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Tulus Kurnia Indah; Pembimbing: Ede Surya Darmawan; Penguji: Helen Andriani, Rakhmat Hidayat, Nugraharti, Erwien Sri Ujianto
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Latar Belakang: Proses perawatan di rumah sakit didukung oleh berbagai aktivitas operasional diantaranya pengelolaan logistik dan distribusi perbekalan farmasi. Biaya perbekalan kesehatan merupakan pengeluaran terbesar kedua di rumah sakit setelah belanja pegawai, oleh sebab itu pimpinan rumah sakit perlu mengidentifikasi peluang untuk meningkatkan proses logistik untuk menurunkan biaya dan meningkatkan kualitas pelayanan kesehatan. Untuk meningkatan proses logistik diperlukan pemahaman terkait kinerja rantai pasokan yang saat ini berjalan, sehingga melakukan analisa kinerja rantai pasokan merupakan hal mendasar untuk mengatasi kekurangan dalam aktivitas logistik. Tujuan: Studi ini bertujuan melakukan analisa terkait waste yang ada pada proses perencanaan dan pengadaan obat di RSUPN Dr. Cipto Mangunkusumo, kemudian mencari penyebab dan akar masalah timbulnya pemborosan. Metode: Penelitian ini menggunakan metode kualitatif dengan pendekatan studi kasus. Lokasi penelitian di RSUPN Dr. Cipto Mangunkumo bulan April-Mei 2024. Data primer diperoleh melalui wawancara dengan key specialist informan yang terkait dengan kegiatan perencanaan dan pengadaan dan observasi lapangan. Data sekunder diperoleh dari telaah data realisasi pemakaian obat tahun 2022, data usulan perencanaan dari unit kerja dan hasil rekapitulasi instalasi farmasi tahun 2023, data daftar barang dalam kontrak tahun 2023, datapenerimaan dan data pemakaian obat tahun 2023. Tahapan penelitian disusun berdasarkan lean six sigma dari mulai define, measure, analyze dan improve. Hasil: Jenis waste yang terjadi diantaranya penyedia tidak mengirimkan obat terhadap item perencanaan yang telah memiliki kontrak, obat yang dipesan dan dikirim tetapi tidak memiliki realisasi penggunaan, penyedia bersedia mengirimkan obat tetapi tidak mau berkontrak dengan rumah sakit, penyedia tidak bersedia mengirimkan obat dan tidak mau berkontrak dengan rumah sakit dan adanya pengadaan lain di luar jalur kontrak utama. Dari seluruh waste yang ada terjadinya pengadaan di luar jalur kontrak utama merupakan jumlah waste yang paling sering terjadi sehingga menjadi area improvement pada penelitian ini. Penyebab dari pemborosan yang masih dapat dikontrol oleh internal rumah sakit adalah keterlambatan penerbitan kontrak. Akar masalahnya karena tiap unit kerja yang terkait dengan kegiatan perencanaan dan pengadaan menyelesaikan proses kerja tanpa mempertimbangkan waktu penyelesaian proses sesudahnya, sehingga tujuan dari perencanaan dan pengadaan yang berupa penerbitan kontrak sebelum tahun anggaran menjadi tidak terlaksana. Kesimpulan: Dalam proses yang berjalan secara berkelanjutan diperlukan proses kerja yang terintegrasi berdasarkan komitmen setiap anggota rantai agar tujuan proses tersebut dapat tercapai.
Introduction: The hospital care process is supported by various operational activities including logistics management and distribution of pharmaceutical supplies. The cost of health supplies is the second largest expenditure in hospitals after personnel expenditure, therefore hospital leaders need to identify opportunities to improve logistics processes to reduce costs and improve the quality of health services. To improve logistics processes, an understanding of current supply chain performance is required, so analyzing supply chain performance is fundamental to overcoming deficiencies in logistics activities. Objective: This study aims to analyze waste in the drug planning and procurement at RSUPN Dr. Cipto Mangunkusumo, then looked for the causes and root causes of waste. Method: This research uses qualitative methods with a case study approach. The research location is at RSUPN Dr. Cipto Mangunkumo on April-May 2024. Primary data was obtained through interviews with key specialist informants related to planning and procurement activities and field observations. Secondary data was obtained from a review of drug use in 2022, drug planning proposals from units and results of drug planning recapitulation by pharmaceutical installations in 2023, list of drugs in contracts 2023, drug receive order and drug use in 2023. The research stages were arranged based on lean six sigma method from define, measure, analyze and improve. Results: Types of waste that occur include supplier not sending drugs from planning items that already have a contract, drugs ordered and sent but not having actual use, suppliers willing to send drugs but refusev to contract with the hospital, suppliers refuse to send drugss and refuse to contracts with hospitals and procurements that come from another its main contracts. The procurements that come from another its main contract occurs most frequently, so it is an area of improvement in this research. The cause of waste that can still be internally controlled by the hospital is delays in issuing contracts. The root of the problem is because each unit related to planning and procurement activities completes the process without considering the completion time of the process afterwards, so that the aim of planning and procurement to complete all the procurement contract before end of the year do not achieved. Conclusion: In a process that runs continuously, an integrated work process is needed based on the commitment of each member of the chain so that the process objectives can be achieved.
B-2469
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Aurelianne; Pembimbing: Mardiati Nadjib; Penguji: Amal Chalik Sjaaf, Masyitoh, Novita D. Istanti, Suriadi
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Standar Pelayanan Minimal di rumah sakit menjadi acuan dalam mencapai mutu yang baik di sebuah institusi ataupun rumah sakit. Keputusan Menteri Kesehatan Nomor 129 tahun 2008 telah mengatur SPM waktu tunggu yang diperlukan oleh pasien sejak mendaftar hingga mendapatkan pelayanan dokter yaitu tidak lebih dari 60 menit. Dalam pelayanannya Tzu Chi Hospital tentu tidak terlepas dari beberapa kendala yang terjadi selama pelayanan baik kendala yang disebabkan oleh sarana dan prasarana, administratif maupun yang berasal dari SDM. Data waktu kedatangan dokter spesialis anak, waktu keterlambatan mencapai 1 jam 15 menit dan telah melebihi aturan SPM waktu tunggu pelayanan < 60 menit. Oleh karena itu penelitian ini bertujuan untuk mengidentifikasi penyebab lamanya waktu tunggu rawat jalan serta mengembangkan usulan perbaikan waktu tunggu poliklinik rawat jalan spesialis anak Tzu Chi Hospital. Penelitian ini merupakan penelitian kualitatif dengan metode pengumpulan data yang didapatkan melalui pengamatan dan pencatatan waktu tunggu rawat jalan spesialis anak, serta menggali informasi secara mendalam dan rinci kepada infroman baik informan dalam maupun pasien penerima layanan rawat jalan spesialis anak di Tzu Chi Hospital dan melakukan telaah dokumen. Dilakukan observasi dan wawancara mendalam terhadap 33 pasien di shift yang berbeda setiap harinya sehingga didapatkan value perspektif customer sesuai dengan prinsip metode Lean Six Sigma. Data yang diperoleh kemudian dianalisis untuk mendapat faktor penyebab adanya keterlambatan pelayanan menggunakan fishbone diagram yang dikelompokkan ke dalam kategori Man, Machine, Method, Money dan Environment sehingga penyebab masalah teridentifikasi dan dapat dirumuskan prioritas usulan perbaikan yang perlu dilakukan. Hasil penelitian yang dilakukan di bulan Oktober-November 2023 didapatkan rata – rata total waktu yang dibutuhkan untuk satu pasien melakukan pemeriksaan rawat jalan di poliklinik spesialis anak yaitu dari proses pendaftaran hingga pasien mengambil obat di instalasi farmasi adalah sebanyak 161,25menit atau sebanyak 2 jam 41 menit 15 detik. Beberapa faktor yang menjadi penyebab adanya non value added dan waste yang terjadi adalah keterlambatan dokter spesialis yang masih melakukan memeriksa pasien rawat inap atau menangani pasien di fasilitas kesehatan lain. Selain itu kemampuan dan kurangnya petugas di pelayanan rawat jalan spesialis anak juga menyebabkan adanya waste yang terjadi, dan ketersediaan alat, BHP dan fasilitas pendukung kegiatan yang terbatas turut mendukung adanya waste dan mengakibatkan banyaknya non value added yang teridentifikasi tentunya menyebabkan pasien menunggu. Kedepannya peneliti mengharapkan strategi perbaikan yang telah diberikan dapat terus diterapkan untuk memperbaiki dan mengeliminasi kegiatan non value added yang terjadi yaitu dengan menambah SDM yang mendukung dan membuat platform yang dapat dimanfaatkan untuk menyimpan data saat SIMRS mengalami gangguan.
Minimum Service Standards in hospitals are a reference in achieving good quality in an institution or hospital. Minister of Health Decree Number 129 of 2008 has regulated the SPM for the waiting time required by patients from registering to receiving doctor's services, namely no more than 60 minutes. In its services, Tzu Chi Hospital certainly cannot be separated from several obstacles that occur during the service, both obstacles caused by facilities and infrastructure, administrative and those originating from human resources. From the data on the arrival time of pediatricians, the delay time reached 1 hour 15 minutes and this specialist doctor's delay certainly exceeded the SPM rule for waiting time for service < 60 minutes. Therefore, this study aims to identify the causes of long waiting times for outpatient care and develop proposals for improving the waiting time for Tzu Chi Hospital's pediatric specialist outpatient clinic. This research is a qualitative research with data collection methods obtained through observing and recording waiting times for pediatric specialist outpatient care, as well as digging in-depth and detailed information from informants at Tzu Chi Hospital and reviewing documents. Observations and in-depth interviews were carried out on 33 patients in different shifts every day to obtain customer perspective values in accordance with the principles of the Lean Six Sigma method. Data is analyzed to determine the factors causing service delays using a fishbone diagram which is grouped into the categories Man, Machine, Method, Money and Environment so that the causes of the problems identified can prioritize recommendations for improvements that are suitable and need to be formulated. The results of research conducted in October-November 2023 showed that the average total time required for one patient to undergo an outpatient examination at a pediatric specialist polyclinic, namely from the registration process until the patient picks up the medicine at the pharmacy installation, was 161.25 minutes or as much as 2 hours 41 minutes 15 seconds. Several factors that cause non-value added and waste that occur are delays in specialist doctors who are still examining inpatients or treating patients in other health facilities, the capacity and lack of staff in specialist pediatric outpatient services also causes waste to occur, and the limited availability of equipment, BHP and activity support facilities also supports the existence of waste and results in a large number of non-value added being identified in which causes patients to wait. In the future, researcher hope that the improvement strategies that have been provided can continue to be implemented to improve and eliminate non-value added activities that occur, namely by adding supporting human resources and creating a platform that can be used to store data when SIMRS experiences problems.
B-2484
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Ahmad Riza`i; Pembimbing: Pujiyanto; Penguji: Masyitoh, Purnawan Junadi, Ratna Dwi Restuti, Yogi Prabowo
B-1942
Depok : FKM UI, 2018
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Kristanti Diliasari; Pembimbing: Dumilah Ayuningtyas; Penguji: Pujiyanto, Purnawan Junadi, Yuliana dan Martha ML Siahaan
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Studi ini bertujuan untuk mengevaluasi penerapan Lean Six Sigma sebagai strategi untuk mengurangi waktu tunggu di klinik anak Rumah Sakit X, yang merupakan aspek kritis dalam memengaruhi kepuasan pasien dan mutu layanan rawat jalan. Waktu tunggu yang berkepanjangan telah menjadi isu utama yang perlu diperbaiki, terutama di klinik anak yang memiliki kunjungan tertinggi namun belum mencapai target Indikator Nasional Mutu (INM). Penelitian ini menggunakan pendekatan action research selama satu minggu dengan mengamati 60 pasien yang memiliki janji temu di klinik tersebut. Perbaikan seperti peningkatan waktu pemeriksaan dokter, pengaturan ulang ruang pengkajian dan pengurangan pemborosan telah signifikan dalam mengurangi waktu tunggu dari 55.94 menit menjadi 29.60 menit. Hasil dari penelitian ini menunjukkan bahwa implementasi Lean Six Sigma berhasil meningkatkan efisiensi dan kualitas layanan di Klinik Anak Rumah Sakit X. Langkah-langkah ini diharapkan dapat terus meningkatkan efisiensi operasional dan kualitas pelayanan di lingkungan Klinik Anak Rumah Sakit X serta menunjukkan potensi Lean Six Sigma dalam konteks pelayanan kesehatan.
This study aims to evaluate the implementation of Lean Six Sigma as a strategy to reduce waiting times at the pediatric clinic at X Hospital, which is a critical aspect in influencing patient satisfaction and the quality of outpatient services. Prolonged waiting times have become a major issue that needs to be improved, especially in pediatric's clinic which have the highest number of visits but have not yet reached the National Quality Indicator (INM) target. This study used an action research approach for one week by observing 60 patients who had appointments at the clinic. Improvements such as increasing doctor examination times, reorganizing assesment rooms, and reducing waste have been significant in reducing waiting times from 55.94 minutes to 29.60 minutes, The results of this research show that the implementation of Lean Six Sigma has succeeded in increasing the efficiency and quality of services at the pediatric's clinic at X Hospital. It is hoped that these steps will continue to improve operational efficiency and service quality in the pediatric clinic environment at X Hospital and demonstrate the potential of Lean Six Sigma in the context of heath services
B-2466
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Anni Farida Ritonga; Pembimbing: Amal Chalik Sjaaf; Penguji: Ede Surya Darmawan, Dumilah Ayuningtyas, Surahman Hakim, Eka Ginanjar
Abstrak:
ABSTRAK Nama : Anni Farida Ritonga Program Studi : Kajian Adminsitrasi Rumah Sakit Judul : Analisis Pelayanan Door To Balloon Time Pada Primary Percutaneous Coronary Intervention Dengan Menggunakan Pendekatan Lean Six Sigma Di RSUPN Dr Cipto Mangunkusumo Tahun 2017 Pembimbing : Prof.dr Amal C. Sjaaf, SKM, Dr.PH Rumah Sakit Umum Pusat Nasional dr Cipto Mangunkusumo (RSCM) telah memberikan pelayanan Primary Percutaneous Coronary Intervention (PCI) sejak tahun 2010 dengan pedoman pada tahun 2017 dari European Society of Cardiology (2012) yang memberikan anjuran door to balloon ≤90 menit untuk tindakan Primary PCI pada pasien STEMI dengan onset ≤ 12 jam. Untuk memenuhi target tersebut Instalasi Gawat Darurat (IGD) dan Unit Pelayanan Jantung Terpadu (PJT) telah bekerja sama untuk memperbaiki proses pelayanan Primary PCI sejak awal tahun 2017 dengan capaian door to balloon time bulan Januari – Agustus 2017 adalah 203,5 menit. Penelitian ini untuk mengetahui pedoman pelayanan, alur pelayanan, mengidentifikasi kegiatan yang tidak memberikan nilai tambah (waste), akar masalah panjangnya door to balloon time serta usulan perbaikan pelayanan Primary PCI. Desain penelitian ini adalah analisa kualitatif dengan metode observasi, telaah dokumen, dan wawancara mendalam di IGD dan PJT dengan kerangka acuan DMAI (Define, Measure, Analyse, Improve). Hasil penelitian didapatkan SPO dan PPK terkait pelayanan Primary PCI belum ada, Clinical Pathway Terintegrasi belum ditetapkan, bulan September – Desember 2017 didapatkan capaian door to balloon time dengan median 182 menit, namun tidak dapat dibuat Value Stream Maping (VSM) dikarenakan data dalam rekam medik tidak lengkap. Hasil observasi Februari – April 2018 didapatkan capaian door to balloon time dengan median 126 menit dengan lead time 270,5 menit, cycle time 209,8 menit, waiting time 60,7 menit dengan value added 41,7% dan non value added 58,3%. Penelitian ini menyimpulkan bahwa alur proses pelayanan pasien STEMI dengan tindakan Primary PCI masih tergolong un-lean dan perhitungan Six Sigma berada di level sigma 2 yang memungkinkan terdapat 308.538 tindakan Primary PCI melebihi door to balloon time ≤ 90 menit dari 1 juta kesempatan. Terdapat 40 waste dan 10 varian diseluruh proses pelayanan, dimana waste yang terbanyak terdapat pada waiting, extra processing dan confusion. Hasil analisis Fishbone didapatkan faktor man dan method adalah yang paling dominan menjadi penyebab keterlambatan pelayanan pasien STEMI dengan tindakan Primary PCI. Dibutuhkan komitmen dari managemen rumah sakit dan dukungan dari seluruh tim yang terlibat dalam pelayanan Primary PCI untuk melakukan perbaikan secara terus menerus dengan pembuatan SPO dan PPK sebagai pedoman pelayanan, managemen rumah sakit membuat sistem yang baik agar pelayanan Primary PCI dapat terlaksana 24 jam, mengurangi dokumentasi rekam medik di IGD, penggantian mesin EKG, pemendekan jalur pemindahan pasien, segera menggunakan Clinical Pathway Terintegrasi Primary PCI serta melakukan evaluasi kualitas pelayanan yaitu mortality dan LOS. Kata kunci: Door to balloon time; Lean Six Sigma; Primary PCI
ABSTRACT Name : Anni Farida Ritonga Study Program : Magister of Hospital Administration Title : Analysis Of Door To Balloon Time On Primary Percutaneous Coronary Intervention With Lean Six Sigma Approach In Dr Cipto Mangunkusumo National Referral Hospital, 2017 Counsellor : Prof. dr Amal C. Sjaaf, SKM, Dr.PH Cipto Mangunkusumo National General Hospital (RSCM) has been providing Primary Percutaneous Coronary Intervention (PCI) services since 2010 with a guideline in 2017 from the European Society of Cardiology (2012) which provides a door to balloon ≤90 minutes for PCI Primary Action in STEMI patients with an onset of ≤ 12 hours. To meet the target, Emergency Installation (IGD) and Integrated Heart Service Unit (PJT) have been working together to improve the Primary PCI service process since early 2017 with the achievement of door to balloon time from January to August 2017 is 203.5 minutes. This research is to know the guidance of service, service line, identify activity which do not give added value (waste), root of problem of door to balloon time length and suggestion of service improvement of Primary PCI. This research design is qualitative analysis with observation method, document review, and depth interview at IGD and PJT with DMAI reference frame (Define, Measure, Analyze, Improve). The result of the research shows that SPO and PPK related to Primary PCI service is not yet available, Clinical Pathway Integrated has not been established, September - December 2017 got door to balloon time with median 182 minutes, but can not be made Value Stream Maping (VSM) because data in medical record incomplete. The result of observation from February to April 2018 was achieved by door to balloon time with median 126 minutes with lead time 270,5 minutes, cycle time 209,8 minutes, waiting time 60,7 minutes with value added 41,7% and non value added 58, 3%. This study concludes that the flow of STEMI patient service process with Primary PCI action is still classified un-lean and Six Sigma calculation is at sigma level 2 which enables 308,538 Primary PCI actions beyond the door to balloon time ≤ 90 minutes from 1 million occasions. There are 40 waste and 10 variants throughout the service process, where the most waste is in waiting, extra processing and confusion. Fishbone analysis results obtained man factor and method is the most dominant cause of delay in patient service STEMI with Primary PCI action. It takes commitment from hospital management and support from all team involved in Primary PCI service to make continuous improvement with SPO and KDP as service guidance, hospital management make good system for Primary PCI service can be done 24 hours, reduce documentation medical records at ER, ECG machine replacement, shortening of patient transfer path, immediately using Clinical Pathway Integrated Primary PCI and evaluating service quality that is mortality and LOS. Keywords: Door to balloon time; Lean Six Sigma; Primary PCI
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ABSTRACT Name : Anni Farida Ritonga Study Program : Magister of Hospital Administration Title : Analysis Of Door To Balloon Time On Primary Percutaneous Coronary Intervention With Lean Six Sigma Approach In Dr Cipto Mangunkusumo National Referral Hospital, 2017 Counsellor : Prof. dr Amal C. Sjaaf, SKM, Dr.PH Cipto Mangunkusumo National General Hospital (RSCM) has been providing Primary Percutaneous Coronary Intervention (PCI) services since 2010 with a guideline in 2017 from the European Society of Cardiology (2012) which provides a door to balloon ≤90 minutes for PCI Primary Action in STEMI patients with an onset of ≤ 12 hours. To meet the target, Emergency Installation (IGD) and Integrated Heart Service Unit (PJT) have been working together to improve the Primary PCI service process since early 2017 with the achievement of door to balloon time from January to August 2017 is 203.5 minutes. This research is to know the guidance of service, service line, identify activity which do not give added value (waste), root of problem of door to balloon time length and suggestion of service improvement of Primary PCI. This research design is qualitative analysis with observation method, document review, and depth interview at IGD and PJT with DMAI reference frame (Define, Measure, Analyze, Improve). The result of the research shows that SPO and PPK related to Primary PCI service is not yet available, Clinical Pathway Integrated has not been established, September - December 2017 got door to balloon time with median 182 minutes, but can not be made Value Stream Maping (VSM) because data in medical record incomplete. The result of observation from February to April 2018 was achieved by door to balloon time with median 126 minutes with lead time 270,5 minutes, cycle time 209,8 minutes, waiting time 60,7 minutes with value added 41,7% and non value added 58, 3%. This study concludes that the flow of STEMI patient service process with Primary PCI action is still classified un-lean and Six Sigma calculation is at sigma level 2 which enables 308,538 Primary PCI actions beyond the door to balloon time ≤ 90 minutes from 1 million occasions. There are 40 waste and 10 variants throughout the service process, where the most waste is in waiting, extra processing and confusion. Fishbone analysis results obtained man factor and method is the most dominant cause of delay in patient service STEMI with Primary PCI action. It takes commitment from hospital management and support from all team involved in Primary PCI service to make continuous improvement with SPO and KDP as service guidance, hospital management make good system for Primary PCI service can be done 24 hours, reduce documentation medical records at ER, ECG machine replacement, shortening of patient transfer path, immediately using Clinical Pathway Integrated Primary PCI and evaluating service quality that is mortality and LOS. Keywords: Door to balloon time; Lean Six Sigma; Primary PCI
B-2005
Depok : FKM-UI, 2018
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Ahmat Yurdiansyah; Pembimbing: Helen Andriani; Penguji: Vetty Yulianty Permanasari, Purnawan Junadi, Yahya Ulumuddin, Endang Adriyani
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Manajemen pengelolaan obat sering kali menjadi masalah utama dalam pelayanan farmasi di rumah sakit, terutama dalam proses perencanan dan pengadaan. Masalah tersebut tentunya berdampak pada persediaan obat yang ada dirumah sakit. Penelitian ini ingin menganalisis perencaan obat yang ada di Instalasi Farmasi RS H.L. Manambai Abdulkadir serta melakukan pengendalian persediaan dengan metode minimum maksimum stok level dengan melihat angka safety stock, stok minimum dan stok maksimum persediaan obat di Instalaasi Farmasi . Setelah melakukan pengendalian persediaan dengan metode tersebut dilakukan penilaian terhadap keberhasilan pengendalian dengan menggunakan indikator pengendalian seperti ketepatan perencanaan, perhitungan nilai stock out, perhitungan nilai backorder, perhitungan nilai over stock obat, ITOR dan Fill rate. Hasil penelitian menunjukan Nilai stock out, backorder cost, ITOR dan Fillrate di Instalasi Farmasi diukur pada bulan Januari – April 2024. Dengan hasil rata rata berturut-turut adalah 496 stock out dengan nilai backorder cost sebesar Rp. 45.102.095. Rasio ITOR dengan kisaran 0,88 - 1,12 serta nilai filrate dengan rata-rata 97,35%. Hasil impelentasi analisis metode MMSL pada bulan mei 2024 memberikan dampak positif terhadap penurunan angka stock out, backorder cost, dan fillrate. Namun tidak berdampak signifikan terhadap nilai ITOR, hal ini disebabkan sebelum implementasi dilakukan instalasi farmasi memiliki nilai persediaan obat yang sangat tinggi terutama untuk obat-obatan slow moving atau kategori C ABC Volume. Dengan demikian dapat disimpulkan bahwa pengendalian persediaan obat di Instalasi farmasi RS H.L Manambai Abdulkadir efektif terhadap nilai stock out, backorder cost dan fillrate, tetapi belum efektif dalam nilai ITOR karena masih tingginya nilai persediaan obat.
Medication management often presents a major challenge in hospital pharmacy services, particularly in the planning and procurement processes. These issues significantly impact the inventory of medications available in hospitals. This study aims to analyze the medication planning at the Pharmacy Installation of H.L. Manambai Abdulkadir Hospital and to implement inventory control using the minimum-maximum stock level method by examining the safety stock, minimum stock, and maximum stock levels of medications. After implementing inventory control with this method, the success of the control was evaluated using control indicators such as planning accuracy, stock out value calculation, backorder value calculation, overs tock value calculation, ITOR (Inventory Turnover Ratio), and fill rate. The results of the study showed that the values of stock out, backorder cost, ITOR, and fill rate at the Pharmacy Installation were measured from January to April 2024. The average results were 496 stock outs with a backorder cost of IDR 45,102,095, an ITOR ratio ranging from 0.88 to 1.12, and an average fill rate of 97.35%. The implementation of the MMSL method analysis in May 2024 had a positive impact on reducing stock out numbers, backorder costs, and fill rate. However, it did not significantly affect the ITOR value, as the pharmacy installation had a very high inventory value prior to implementation, especially for slow-moving drugs or category C ABC Volume. Therefore, it can be concluded that the inventory control of medications at the Pharmacy Installation of H.L. Manambai Abdulkadir Hospital is effective in terms of stock out value, backorder cost, and fill rate, but not yet effective in ITOR value due to the still high inventory value of medications.
B-2458
Depok : FKM-UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Rendra Fariadi; Pembimbing: Helen Andriani; Penguji: Purnawan Junadi, Nine Mei, IIng Ichsan Hanafi
Abstrak:
Persediaan farmasi harus dikelola dengan baik untuk kelancaran pelayanan dan keuangan rumah sakit. Pengelolaan sedian farmasi rumah sakit dimulai dari alur perencanaan dan pengadaan obat-obatan di rumah sakit. Sistem perencaanaan yang tepat dibutuhkan untuk pengelolaan perencaan dan persediaan di rumah sakit agar efisiensi dalam proses pengadaan obat dapat tercapai. RS Hermina Medan melakukan perubahan dalam sistem perencaan obat-obatan dari awalnya menggunakan sistem min-max menjadi sistem pareto. Penelitian ini bertujuan untuk membandingkan tingkat efisiensi terhadap kedua sistem tersebut. Penelitian ini dilakukan dengan riset operasional terhadap sampel obat hasil analisis ABC dan menggabungkan metode kualitatif. Hasil analisis ABC berdasarkan nilai pemakaian selama Agustus dan September 2023 diperoleh obat kategori A mewakili 80% dari total nilai persedian obat JKN di Instalasi Farmasi. Hasil penelitian menunjukan dengan membandingkan perhitungan untuk perencanaan pengadaan obat kategori A dengan sistem pareto dan min-max didapatkan total inventory cost lebih rendah dengan menggunakan sistem min-max. Namun, rencana pengadaan dengan sistem min-max dapat lebih baik apabila perhitungan pemakaian obat di kontrol secara rutin dan proses perencanaan pengadaan dibantu oleh sistem informasi yang lebih baik. Penelitian diharapkan dapat dilanjutkan dengan waktu yang lebih panjang agar penilaian inventory cost dapat lebih akurat.
Pharmaceutical supplies must be managed well for the smooth running of hospital services and finances. Management of hospital pharmaceutical supplies starts from the flow of planning and procurement of medicines in the hospital. An appropriate planning system is needed for managing planning and supplies in hospitals so that efficiency in the drug procurement process can be achieved. Hermina Medan Hospital made changes to its medicine planning system from initially using a min-max system to a Pareto system. This research aims to compare the level of efficiency of the two systems. This research was conducted using operational research on drug samples resulting from ABC analysis and combining qualitative methods. The results of ABC analysis based on usage values during August and September 2023 showed that category A drugs represent 80% of the total value of UHC drug supplies in pharmacy installations. The research results show that by comparing calculations for planning the procurement of category A drugs using the Pareto and min-max systems, the total inventory cost is lower using the min-max system. Procurement planning using a min-max system can be better if the calculation of drug use is routinely controlled and the procurement planning process is assisted by a better information system. It is hoped that the research can be continued for a longer period so that inventory cost assessments can be more accurate.
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Pharmaceutical supplies must be managed well for the smooth running of hospital services and finances. Management of hospital pharmaceutical supplies starts from the flow of planning and procurement of medicines in the hospital. An appropriate planning system is needed for managing planning and supplies in hospitals so that efficiency in the drug procurement process can be achieved. Hermina Medan Hospital made changes to its medicine planning system from initially using a min-max system to a Pareto system. This research aims to compare the level of efficiency of the two systems. This research was conducted using operational research on drug samples resulting from ABC analysis and combining qualitative methods. The results of ABC analysis based on usage values during August and September 2023 showed that category A drugs represent 80% of the total value of UHC drug supplies in pharmacy installations. The research results show that by comparing calculations for planning the procurement of category A drugs using the Pareto and min-max systems, the total inventory cost is lower using the min-max system. Procurement planning using a min-max system can be better if the calculation of drug use is routinely controlled and the procurement planning process is assisted by a better information system. It is hoped that the research can be continued for a longer period so that inventory cost assessments can be more accurate.
B-2489
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Osi Ramadia; Pembimbing: Puput Oktamianti; Penguji: Pujiyanto, Wachyu Sulistiadi, Indro Chayadi Saleh dan Novita Dwi Istanti
Abstrak:
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Proses pemulangan pasien rawat inap adalah pelayanan rumah sakit untuk yang melibatkan DPJP, keperawatan, farmasi, administrasi dan pasien. Proses ini berimplikasi pada kepuasan pasien, penumpukan pasien IGD hingga efisiensi pelayanan. Metode lean merupakan metode yang dapat meningkatkan kualitas dan efisiensi pelayanan proses ini. Penelitian riset operasional dengan metode lean ini bertujuan untuk menganalisa proses pemulangan pasien rawat inap di RS Restu Kasih. Hasil penelitian: lead time pasien jaminan BPJS yaitu 5 jam 30 menit, jaminan asuransi 5 jam 10 menit dan non-jaminan 4 jam 1 menit. Persentase kegiatan NVA DPJP: 11% jaminan asuransi, 25% jaminan BPJS; keperawatan: 52% non-jaminan, 64% jaminan asuransi, 53% jaminan BPJS; farmasi: 16% non-jaminan, 22% jaminan asuransi, 23% jaminan BPJS; administrasi: 11% non-jaminan, 57% jaminan asuransi, 14% jaminan BPJS; pasien: 51% non-jaminan, 75% jaminan asuransi, 85% jaminan BPJS. Waste pada pasien non-jaminan yaitu 89% motion, 11% waiting; jaminan asuransi yaitu 42% waiting, 32% motion, 16% deffects, 11% inventory; jaminan BPJS yaitu 50% motion, 43% waiting, 7% inventory. Implementasi visual management dan berkoordinasi dengan unit terkait penugasan pada pasien jaminan BPJS menghasilkan penurunan lead time 45% menjadi 3 jam 3 menit dan penurunan kegiatan NVA sebesar 48% dari 2 jam 5 menit menjadi 1 jam 5 menit.
Process of discharging inpatients is hospital service that involves doctors, nurses, pharmacy, administration and patient. This process have implications for patient satisfaction, stagnancy of ER patients and efficiency of services. Lean method could improve quality and efficiency of this process. This operational research study using a lean method approach aims to analyze the discharge process of inpatients at Restu Kasih Hospital. The results show, lead time for BPJS coverage is 5 hours 30 minutes, insurance coverage 5 hours 10 minutes and non-insurance 4 hours 1 minute. The percentage of non-value added activities of doctors: 11% insurance coverage, 25% BPJS coverage; nurses: 52% non-insurance, 64% insurance coverage, 53% BPJS coverage; pharmacy: 16% non-insurance, 22% insurance coverage, 23% BPJS coverage; administration: 11% non-insurance, 57% insurance coverage, 14% BPJS coverage; patient: 51% non-insurance, 75% insurance coverage, 85% BPJS coverage. Waste for non-insurance: 89% motion, 11% waiting; insurance coverage: 42% waiting, 32% motion, 16% defects, 11% inventory; BPJS coverage: 50% motion, 43% waiting,7% inventory. Visual management and coordinating with each unit implementation for BPJS coverage resulting on reducing lead time by 45% to 3 hours 3 minutes and reducing non-value added activity by 48% from 2 hours 5 minutes to 1 hour 5 minutes
T-6990
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Royyadi Chandra Saputra; Pembimbing: Masyitoh; Penguji: Purnawan Junadi, Umi Aisyiyah
Abstrak:
Penelitian ini membahas tentang analisis proses pemulangan pasien rawat inap teratai dengan metode lean six sigma di RSUP Fatmawati. Tujuan dari penelitian ini adalah untuk mengetahui proses pemulangan pasien rawat inap sampai pasien meninggalkan ruangan rawat inap di RSUP Fatmawati. Jenis penelitian ini adalah kuantitatif dan kualitatif dengan menggunakan time motion studies dan menggunakan operational research dengan metode observasi dan wawancara mendalam. Hasil penelitian didapatkan rata-rata waktu proses pemulangan pasien adalah 230 menit dengan penilaian aktivitas non value added 212 menit dan penilaian aktivitas value added 18 menit. Proses yang paling lama terjadi di kamar rawat inap dengan lama waktu 143 menit, disebabkan keluarga pasien menunggu untuk mengurus administrasi pulang. Hasil penelitian menyarankan untuk adanya petugas administrasi pemulangan pasien, analisis beban kerja terkait, melakukan pengkajian ulang tentang kebijakan pemulangan pasien, dan mengoptimalkan SIMRS dengan memberlakukan sistem elektronik untuk efisiensi waktu dan SDM.
Kata Kunci : Lean Six Sigma, pemulangan pasien, rawat inap
This study discusses the analysis of the process of inpatient discharge process with lean six sigma method in RSUP Fatmawati. The purpose of this research is to know the process of inpatient discharge until the patient left the inpatient room at RSUP Fatmawati. This type of research is quantitative and qualitative by using time motion studies and using operational research with the method of observation and in-depth interview. The result of the research shows that the average return time of patient is 230 minutes with non value added activity 212 minutes and value added activity 18 minutes. The longest process took place in an inpatient room with a duration of 143 minutes, due to the patient's family waiting to take care of the administration home. The results of the study suggest that the patient discharge administration officer, the associated workload analysis, conduct a review of the patient's return policy, and optimize SIMRS by enforcing the electronic system for time and human resource efficiency.
Keywords: Lean Six Sigma, discharge process, inpatient
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Kata Kunci : Lean Six Sigma, pemulangan pasien, rawat inap
This study discusses the analysis of the process of inpatient discharge process with lean six sigma method in RSUP Fatmawati. The purpose of this research is to know the process of inpatient discharge until the patient left the inpatient room at RSUP Fatmawati. This type of research is quantitative and qualitative by using time motion studies and using operational research with the method of observation and in-depth interview. The result of the research shows that the average return time of patient is 230 minutes with non value added activity 212 minutes and value added activity 18 minutes. The longest process took place in an inpatient room with a duration of 143 minutes, due to the patient's family waiting to take care of the administration home. The results of the study suggest that the patient discharge administration officer, the associated workload analysis, conduct a review of the patient's return policy, and optimize SIMRS by enforcing the electronic system for time and human resource efficiency.
Keywords: Lean Six Sigma, discharge process, inpatient
S-9451
Depok : FKM UI, 2017
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Arini Cyndwiana Prastiwi; Pembimbing: Dumilah Ayuningtyas; Penguji: Masyitoh, Pujiyanto, Erwindo Rinaldo, Novita Dwi Istanti
Abstrak:
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Rumah sakit sebagai pelayanan kesehatan harus memenuhi standar pelayanan sesuai dengan Indikator Nasional Mutu Pelayanan Kesehatan. Salah satu komponen indikator mutu rumah sakit adalah waktu tunggu rawat jalan. Waktu tunggu yaitu waktu yang dibutuhkan mulai saat pasien kontak dengan petugas pendaftaran sampai mendapat pelayanan dokter/dokter spesialis. Menurut PMK No. 129 tahun 2008, Standar Pelayanan Minimal Rumah Sakit untuk waktu tunggu di unit rawat jalan yaitu ≤ 60 menit. RSUI merupakan RS-PTN kelas B yang berlokasi di Kota Depok dan memiliki pelayanan mencapai 30 klinik. Poli penyakit dalam termasuk kedalam Indikator minimal ketersediaan pelayanan di unit rawat jalan yang harus dimiliki oleh rumah sakit dan memiliki jumlah pasien yang cukup besar di RSUI. Berdasarkan studi pendahuluan menggunakan data rekam medik, waktu tunggu di poli tersebut belum memenuhi standar dan sering mendapat laporan keluhan waktu tunggu yang lama. Penelitian ini merupakan penelitian kualitatif menggunakan metode Lean Six Sigma dengan tahapaan Define, Measure, Analyse, dan Improve. Metode pengambilan data dengan observasi, telaah dokumen, wawancara, dan Consensus Making Disscusion Group (CDMG). Penghitungan Value Added, Non Value Added, Cycle Time, dan Lead Time didasarkan pada perspektif pasien. Waktu yang dibutuhkan pasien dari mulai pendaftaran sampai bertemu dengan dokter spesialis penyakit dalam belum mencapai standar yang telah ditentukan yaitu rata-rata lead time 149 menit. Pada Value Stream Mapping proses pelayanan terlihat beberapa waste, yaitu Over Processing, Waiting dan Defect dengan akar masalah dibagi menjadi Man, Machine, Methode, dan Environment. Waste waiting terbesar ada di proses menunggu tahapan. Rekomendasi yang dapat diberikan kepada rumah sakit sebagai langkah strategi perbaikan pelayanan di rawat jalan dibagi menjadi jangka pendek, jangka panjang, dan Future State Value Stream Mapping.
Hospitals as health services must have service standards in accordance with the National Health Service Quality Indicators. One component of hospital quality indicators is outpatient waiting time. Waiting time is the time required from the time the patient meets the registration officer until he receives the services of a doctor/specialist. According to PMK No. 129 of 2008, Minimum Hospital Service Standards for waiting time in outpatient units is ≤ 60 minutes. RSUI is a class B PTN Hospital located in Depok City and has services for up to 30 clinics. Internal medicine poly is included in the minimum indicators of service availability in the outpatient unit that must be owned by the hospital and has many patients in RSUI. Based on a preliminary study using medical record data, the waiting time at the poly did not meet the standards and there were often reports of complaints of long waiting times. This research is qualitative research using the Lean Six Sigma method with the Define, Measure, Analyze, and Improve stages. Data collection methods are observation, document review, interviews, and the Consensus Making Discusion Group (CDMG). Calculation of Value Added, Non Value Added, Cycle Time, and Lead Time is based on the patient's perspective. The time needed by patients from registration to meeting with specialists in internal medicine has not reached the predetermined standard, namely the average lead time is 149 minutes. In Value Stream Mapping, the service process shows several wastes, namely Over Processing, Waiting and Defects with the root causes divided into Man, Machine, Method, and Environment. The biggest waste waiting is in the process of waiting for stages. Recommendations that can be given to hospitals as a strategic step to improve outpatient services are divided into short term, long term, and Future State Value Stream Mapping.
B-2379
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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