79 menit menjadi 69 menit meskipun tidak bermakna secara statistik (p=0,110). Pada subjek tanpa pemeriksaan penunjang terdapat reduksi waktu tunggu pasien rawat jalan sebesar 16% dari 77 menit menjadi 65 menit (p=0,016), pada subjek dengan pemeriksaan laboratorium dari 151 menit menjadi 124 menit (p=0,176), dan pada subjek dengan pemeriksaan radiologi dari 120 menit menit menjadi 90 menit. Terdapat reduksi waktu tunggu rawat jalan berdasarkan definisi SPM sebesar 29%, yaitu dari 58 menit menjadi 41 menit (p=0,002). Terdapat 26% subjek dengan sistem perjanjian yang datang terlambat. Subjek yang datang terlambat dilakukan relokasi slot, yaitu mengisi slot kosong sesuai antrian pasien yang sudah datang. Apabila dilakukan analisis terhadap subjek yang datang tepat waktu saja, didapatkan adanya reduksi median waktu tunggu pasien rawat jalan sebesar 13%, yaitu dari 79 menit menjadi 69 menit (p=0,014) dan reduksi waktu tunggu rawat jalan berdasarkan SPM sebesar 36%, yaitu dari 58 menit menjadi 37 menit (p=0,000). Khusus pada kelompok pasien dengan pemeriksaan laboratorium, terjadi pengurangan variasi alur cabang dan proporsi pasien yang menjalani alur cabang (p=0,000), serta pengurangan frekuensi kunjungan ke kasir lebih dari satu kali. Rancangan upaya perbaikan yang disusun berdasarkan metode LSS bermanfaat dalam mereduksi waktu tunggu pasien rawat jalan, mengurangi variasi alur cabang di rawat jalan, dan menurunkan defek, dengan komitmen dari pimpinan rumah sakit, dokter, staf, dan pasien. Evaluasi berkala dan perbaikan berkesinambungan perlu dilakukan agar kontinuitas reduksi waktu tunggu pasien rawat jalan dapat berlangsung

Hospital should maintain good quality of care for its patients. Outpatient waiting time is a quality indicator measured by hospital. Only 54% of outpatient waiting time in Internal Medicine Clinic of Charitas Hospital Palembang meets the standard. An experimental study was conducted to examine how Lean Six Sigma (LSS) Methodology would reduce outpatient waiting time. Improvement project comprised of appointment system and outpatient flow simplification was conducted from April 2021 to January 2022. Pre-implementation data was taken from hospital information system on March 2021 and post- implementation data from February to March 2022, with a sample size of 222 subjects in each group. There was an 11% reduction in overall median outpatient waiting time i.e, from 79 minutes to 69 minutes eventhough statistically insignificant (p=0.110), with 16% reduction from 77 minutes to 65 minutes in subjects without ancillary examination (p=0.016), 18% reduction from 151 minutes to 124 minutes in those with laboratory examination (p=0.176), and 25% reduction from 120 minutes to 90 minutes in those with radiology examination. There was a 29% reduction from 58 minutes to 41 minutes in median outpatient waiting time as defined by government minimal standard of care (p=0.002). As many as 26% subjects with appointment system came late, which were then relocated to the available slots. Comparison was conducted between waiting time before intervention and after intervention in groups of appointment patients who came on-time and resulted in a 13% reduction of median outpatient waiting time from 79 minutes to 69 minutes (p=0,014) as well as a 36% reduction in waiting time as defined by government minimal standard of care from 58 minutes to 36 minutes (p=0,000). In subjects with laboratory examination, there was a reduction in the number of patients undergoing branch lines flow (p=0.000). Improvement project designed using LSS methodology is beneficial in reducing outpatient waiting time, variation in outpatient flow, and defect, especially when supported by commitment of hospital leaders, doctors, staffs, and patients. Regular evaluation and continuous improvement are needed to ensure sustainable reduction of outpatient waiting time. Key words: waiting time, outpatient department, hospital

Latar belakang: Medical Check Up rutin sangat penting untuk deteksi dini masalah kesehatan akibat kerja, sejalan dengan regulasi K3 yang mewajibkan medical check up. Waktu tunggu yang lama dalam layanan medical check up dapat mengurangi efisiensi dan kepuasan pasien. Deteksi dini membantu mencegah risiko kesehatan serius, namun efisiensi waktu tunggu perlu diperbaiki untuk menjaga kualitas layanan. Pengelolaan waktu tunggu menjadi kunci menciptakan lingkungan kerja yang aman dan pelayanan yang optimal. Tujuan penelitian: penelitian ini bertujuan untuk mendapatkan hasil analisis waktu tunggu pada Medical Check Up menggunakan metode Lean Six Sigma di Klinik X Sudirman tahun 2024. Metodologi penelitian: penelitian ini menggunakan observasi dengan teknik time motion study, wawancara mendalam, dan telaah dokumen dengan pendekatan kuantitatif dan kualitatif. Sampel penelitian diambil menggunakan metode purposive sampling dengan jumlah 30 responden. Hasil penelitian: hasil penelitian ini menunjukkan non value added terbanyak pada tahapan treadmill selama 41 menit 44 detik (71%) pada jenis waste waiting dan transportation. Kedua pada tahapan EKG dengan non value added selama 34 menit 13 detik (70%) dengan jenis waste waiting.  Ketiga pada tahapan urine selama 7 menit 53 detik (68%) dengan jenis waste waiting dan transportation dari keseluruhan kegiatan value-added sebesar 2 jam 10 menit 20 detik atau 56% dan kegiatan non value-added sebesar 2 jam 1 menit 20 detik atau 44%.

**Background:** Routine medical check-ups are essential for the early detection of health issues caused by work-related factors, in alignment with occupational health and safety (OHS) regulations that mandate medical check-ups. Long waiting times during medical check-up services can reduce efficiency and patient satisfaction. Early detection helps prevent serious health risks; however, waiting time efficiency needs improvement to maintain service quality. Managing waiting times is crucial to creating a safe working environment and delivering optimal services.  **Research Objective:** This study aims to analyze waiting times during medical check-ups using the Lean Six Sigma method at Clinic X Sudirman in 2024.  **Research Methodology:** The study uses observation with time-motion study techniques, in-depth interviews, and document review, adopting both quantitative and qualitative approaches. The research sample was selected using purposive sampling, consisting of 30 respondents.  **Research Results:** The study found the highest non-value-added activity occurred in the treadmill phase, lasting 41 minutes and 44 seconds (71%) due to waiting and transportation waste. The second-highest was in the EKG phase, with 34 minutes and 13 seconds (70%) of non-value-added activities due to waiting waste. The third was in the urine phase, with 7 minutes and 53 seconds (68%) of non-value-added activities due to waiting and transportation waste. Overall, value-added activities accounted for 2 hours, 10 minutes, and 20 seconds (56%), while non-value-added activities totaled 2 hours, 1 minute, and 20 seconds (44%).