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Veronica Yoseva; Pembimbing: Helen Andriani; Penguji: Masyitoh, Nadia Farhanah Syafhan, Renita Agustina, Teuku Nebrisa Zagladin
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Pelayanan farmasi rawat jalan merupakan salah satu komponen penting dalam penyelenggaraan pelayanan rumah sakit yang berperan dalam menjamin mutu pelayanan, keselamatan pasien, serta tingkat kepuasan pasien. Salah satu indikator mutu pelayanan farmasi adalah waktu tunggu pelayanan resep. Hasil pengamatan awal di Instalasi Farmasi Rawat Jalan Charitas Hospital Palembang menunjukkan bahwa waktu tunggu pelayanan resep, khususnya resep racikan, masih belum memenuhi Standar Pelayanan Minimal (SPM) yang ditetapkan. Penelitian ini bertujuan untuk menganalisis penerapan Lean Hospital sebagai upaya meningkatkan efisiensi proses pelayanan dan menurunkan waktu tunggu pelayanan resep di Instalasi Farmasi Rawat Jalan Charitas Hospital Palembang. Penelitian ini merupakan studi operasional dengan pendekatan Lean Hospital. Pengumpulan data dilakukan melalui observasi langsung terhadap alur pelayanan resep dan pengukuran waktu pada setiap tahapan pelayanan. Sebanyak 200 resep dianalisis, yang terdiri atas 152 resep obat jadi dan 48 resep racikan. Analisis dilakukan menggunakan Value Stream Mapping (VSM), identifikasi pemborosan (waste) berdasarkan prinsip Lean dan fishbone diagram, serta pengukuran efisiensi proses melalui perhitungan Value Added Ratio (VAR). Hasil penelitian menunjukkan bahwa pada kondisi current state, lead time pelayanan resep obat jadi mencapai 34,5 menit yang terdiri atas Value Added Time (VAT) sebesar 16,8 menit dan Non-Value Added Time (NVAT) sebesar 17,8 menit. Sementara itu, lead time pelayanan resep racikan mencapai 74,3 menit dengan VAT sebesar 45,4 menit dan NVAT sebesar 29,1 menit. Analisis waste menunjukkan bahwa jenis pemborosan yang paling dominan adalah waiting waste, yaitu sebesar 61,8% pada pelayanan resep obat jadi dan 53,61% pada pelayanan resep racikan, diikuti oleh overprocessing waste. Berdasarkan hasil analisis penyebab waste, dilakukan berbagai intervensi perbaikan Lean yang meliputi penambahan Tenaga Teknis Kefarmasian (TTK) pada shift pagi dan siang, pemanfaatan WhatsApp Blast sebagai media pemberitahuan real-time kepada pasien terkait penyelesaian obat, penguatan koordinasi dengan pihak provider asuransi, penyediaan hand blender dan alat pengisi kapsul untuk mendukung proses peracikan, implementasi prinsip 5S, optimalisasi tata letak ruang pelayanan, penerapan visual management, serta penyesuaian jadwal praktik dokter spesialis dan peningkatan kepatuhan terhadap jadwal pelayanan. Hasil future state mapping menunjukkan adanya peningkatan efisiensi proses pelayanan. Lead time pelayanan resep obat jadi menurun menjadi 20,3 menit atau berkurang sebesar 41,2%, sedangkan lead time pelayanan resep racikan menurun menjadi 52,9 menit atau berkurang sebesar 28,8%. Selain itu, nilai VAR pada resep obat jadi meningkat dari 48,7% menjadi 49,75%, sedangkan nilai VAR pada resep racikan meningkat dari 61,1% menjadi 62,75%. Penelitian ini menyimpulkan bahwa penerapan Lean Hospital mampu mengidentifikasi dan mengeliminasi aktivitas yang tidak memberikan nilai tambah sehingga meningkatkan efisiensi proses pelayanan farmasi dan menurunkan waktu tunggu pelayanan resep di Instalasi Farmasi Rawat Jalan Charitas Hospital Palembang.
Outpatient pharmacy services constitute an essential component of hospital healthcare delivery, playing a significant role in ensuring service quality, patient safety, and patient satisfaction. One of the key indicators of pharmacy service quality is prescription waiting time. Preliminary observations conducted at the Outpatient Pharmacy Department of Charitas Hospital Palembang indicated that prescription waiting times, particularly for compounded prescriptions, had not yet met the established Minimum Service Standards (MSS). This study aimed to analyze the implementation of Lean Hospital principles as an approach to improving service efficiency and reducing prescription waiting times at the Outpatient Pharmacy Department of Charitas Hospital Palembang. This study employed an operational research design using a Lean Hospital approach. Data were collected through direct observation of prescription service workflows and time measurements at each stage of the dispensing process. A total of 200 prescriptions were analyzed, comprising 152 non-compounded prescriptions and 48 compounded prescriptions. Data analysis was conducted using Value Stream Mapping (VSM), waste identification based on Lean principles and fishbone diagram analysis, as well as process efficiency assessment through the calculation of the Value Added Ratio (VAR). The findings revealed that, in the current state, the lead time for non-compounded prescriptions was 34.5 minutes, consisting of 16.8 minutes of Value Added Time (VAT) and 17.8 minutes of Non-Value Added Time (NVAT). Meanwhile, the lead time for compounded prescriptions was 74.3 minutes, comprising 45.4 minutes of VAT and 29,1 minutes of NVAT. Waste analysis demonstrated that waiting waste was the most dominant type of waste, accounting for 61.8% of total waste in non-compounded prescription services and 53.61% in compounded prescription services, followed by overprocessing waste. Based on the analysis of waste causes, several Lean improvement interventions were implemented, including the addition of pharmacy technicians during morning and afternoon shifts, the utilization of WhatsApp Blast as a real-time notification system to inform patients when medications were ready for collection, enhanced coordination with insurance providers, the provision of hand blenders and capsule-filling devices to support compounding activities, implementation of the 5S methodology, optimization of pharmacy layout, application of visual management techniques, and adjustment of specialist physicians’ practice schedules along with improved compliance with service schedules. The future state mapping demonstrated improved process efficiency. The lead time for non-compounded prescriptions decreased to 20.3 minutes, representing a 41.2% reduction, while the lead time for compounded prescriptions decreased to 52.9 minutes, representing a 28.8% reduction. Furthermore, the VAR for non-compounded prescriptions increased from 48.7% to 49.75%, whereas the VAR for compounded prescriptions increased from 61.1% to 62.75%. This study concludes that the implementation of Lean Hospital principles effectively identified and eliminated non-value-added activities, thereby improving pharmacy service efficiency and reducing prescription waiting times at the Outpatient Pharmacy Department of Charitas Hospital Palembang.
B-2616
Depok : FKM-UI, 2026
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Danyel Suryana; Pembimbing: Adang Bachtiar; Penguji: Puput Oktamianti, Amal Chalik Sjaaf, Hinarto Satryana, Andi Heryono
Abstrak:
Salah satu cara untuk melakukan efisiensi, meningkatkan mutu pelayanan dan meningkatkan keselamatan pasien di Amerika dengan menggunakan konsep Lean Thinking yang diterapkan di rumah sakit menjadi Lean Hospital. Di Rumah Sakit Atma Jaya yang merupakan Rumah Sakit Swata Kelas B Pendidikan, penelitian ini menganalisis alur pelayanan resep di Instalasi Farmasi Rawat Jalan sebagai data untuk perbaikan. Dengan menggunakan Root Cause Analysis (RCA), metodologi penelitian operational research, dilakukan observasi dan wawancara mendalam memperlihatkan bahwa kegiatan non value added bisa sampai 85% dan kegiatan value added hanya 15% pada penyiapan obat non racikan. Sedangkan untuk obat racikan kegiatan non value added sekitar 68% dan value added sebesar 32% nilainya. Data tersebut menunjukan bahwa telah terjadi pemborosan (waste). Usulan perbaikan untuk mengurangi pemborosan antara lain penggantian SIM RS yang baru dan menggiatkan fungsi Tim Kendali Mutu di Instalasi Farmasi. Bila perbaikan ini telah di implementasi, diharapakan terjadi peningkatan efisiensi di Instalasi Farmasi Rawat Jalan dan meningkatkan kepuasan pasien. Kata kunci: Konsep Lean, Lean Thinking, Lean Hospital, Resep, waktu tunggu obat, rawat jalan, pemborosan, analisis akar masalah One option to increase efficiency, service quality and patient safety in the United States of America is by using the Lean Thinking concept, which are implemented in Hospitals to become a Lean Hospital. In Atma Jaya Hospital, a class B study private hospital, the research analyses the workflow of prescription sevice in outpatient pharmacy departement to act as data for improvement analysis. Also, by utilizing Root Cause Analysis (RCA), operational research methology, indepth observation and interviews are conducted at compounding and noncompounding medicine storage of Outpatient Patient Departement, the result shows non-value added activities reaches 85%, while value added activities are only 15% on non-compounding medicine storage. While, on compounding medicine storage, non-value added and value added activities are at 68% and 32% respectively. These data clearly shows that great inefficiencies has occurred. Solution is suggested to increase the efficiency in the department, changing Hospital Information System and activate the Quality Control Team function. If these steps are implemented, we can expect the overall efficiency in the Outpatient Pharmacy Departement to improve significantly and resulted in higher patient satisfaction. Keywords: Concepts Lean, Lean Thinking, Lean Hospital, Prescription, drug waiting time, outpatient, waste, Root Cause Analysis
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B-1877
Depok : FKM-UI, 2017
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Elina Waiman; Pembimbing: Anhari Achadi; Penguji: Masyitoh, Wahyu Sulistiadi, Jocelyn Adrianto, Noer Triyanto Rusli
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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
B-2294
Depok : FKM-UI, 2022
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Ni Wayan Ari Anindita Sari; Pembimbing: Helen Andriani; Penguji: Pujiyanto, Purnawan Junadi, I Putu Oka Dharmawan, Dewa Ayu Swastini
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Lamanya waktu tunggu di pelayanan di instalasi farmasi rawat jalan Rumah Sakit Ari Canti masih belum sesuai target Standar Pelayanan Minimal, dimana standar pelayanan minimal (SPM) mewajibkan waktu tunggu obat non racikan ≤30 menit dan obat racikan ≤60 menit. Penelitian ini bertujuan untuk menganalisis waktu tunggu pelayanan obat rawat jalan JKN dengan lean hospital di RS Ari Canti Tahun 2023. Desain penelitian ini adalah operational research (OR). Tempat dari penelitian adalah Depo Farmasi Rawat Jalan di RS Ari Canti saat hari kerja pada bulan Mei – Juni 2023. Sampel dalam penelitian ini diambil sebanyak 98 resep obat yang dibagi ke dalam beberapa poliklinik di RS Ari Canti. Pengamatan langsung menggunakan lembar observasi VSM dan lembar waste, wawancara mendalam dengan infoman menggunakan lembar wawancara. Hasil penelitian menunjukkan bahwa total waktu dalam pelayanan kefarmasian pada kondisi current state adalah 53 menit 12 detik. Lead time untuk obat racikan selama 1 jam 2 menit 28 detik sedangkan pada resep obat non-recikan selama 51 menit 41 detik. Setelah dilakukan pengkajian ditemukan 10 aktivitas waste yang terdiri dari 56,89% waste waiting, 20,75% waste defect, 15,53% waste motion, dan 6,83%waste overprocessing. Setelah dilakukannya intervensi lean hospital berupa 5S, visual management, heijunka borda pareto dan PDCA terjadi penurunan lead time dari 53 menit 12 detik menjadi 19 menit 47 detik dengan persentase penurunan sebesar 62,80%. Kemudian lead time berdasarkan resep obat racikan pasca intervensi selama 42 menit 7 detik, sedangkan lead time resep obat non racikan selama 18 menit 47 detik. Nilai value to waste ratio juga terjadi peningkatan dari sebelumnya pre intervensi sebesar 40,90% menjadi 88,32% pasca intervensi. Kesimpulan penelitian ini alalah Lean Hospital merupakan metode atau tool yang tepat untuk meningkatkan value to waste ratio dengan mengurangi pemborosan dan meningkatkan nilai tambah untuk pasien. Manajemen dapat melakukan langkah awal continuous improvement seperti menghitung kebutuhan obat secara berkala untuk dapat memproyeksikan persiapan obat sesuai dengan permintaan.
The length of time waiting for service at the outpatient pharmacy installation at Ari Canti Hospital is still not in accordance with the Minimum Service Standard target, where the minimum service standard (SPM) requires waiting time for non-concoction drugs ≤30 minutes and for mixed drugs ≤60 minutes. This study aims to analyze the waiting time for JKN outpatient drug services with lean hospital at Ari Canti Hospital in 2023. The design of this research is operational research (OR). The location of the research was the Outpatient Pharmacy Depot at Ari Canti Hospital during weekdays from May to June 2023. The sample in this study was taken as many as 98 drug prescriptions which were divided into several polyclinics at Ari Canti Hospital. Direct observation using VSM observation sheets and waste sheets, in-depth interviews with informants using interview sheets. The results showed that the total time in pharmaceutical services in the current state was 53 minutes 12 seconds. The lead time for concoction drugs is 1 hour 2 minutes 28 seconds while for non-recipe drug prescriptions it is 51 minutes 12 seconds. After conducting the study, it was found that 9 waste activities consisted of 56,89% waste waiting, 20,75% waste defects, 15,53% waste motion, and 6,83% waste overprocessing. After the lean hospital intervention in the form of 5S, visual management, heijunka borda pareto and PDCA, the lead time decreased from 53 minutes 12 seconds to 19 minutes 47 seconds with a decrease percentage of 62.80%. Then the lead time based on post-intervention concoction drug prescription was 42 minutes 7 seconds, while the non-concoction drug prescription lead time was 18 minutes 47 seconds. The value to waste ratio also increased from the previous pre-intervention of 40.90% to 88.32% post-intervention. The conclusion of this study is that Lean Hospital is the right method or tool to increase the value to waste ratio by reducing waste and increasing added value for patients. Management can take initial steps for continuous improvement, such as calculating drug needs on a regular basis to be able to project drug preparations according to demand.
B-2390
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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M. Hanifan Irham Fauzan; Pembimbing: Masyitoh; Pneguji: Helen Andriani, Maria Linggar Pratiwi, Melanie Vandauli
Abstrak:
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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.
B-2553
Depok : FKM-UI, 2025
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Clara Niken Larasati; Pembimbing: Helen Andriani; Penguji: Wiku Bakti Bawono Adisasmito, Taufik Santoso, Maria Immaculata Windarti
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Kekosongan obat di Instalasi Farmasi Charitas Hospital Palembang mengganggu operasional pelayanan dan mengancam keselamatan pasien, dengan kejadian penundaan resep mencapai 1,16% di Farmasi Rawat Jalan dan sekitar 50% pasien tidak kembali mengambil obat. Penelitian ini bertujuan untuk menganalisis dampak implementasi Lean Six Sigma terhadap penurunan kejadian kekosongan obat dan mempertahankan nilai Inventory Turn Over Ratio (ITOR). Desain penelitian menggunakan action research dengan membandingkan periode sebelum implementasi (Januari–April 2026) dan sesudah implementasi (Mei 2026), menerapkan metodologi Lean Six Sigma melalui tahapan Define, Measure, Analyze, Improve, dan Control (DMAIC). Hasil penelitian menunjukkan bahwa Farmasi Rawat Inap berhasil mempertahankan persentase penundaan resep di bawah 0,1% (0,07% pada Mei 2026) dengan nilai ITOR stabil di 1,85, sementara Farmasi Rawat Jalan mengalami peningkatan penundaan menjadi 1,16% dengan nilai ITOR terkoreksi ke 1,62. Tiga solusi perbaikan yang diimplementasikan adalah formulasi perencanaan berbasis Excel dengan perhitungan safety stock dan reorder point, edukasi budaya kerja anti-double click, dan upgrade spesifikasi komputer. Kesimpulannya, intervensi jangka pendek yang diterapkan belum optimal mengatasi masalah kekosongan obat di Farmasi Rawat Jalan yang memiliki permintaan dinamis, namun berhasil menjaga keseimbangan antara efisiensi biaya modal kerja dan ketersediaan obat untuk pelayanan pasien. Penelitian ini merekomendasikan kustomisasi sistem informasi farmasi (SIRS) secara permanen, integrasi dasbor pengadaan, dan penguatan hubungan vendor melalui Service Level Agreement (SLA) untuk mencapai perbaikan berkelanjutan.
Drug stock-out at Charitas Hospital Palembang's Pharmacy Department disrupts service operations and threatens patient safety, with prescription delay incidents reaching 1.16% in Outpatient Pharmacy and approximately 50% of patients not returning to purchase medications. This research aims to analyze the impact of Lean Six Sigma implementation on reducing drug stock-out incidents and maintaining Inventory Turn Over Ratio (ITOR) values. The study employs an action research design comparing pre-implementation (January–April 2026) and post-implementation (May 2026) periods, applying Lean Six Sigma methodology through Define, Measure, Analyze, Improve, and Control (DMAIC) phases. Results showed that Inpatient Pharmacy successfully maintained prescription delay rates below 0.1% (0.07% in May 2026) with stable ITOR at 1.85, while Outpatient Pharmacy experienced increased delays to 1.16% with ITOR corrected to 1.62. Three improvement solutions implemented were Excel-based planning formulation incorporating safety stock and reorder point calculations, anti-double click work culture education, and computer specification upgrades. In conclusion, short-term interventions proved suboptimal for addressing drug stock-out in Outpatient Pharmacy with highly dynamic demand, but successfully maintained balance between working capital efficiency and drug availability for patient care. This research recommends permanent pharmacy information system (SIRS) customization, integrated procurement dashboard implementation, and strengthened vendor relationships through Service Level Agreements (SLA) to achieve sustainable improvements.
B-2607
Depok : FKM-UI, 2026
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Angga Perdana Kusumah; Pembimbing: Anhari Achadi; Penguji: Masyitoh, Adik Wibowo, Dedi Wahyudi, Muhammad Bascharul Asana
Abstrak:
Rumah sakit memiliki kewajiban untuk memberikan pelayanan kesehatan yang aman, bermutu, anti diskriminatif dan efektif. Salah satunya adalah pelayanan kefarmasian yang merupakan bagian integral sistem pelayanan RS yang bertanggung jawab memastikan ketersediaan obat yang aman, bermutu dan berkhasiat. KMK 129/Menkes/SK/II/2008 menyebutkan bahwa RS wajib memenuhi Standar Pelayanan Minimal (SPM) yang salah satunya adalah Waktu Tunggu Pelayanan Obat. RS Jantung Hasna Medika Cirebon melayani 4000-5000 kunjungan rawat jalan setiap bulan dengan 92% diantaranya pasien BPJS Kesehatan. Rerata pencapaian waktu tunggu obat racikan hanya tercapai ≤ 72% dan obat jadi ≤40%. Tujuan penelitian ini adalah untuk meningkatkan kecepatan pelayanan resep rawat jalan pasien BPJS Kesehatan di instalasi farmasi RS Jantung Hasna Medika Cirebon menggunakan Lean Hospital. Metode penelitian ini adalah operational research dengan pendekatan kualitatif dengan sumber data primer diambil melalui observasi langsung dengan teknik time and motion study, telaah dokumen, wawancara mendalam dan Focus Group Discussion (FGD). Hasil penelitian ditemukan 2 jenis waste yaitu 99,31% waste waiting dan 0,69% waste motion, setelah dilakukan intervensi berupa optimalisasi e-resep, 5S dan visual management serta continuous flow dan process balancing terjadi penurunan lead time dari 01:24:47 menjadi 00:25:30 detik atau menurun sebesar 59 menit 17 detik (69,93%). Kesimpulan penelitian ini bahwa Lean Hospital merupakan metode atau tool yang tepat untuk meningkatkan value to waste ratio dengan mengurangi pemborosan dan meningkatkan nilai tambah untuk pasien. Penelitian ini belum maksimal dikarenakan pilihan lean hospital tools sangat terbatas mengingat waktu yang juga terbatas. Sehingga saran peneliti adalah meminta manajemen RS untuk menjadikan penelitian ini sebagai langkah awal continuous improvement untuk dapat dilanjutkan menggunakan tools lain dan di unit pelayanan yang berbeda
Hospitals have an obligation to provide safe, high quality, anti-discriminatory and effective services. One of them is pharmacy services as an integral part of the hospital service system that is responsible for ensuring the availability of safe, high quality and efficacious drugs. KMK 129/Menkes/SK/II/2008 states that hospitals are required to meet the Standards of Minimum Services (SPM), one of which is the Waiting Time for Drug Services. RS Jantung Hasna Medika Cirebon serves 4000-5000 outpatient visits every month with 92% of them being BPJS Kesehatan patients. The average waiting time for concoction drugs was only achieved by 72% and non-concoction drugs achieved by 40%. The purpose of this study was to increase the speed of outpatient prescription services for BPJS Kesehatan patients at the pharmacy installation of the RS Jantung Hasna Medika Cirebon using Lean Hospital. This research method is operational research with a qualitative approach. Primary data sources taken through direct observation with time and motion study techniques, in-depth interviews and Focus Group Discussion (FGD). The results of the study found 2 types of waste, namely 99.31% waiting waste and 0.69% motion waste, after intervention in the form of optimizing e-prescription, 5S and visual management as well as continuous flow and process balancing there was a decrease in lead time from 01:24:47 to 00:25:30 or decreased by 59 minutes 17 seconds (69.93%). The conclusion of this study is that Lean Hospital is the right method or tool to increase the value to waste ratio by reducing wasting time and increasing additional value for patients. This research has not been maximized because the choice of lean hospital tools is very limited considering the time is short. The researcher's suggestion is to encourage the hospital management to use this research as the first step of continuous improvement by using other tools in another service units
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Hospitals have an obligation to provide safe, high quality, anti-discriminatory and effective services. One of them is pharmacy services as an integral part of the hospital service system that is responsible for ensuring the availability of safe, high quality and efficacious drugs. KMK 129/Menkes/SK/II/2008 states that hospitals are required to meet the Standards of Minimum Services (SPM), one of which is the Waiting Time for Drug Services. RS Jantung Hasna Medika Cirebon serves 4000-5000 outpatient visits every month with 92% of them being BPJS Kesehatan patients. The average waiting time for concoction drugs was only achieved by 72% and non-concoction drugs achieved by 40%. The purpose of this study was to increase the speed of outpatient prescription services for BPJS Kesehatan patients at the pharmacy installation of the RS Jantung Hasna Medika Cirebon using Lean Hospital. This research method is operational research with a qualitative approach. Primary data sources taken through direct observation with time and motion study techniques, in-depth interviews and Focus Group Discussion (FGD). The results of the study found 2 types of waste, namely 99.31% waiting waste and 0.69% motion waste, after intervention in the form of optimizing e-prescription, 5S and visual management as well as continuous flow and process balancing there was a decrease in lead time from 01:24:47 to 00:25:30 or decreased by 59 minutes 17 seconds (69.93%). The conclusion of this study is that Lean Hospital is the right method or tool to increase the value to waste ratio by reducing wasting time and increasing additional value for patients. This research has not been maximized because the choice of lean hospital tools is very limited considering the time is short. The researcher's suggestion is to encourage the hospital management to use this research as the first step of continuous improvement by using other tools in another service units
B-2224
Depok : FKM-UI, 2021
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Dian Elawati; Pembimbing: Pujiyanto; Penguji: Masyitoh Basabih, Vetty Yulianty Purnamasari, Elga Ria Vinensa, Adriansyah
Abstrak:
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Pendahuluan: Waktu tunggu pelayanan obat rawat jalan non racikan dan racikan di Instalasi Farmasi RS Mitra Husada belum mencapai standar nasional yaitu ≤30 menit untuk obat non racikan dan ≤60 menit obat racikan sehingga masih menjadi keluhan bagi RS. Penelitian ini bertujuan menganalisis waktu tunggu pelayanan obat dengan menggunakan konsep Lean Hospital di Instalasi Farmasi RS Mitra Husada. Metode: Penelitian ini adalah deskriptif kualitatif dengan action research, pengambilan data dilakukan pada bulan Mei dan Juni 2022 di Instalasi Farmasi Rawat Jalan. Sampel yang diambil berjumlah 98 resep obat non racikan dan 100 obat racikan. Pengamatan langsung menggunakan lembar observasi VSM dan lembar waste, wawancara dengan informan menggunakan lembar wawancara. Analisis kuantitatif menggunakan SPSS dan kualitatif dengan mengolah data primer, sekunder dan wawancara. Hasil: Pada kondisi current state waktu yang dibutuhkan untuk pelayanan setiap 1 resep (lead time) untuk resep non racikan adalah 63,54 menit dari standar nasional ≤ 30 menit dengan waste 87,5% nya, sedangkan lead time untuk resep racikan adalah 106,5 menit dari standar nasional ≤ 60 menit dengan waste 81,82%. Pada analisa kegiatan non value added terdapat 22 kegiatan yang termasuk dalam waste, tertinggi ada pada kategori waste waiting dantransportation. Root cause analysis dengan metode 5 why’s menyimpulan bahwa akar masalah utama pada penelitian ini pada man. Kesimpulan: Dengan metode lean hospital dapat mengetahui capaian waktu tunggu pelayanan obat rawat jalan, waste dan akar penyebab masalah hingga desain rancangan perubahan sebagai upaya perbaikan berupa desain perbaikan jangka pendek yaitu menggunakan lean kaizen, PDCA, 5S, Visual management dan heijunka, jangka menengah dan panjang. Kata kunci: Waktu tunggu obat, lean, Rawat Jalan, Farmasi
Pendahuluan: Waktu tunggu pelayanan obat rawat jalan non racikan dan racikan di Instalasi Farmasi RS Mitra Husada belum meIntroduction: The waiting time for non compounding and compounding outpatient services at the Pharmacy Installation of Mitra Husada Hospital has not yet reached the national standard, namely 30 minutes for non compounding drugs and 60 minutes for compounding drugs so it is still a complaint for hospitals. This study aims to analyze the waiting time for drug services using the Lean Hospital concept at the Pharmacy Installation of Mitra Husada Hospital. Methods: This research is descriptive qualitative with action research, data collection was carried out in May and June 2022 at the Outpatient Pharmacy Installation. The samples taken amounted to 98 non compounding drug prescriptions and 100 compounding drugs. Direct observations using VSM observation sheets and waste sheets, interviews with informants using interview sheets. Quantitative analysis using SPSS and qualitative by processing primary, secondary and interview data. Results: In the current state, the time required for service for every 1 recipe (Lead Time) for non-compounding recipes is 63.54 minutes from the national standard 30 minutes with 87.5% waste, while the Lead Time for compounding recipes is 106, 5 minutes from the national standard 60 minutes with 81.82% waste. In the analysis of non-value added activities there are 22 activities that are included in the waste, the highest is in the category of waste waiting and transportation. Root cause analysis with the 5 why's method concludes that the main root cause of this research is man. Conclusion: With the lean hospital method, we can find out the waiting time for outpatient drug services, waste and the root causes of the problem to the design of the change design as an improvement effort in the form of short,with lean kaizen, PDCA, 5S, Visual management and heijunka tools and medium and long term improvement designs. Key words: Drug waiting time, lean, Outpatient, Pharmacyncapai standar nasional yaitu ≤30 menit untuk obat non racikan dan ≤60 menit obat racikan sehingga masih menjadi keluhan bagi RS. Penelitian ini bertujuan menganalisis waktu tunggu pelayanan obat dengan menggunakan konsep Lean Hospital di Instalasi Farmasi RS Mitra Husada. Metode: Penelitian ini adalah deskriptif kualitatif dengan action research, pengambilan data dilakukan pada bulan Mei dan Juni 2022 di Instalasi Farmasi Rawat Jalan. Sampel yang diambil berjumlah 98 resep obat non racikan dan 100 obat racikan. Pengamatan langsung menggunakan lembar observasi VSM dan lembar waste, wawancara dengan informan menggunakan lembar wawancara. Analisis kuantitatif menggunakan SPSS dan kualitatif dengan mengolah data primer, sekunder dan wawancara. Hasil: Pada kondisi current state waktu yang dibutuhkan untuk pelayanan setiap 1 resep (lead time) untuk resep non racikan adalah 63,54 menit dari standar nasional ≤ 30 menit dengan waste 87,5% nya, sedangkan lead time untuk resep racikan adalah 106,5 menit dari standar nasional ≤ 60 menit dengan waste 81,82%. Pada analisa kegiatan non value added terdapat 22 kegiatan yang termasuk dalam waste, tertinggi ada pada kategori waste waiting dantransportation. Root cause analysis dengan metode 5 why’s menyimpulan bahwa akar masalah utama pada penelitian ini pada man. Kesimpulan: Dengan metode lean hospital dapat mengetahui capaian waktu tunggu pelayanan obat rawat jalan, waste dan akar penyebab masalah hingga desain rancangan perubahan sebagai upaya perbaikan berupa desain perbaikan jangka pendek yaitu menggunakan lean kaizen, PDCA, 5S, Visual management dan heijunka, jangka menengah dan panjang. Kata kunci: Waktu tunggu obat, lean, Rawat Jalan, Farmasi
B-2277
Depok : FKM-UI, 2022
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Annisaa Perica Rasyid; Pembimbing: Vetty Yulianty Permanasari; Penguji: Jaslis Ilyas, Wahyu Sulistiadi, Netry Listriani, Khafifah Any
Abstrak:
Waktu tunggu yang lama pada pelayanan resep obat akan mengurangi kepuasan pelanggan dan menyebabkan pelayanan tidak efisien. Lean merupakan salah satu metodologi yang dapat digunakan untuk menangani ketidakefisienan dalam pelayanan kesehatan. Penelitian ini bertujuan untuk menganalisis penerapan metode lean dalam mengurangi waktu tunggu pelayanan resep obat pada instalasi farmasi rawat jalan RSUD Pasar Minggu tahun 2017.
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
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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
B-1897
Depok : FKM UI, 2017
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Willy; Pembimbing: Helen Andriani; Penguji: Popy Yuniar, Antonius Yudianto, Benedict Sulaiman
Abstrak:
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ABSTRAK Latar Belakang: Implementasi sistem antrean digital merupakan strategi transformasi digital kesehatan untuk meningkatkan efisiensi pelayanan rawat jalan. Charitas Hospital Palembang telah mengimplementasikan sistem antrean multi-kanal sejak 2024, namun pencapaian Standar Pelayanan Minimal (SPM) waktu tunggu ≤60 menit masih belum konsisten, dengan rata-rata kepatuhan 78,64% pada periode Oktober 2025–Januari 2026. Tujuan: Penelitian ini bertujuan untuk mengevaluasi implementasi sistem antrean digital di instalasi rawat jalan Charitas hospital Palembang Metode: Penelitian kualitatif dilaksanakan di Instalasi Rawat Jalan Charitas Hospital Palembang pada periode April–Mei 2026. Pengumpulan data menggunakan observasi partisipatif, Focus Group Discussion, dan wawancara mendalam (n=20) dengan informan dari pasien, petugas front office, perawat, dan manajemen. Teori yang digunakan mengintegrasikan Model Donabedian (input, proses, output) dan Technology Acceptance Model (TAM) untuk menggali persepsi subjektif, pengalaman nyata, serta dinamika operasional pengguna sistem. Analisis data dilakukan secara tematik dengan triangulasi data untuk memastikan validitas temuan. Hasil: Penelitian mengidentifikasi empat komponen utama: (1) Komponen Input menunjukkan infrastruktur teknologi memadai namun ada kesenjangan integrasi dengan SIMRS dan BPJS; (2) Komponen Proses mengungkapkan sistem mengurangi waktu transaksi loket namun terjadi bottleneck shift dan variabilitas durasi konsultasi; (3) Persepsi Pengguna (TAM) menunjukkan Perceived Ease of Use moderat-mudah dengan variasi antar kelompok pengguna, sementara Perceived Usefulness dipengaruhi pengalaman aktual dengan sistem; (4) Output menunjukkan performa fluktuatif, menunjukkan potensi besar sistem dalam meningkatkan efisiensi pelayanan dan kepuasan pasien melalui pengurangan kepadatan fisik di lokasi pendaftaran. Kesimpulan: Keberhasilan sistem antrean digital bergantung pada interaksi kompleks antara penerimaan pengguna, kesiapan infrastruktur, dan optimalisasi proses operasional. Diperlukan strategi komprehensif mencakup peningkatan literasi digital pasien, optimalisasi integrasi sistem, pelatihan petugas, dan manajemen sumber daya manusia yang lebih efektif. Kata Kunci: Sistem Antrean Digital; Penerimaan Pengguna; Efisiensi Pelayanan; Technology Acceptance Model; Rawat Jalan; Evaluasi Kualitatif.
Background: The implementation of digital queuing systems is a health digital transformation strategy to improve outpatient service efficiency. Charitas Hospital Palembang has implemented a multi-channel queuing system since 2024; however, the achievement of the Minimum Service Standard (SPM) for waiting time of ≤60 minutes remains inconsistent, with average compliance of 78.64% during October 2025–January 2026. Objective: This study aims to evaluate the implementation of the digital queuing system in the outpatient installation of Charitas Hospital Palembang. Methods: A qualitative study was conducted in the Outpatient Installation of Charitas Hospital Palembang during April–May 2026. Data collection employed participatory observation, Focus Group Discussions, and in-depth interviews (n=20) with informants from patients, front office staff, nurses, and management. The theoretical framework integrated the Donabedian Model (input, process, output) and Technology Acceptance Model (TAM) to explore subjective perceptions, actual experiences, and operational dynamics of system users. Data analysis was performed thematically with data triangulation to ensure the validity of findings. Results: The study identified four main components: (1) Input Component shows adequate technological infrastructure but gaps in integration with Hospital Management Information System (SIMRS) and BPJS Health; (2) Process Component reveals the system reduces registration counter transaction time but experiences bottleneck shift and consultation duration variability; (3) User Perception (TAM) shows moderate-easy Perceived Ease of Use with variation across user groups, while Perceived Usefulness is influenced by actual system experience; (4) Output shows fluctuating performance, demonstrating the system's significant potential in improving service efficiency and patient satisfaction through reducing physical congestion at the registration location. Conclusion: The success of the digital queuing system depends on complex interactions between user acceptance, infrastructure readiness, and operational process optimization. A comprehensive strategy is needed including improving patient digital literacy, optimizing system integration, staff training, and more effective human resource management. Keywords: Digital Queuing System; User Acceptance; Service Efficiency; Technology Acceptance Model; Outpatient; Qualitative Evaluation.
B-2606
Depok : FKM-UI, 2026
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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