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Latar Belakang : Length of stay (LOS) atau ideal time merupakan salah satu indikator penilaian key performance indicator (KPI) patient experience untuk menilai pelayanan IGD. Pencapaian LOS di IGD Mayapada Hospital Bogor baru tercapai 91% di bulan September dari target 100% dengan angka variasi waktu pelayanan yang cukup tinggi.
Metodologi : Penelitian ini menggunakan desain penelitian operational research dengan menggabungkan metode penelitian kuantitatif dan kualitatif (mix methode) dan teknik stratified random sampling untuk metode pengambilan sampel dengan jumlah sebanyak 240 pasien IGD. Penentuan sampel menggunakan rumus Slovin.
Hasil Pembahasan : Pada penelitian ini ditemukan waste waiting sebagai penyebab masalah berdasarkan analisa pareto adalah pada kegiatan menunggu hasil laboratorium sebesar 28% (00:36:20), menunggu hasil radiologi sebesar 21% (00:27:38), persiapan obat, alkes dan oplos obat sebesar 19% (00:24:42) dan menunggu keputusan rawat inap sebesar 23% (00:30:11) dengan total keseluruhan sebesar 91%. Intervensi dengan implementasi lean six sigma yang dilakukan mampu menurunkan angka lead time sebesar (↓ 27,7%) dari 3 jam 59 menit 20 detik menjadi 2 jam 53 menit 2 detik dengan menghilangkan kegiatan non value added sebesar (↓ 37%) dari 2 jam 7 menit 4 detik menjadi 1 jam 20 menit 23 detik. Pada fase kontrol LOS pasien IGD menunjukan penurunan angka lead time sebesar 18% yaitu 2 jam 21 menit 23 detik dan penurunan kegiatan non value added menjadi 51 menit 7 detik
Kesimpulan : Intervensi lean six sigma dengan menggunakan tools standardize work, heijunka, 5S dan brainstorming terbukti mampu menurunkan waktu length of stay pelayanan pasien IGD.
Background : Length of stay (LOS) or ideal time, is one of the key performance indicators (KPIs) used to assess patient experience in emergency department (ED) services. LOS achievement in the ED reached only 91% of the target 100% in September at Mayapada Hospital Bogor, with a high variation in service time. Methodology : This study uses an operational research design, combining quantitative and qualitative research methods (mixed methods), and employs stratified random sampling techniques. The sampel size consisted of 240 ED patients, determined using the Slovin formula. Results and Discussion: In this study, the identified cause of the problem based on pareto analysis was waste due to waiting, with the following breakdown : waiting for laboratory results accounted for 28% (00:36:20), waiting for radiology results 21% (00:27:38), preparation of medications, medical devices, and drug mixing 19% (00:24:42), and waiting for inpatient admission decisions 23% (00:30:11), comprising a total of 91%. The intervention through the implementation of lean six sigma successfully reduced lead time by 27.7%, from 3 hours 59 minutes 20 seconds to 2 hours 53 minutes 2 seconds, by eliminating non–value-added activities by 37%, from 2 hours 7 minutes 4 seconds to 1 hour 20 minutes 23 seconds. In the control phase, the Emergency Department patient length of stay (LOS) showed a lead time reduction of 18%, equivalent to 2 hours, 21 minutes, and 23 seconds, and a decrease in non-value-added activities to 51 minutes and 7 seconds. During the control phase, the length of stay (LOS) for emergency department (ED) patients showed a further lead time reduction of 18%, reaching 2 hours 21 minutes 23 seconds, with a reduction in non–value-added activities to 51 minutes 7 seconds. Conclusion : Lean Six Sigma interventions, utilizing tools such as standardized work, heijunka, 5S, and brainstorming, effectively reduced the length of stay for ED patients.
Latar Belakang: Proses pre-registrasi pasien rawat inap di RS Mayapada Tangerang terdiri dari tiga fase utama, yaitu penerimaan berkas admission, review asuransi, serta konfirmasi jadwal dan persiapan pasien. Studi ini bertujuan untuk mengevaluasi proses pre-registrasi dan mengidentifikasi area yang perlu diperbaiki guna meningkatkan efisiensi pelayanan dengan.
Metode: Penelitian ini menggunakan pendekatan Lean six sigma dengan metode DMAIC (Define, Measure, Analyze, Improve, dan Control). Data dikumpulkan melalui observasi langsung, pencatatan waktu proses, dan diskusi kelompok terfokus (FGD) bersama tim terkait. Analisis dilakukan menggunakan Value Stream Mapping (VSM) untuk mengidentifikasi aktivitas bernilai tambah, serta Pareto Analysis dan Problem Tree Analysis untuk menemukan akar penyebab pemborosan dan keterlambatan.
Hasil: Analisis terhadap alur dan capaian waktu proses menunjukkan adanya ketidakefisienan, dengan total waktu mencapai 26 jam 1 menit 48 detik. Proporsi aktivitas bernilai tambah (Value added) tercatat sebesar 71%, sementara 29% lainnya tergolong Non-Value added, dengan pemborosan terbesar terjadi pada fase review asuransi akibat waktu tunggu yang panjang dan aktivitas berulang. Hasil penelitian menunjukkan bahwa intervensi berbasis Lean six sigma efektif dalam meningkatkan efisiensi, ditandai dengan penurunan lead time pada fase post-intervensi. Pada fase I dan II terjadi perbaikan signifikan, seperti penyederhanaan proses konfirmasi DPJP, percepatan verifikasi dokumen, serta pengurangan waktu tunggu pada proses review asuransi.
Kesimpulan: Penerapan Lean six sigma mampu memberikan dampak positif terhadap optimalisasi proses pre-registrasi pasien rawat inap di RS Mayapada Tangerang.
Background : The inpatient pre-registration process at Mayapada Hospital Tangerang consists of three main phases: admission document submission, insurance review, and confirmation of schedule and patient preparation. This study aims to evaluate the pre-registration process and identify areas that need improvement to enhance service efficiency. Method : This research uses the Lean six sigma approach with the DMAIC method (Define, Measure, Analyze, Improve, and Control). Data were collected through direct observation, process time tracking, and focus group discussions (FGDs) with relevant teams. The analysis was conducted using Value Stream Mapping (VSM) to identify value-added activities, along with Pareto Analysis and Problem Tree Analysis to determine the root causes of waste and delays. Results : Analysis of the process flow and time achievements revealed inefficiencies, with a total duration of 26 hours, 1 minute, and 48 seconds. The proportion of Value-Added (VA) activities was recorded at 71%, while the remaining 29% were classified as Non-Value added (NVA), with the most significant waste occurring during the insurance review phase due to long waiting times and repetitive tasks. The results showed that Lean six sigma-based interventions were effective in improving efficiency, as indicated by a reduction in lead time during the post-intervention phase. Significant improvements were observed in Phases I and II, including the simplification of DPJP (attending physician) confirmation, acceleration of document verification, and reduction in waiting time during the insurance review process. Conclusion : The implementation of Lean six sigma has a positive impact on optimizing the inpatient pre-registration process at Mayapada Hospital Tangerang
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.
Analisis penerapan Penganggaran berbasis Kinerja untuk Standar Pelayanan Minimal (SPM) Orang dengan Gangguan Jiwa (ODGJ) Berat di Dinas Kesehatan Kota Depok Tahun 2025, Penelitian ini menganalisis pelaksanaan penganggaran berbasis kinerja (PBK) terhadap Standar Pelayanan Minimal (SPM) ODGJ Berat di Dinas Kesehatan Kota Depok telah mencerminkan kebutuhan riil di lapangan. Meskipun capaian SPM tercatat mencapai 100% pada tahun 2023 dan 2024, alokasi anggaran justru mengalami penurunan signifikan: dari (0,06%) pada 2023 menjadi hanya (0,02%) pada 2024 dari total anggaran Dinas Kesehatan. Kontradiksi ini mencolok, terutama ketika prevalensi gangguan jiwa di Kota Depok masih sangat tinggi 9,1% di kalangan pegawai pemerintah dan 15,3% di masyarakat umum, angka provinsi (4,4%) dan nasional (2%). Kondisi ini menunjukkan adanya tantangan serius dalam penerapan PBK yang seharusnya mengedepankan prinsip efektivitas, efisiensi, dan evidence-based. Penelitian ini menggunakan pendekatan komprehensif terhadap komponen struktur, proses, dan komitmen daerah, untuk menilai apakah kebijakan penganggaran yang diterapkan sudah mendukung keberlanjutan layanan kesehatan jiwa secara substantif, bukan sekadar administratif.
Analysis of the Implementation of Performance-Based Budgeting for Minimum Service Standards (SPM) for People with Severe Mental Disorders (ODGJ) at the Depok City Health Office in 2025,This study analyzes whether the implementation of performance-based budgeting (PBB) for the Minimum Service Standards (SPM) for People with Severe Mental Disorders (ODGJ) at the Depok City Health Office reflects the actual needs in the field. Although SPM achievements reached 100% in 2023 and 2024, the allocated budget experienced a significant decline—from 0.06% in 2023 to only 0.02% in 2024 of the total Health Office budget. This contradiction is striking, especially considering the high prevalence of mental disorders in Depok: 9.1% among government employees and 15.3% in the general population, far exceeding the provincial average (4.4%) and the national rate (2%). This situation highlights serious challenges in the application of PBB, which should prioritize effectiveness, efficiency, and evidence-based principles. This study adopts a comprehensive approach by examining structural components, processes, and regional commitment to assess whether the current budgeting policy supports the sustainability of mental health services in a substantive, rather than merely administrative, manner.
Latar belakang: Hipertensi merupakan penyakit tidak menular dengan prevalensi tertinggi Indonesia. Berdasarkan data Survei Kesehatan Indonesia (SKI) 2023, 30,8% penduduk usia ≥18 tahun mengalami hipertensi berdasarkan pengukuran, sedangkan prevalensi hipertensi berdasarkan diagnosis dokter adalah 8,6%. Selain itu, laporan SKI 2023 menekankan adanya kesenjangan antara perilaku pencarian pengobatan hipertensi dengan proporsi masyarakat yang terdiagnosis. Saat ini, sebesar 53,3% penyandang hipertensi tidak teratur minum obat atau tidak minum obat antihipertensi, dan 56,9% tidak teratur atau sama sekali tidak melakukan pemeriksaan ulang ke tenaga kesehatan.
Tujuan: Mengetahui faktor-faktor yang berhubungan dengan perilaku pencarian pengobatan hipertensi pada penyandang hipertensi usia ≥18 tahun di Indonesia.
Metode: Sebanyak 53.648 penyandang hipertensi usia ≥18 tahun berdasarkan data SKI 2023 diteliti dalam penelitian cross-sectional ini. Uji chi-square dan regresi logistik sederhana dilakukan untuk melihat hubungan antar variabel. Variabel luaran adalah perilaku pencarian pengobatan hipertensi. Variabel prediktor adalah jenis kelamin, usia, status pernikahan, tingkat pendidikan, status pekerjaan, pengetahuan terkait hipertensi, tempat tinggal, wilayah geografis, status sosial ekonomi, kepemilikan jaminan kesehatan, akses ke fasilitas kesehatan, multimorbiditas, dan perilaku cek kesehatan berkala.
Hasil: Proporsi perilaku pencarian pengobatan hipertensi yang aktif pada penyandang hipertensi usia ≥18 tahun di Indonesia tahun 2023 adalah 76,2%. Faktor-faktor yang berhubungan dengan perilaku pencarian pengobatan hipertensi adalah berjenis kelamin perempuan (OR = 1,24; 95% CI: 1,15-1,33), berusia 65-74 tahun (ref. 18-24 tahun; OR = 6,60; 95% CI: 4,35-10,04), sedang menikah (OR = 0,92; 95% CI: 0,85-0,99), memiliki tingkat pendidikan tersier (ref. Tidak sekolah; OR = 1,28; 95% CI: 1,12-1,47), tidak bekerja (OR = 1,15; 95% CI: 1,08-1,23), pernah mendapat informasi pengobatan hipertensi (OR = 3,98; 95% CI: 3,70-4,28), berasal dari Kepulauan Maluku (ref. Papua; OR = 1,97; 95% CI: 1,51-2,58), memiliki status sosial ekonomi teratas (OR = 1,36; 95% CI: 1,17-1,59), memiliki jaminan kesehatan (OR = 1,48; 95% CI: 1,36-1,61), memiliki multimorbiditas (OR = 1,77; 95% CI: 1,63-1,92), dan melakukan cek kesehatan minimal 1 bulan sekali (ref. Tidak pernah; OR = 6,16; 95% CI: 5,54-6,84).
Kesimpulan: Studi ini menunjukkan dibutuhkannya program untuk meningkatkan kesadaran dan partisipasi aktif masyarakat, khususnya kelompok usia produktif, dalam melakukan pengobatan hipertensi.
Kata kunci: Perilaku pencarian pengobatan, penyandang hipertensi, hipertensi
Background: Hypertension is a non-communicable disease with the highest prevalence in Indonesia. According to the Indonesian Health Survey (SKI) in 2023, 30.8% of people aged ≥18 experienced hypertension based on blood pressure measurement, while the prevalence of hypertension based on a doctor’s diagnosis was 8.6%. In addition, the SKI 2023 report emphasised the gap between hypertension health-seeking behaviour and the proportion of diagnosed patients. Currently, 53.3% of hypertensive patients do not regularly or do not take anti-hypertensive medication, and 56.9% do not regularly or do not have re-examinations with health professionals. Objective: This study aims to determine the factors associated with hypertension health-seeking behaviour in hypertensive patients aged ≥18 years in Indonesia. Methods: A total of 53.648 hypertensive patients aged ≥18 years based on SKI 2023 were analysed in this cross-sectional study. Chi-square test and simple logistic regression were used to determine the associations between variables. The outcome variable is hypertension health-seeking behaviour. The independent variables are gender, age, marital status, education level, employment status, hypertension-related knowledge, place of residence, geographic area, socioeconomic status, health insurance ownership, access to health facility, multimorbidity, and regular health check-up. Results: The proportion of active hypertension health-seeking behaviour in hypertensive patients aged ≥18 years in Indonesia in 2023 was 76.2%. Factors associated with hypertension health-seeking behaviour were female (OR = 1.24; 95% CI: 1.15-1.33), aged 65-74 years (ref. 18-44 years; OR = 6.60; 95% CI: 4.35-10.04), married (OR = 0.92; 95% CI: 0.85-0.99), having tertiary education (ref. no formal education; OR = 1.28; 95% CI: 1.12-1.47), not working (OR = 1.15; 95% CI: 1.08-1.23), having received information on hypertension treatment (OR = 3.98; 95% CI: 3.70-4.28), living in the Maluku Islands (ref. Papua; OR = 1.97; 95% CI: 1.51-2.58), having the highest socioeconomic status (OR = 1.36; 95% CI: 1.17-1.59), insured (OR = 1.48; 95% CI: 1.36-1.61), having multimorbidity (OR = 1.77; 95% CI: 1.63-1.92), and doing a health check-up at least once a month (ref. never; OR = 6.16; 95% CI: 5.54-6.84). Conclusion: This study indicates the need for a program to raise awareness and the active participation of the public, particularly the productive age population, in seeking hypertension treatment. Key words: Health-seeking behaviour, hypertensive patients, hypertension
