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Fransiska Satriani Damput; Pembimbing: Wachyu Sulistiadi; Penguji: Helen Andriani, Masyitoh, Adhitya Wardhana, Vitrie Winastri
Abstrak:
Latar Belakang : Pengelolaan inventori obat yang efisien merupakan faktor penting dalam menjamin ketersediaan obat, mutu pelayanan, dan efisiensi biaya rumah sakit. Ketidakefisienan pengelolaan inventori dapat menimbulkan berbagai waste, seperti kelebihan stok, kekosongan stok, obat non-moving, dan obat kedaluwarsa, yang berdampak pada peningkatan biaya, penurunan mutu pelayanan, serta keterlambatan terapi pasien. Berbagai faktor, antara lain perencanaan yang tidak akurat, lamanya waktu pengadaan, penyimpanan yang belum optimal, dan variasi proses operasional, menjadi penyebab utama ketidakefisienan pengelolaan inventori obat. Tujuan: Mengoptimalkan manajemen rantai pasok internal farmasi di Instalasi Farmasi Medistra Hospital melalui pendekatan lean six sigma dalam pengendalian dan peningkatan efisiensi inventori obat sehingga dapat mengurangi pemborosan, menekan variasi proses, mengoptimalkan ketersediaan obat, serta mendukung mutu pelayanan rumah sakit. Metode: Penelitian ini menggunakan desain operational research dengan pendekatan mix method, dimana kerangka kerja Lean Six Sigma melalui DMAIC digunakan sebagai panduan sistematis untuk mengintegrasikan analisis data kuantitatif inventori obat dan data kualitatif operasional. Teknik pengambilan sampel yang digunakan adalah stratified random sampling, dengan total sampel sebanyak 400 nomor perencanaan obat. Hasil: Pendekatan Lean Six Sigma mengidentifikasi lead time pengelolaan inventori obat sebesar 139 jam 26 menit 30 detik (5,7 hari), dengan 99% waktu proses merupakan kegiatan non-value added yang didominasi oleh waste tipe waiting sebesar 137 jam 37 menit 3 detik. Kondisi awal inventori menunjukkan nilai persediaan sebesar Rp 12.223.885.423,40, terdiri atas 343 item obat overstock senilai Rp 301.047.282, 88 item obat kosong, 35 item obat stagnan senilai Rp 34.775.208, dan 9 item obat expired senilai Rp1.613.710. Akar masalah yang teridentifikasi meliputi belum optimalnya SIMRS inventori, tingginya variasi me-too brand dalam formularium rumah sakit, variasi pengetahuan dan kompetensi petugas, belum adanya regulasi tindak lanjut purchase order kepada distributor, kurangnya pemahaman staf pembelian terhadap kebutuhan pelayanan, pembatasan jam persetujuan purchase order, kurangnya supervisi pada tahap penerimaan, keterlambatan penyimpanan obat, belum tersedianya visual management untuk penerapan FEFO/FIFO, serta penempatan obat LASA yang belum sesuai regulasi. Intervensi Lean Six Sigma dilakukan melalui penerapan standardized work, sosialisasi ulang alur kerja, implementasi sistem kanban pada tahap perencanaan, optimalisasi prinsip 5R di gudang logistik farmasi, serta penerapan visual management untuk mendukung implementasi FEFO/FIFO. Kesimpulan : Implementasi lean six sigma berhasil menurunkan lead time pengelolaan inventori obat, menurunkan nilai stok inventori obat dan jumlah item inventori obat, menurunkan nilai pembelian obat, menurunkan nilai obat overstock, menurukan jumlah obat kosong, menurunkan jumlah obat stagnan dan menurunkan jumlah obat expired.

Background: Efficient drug inventory management is essential to ensure medicine availability, improve service quality, and enhance hospital cost efficiency. Inefficient inventory management can generate various forms of waste, including overstock, stockouts, non-moving medicines, and expired medicines, leading to increased costs, reduced quality of care, and delays in patient treatment. Inaccurate planning, prolonged procurement lead times, suboptimal storage practices, and variations in operational processes are among the major contributors to inefficiencies in drug inventory management. Objective: To optimize internal pharmaceutical supply chain management at the Pharmacy Department of Medistra Hospital through the implementation of Lean Six Sigma to improve drug inventory control and operational efficiency, thereby reducing waste, minimizing process variation, optimizing medicine availability, and supporting the quality of hospital services. Methods: This operational research employed a mixed-methods design. The Lean Six Sigma DMAIC (Define, Measure, Analyze, Improve, and Control) framework was used as a systematic approach to integrate quantitative drug inventory data with qualitative operational data. A stratified random sampling technique was applied, resulting in a total sample of 400 drug planning records. Results: The Lean Six Sigma approach identified a total drug inventory management lead time of 139 hours, 26 minutes, and 30 seconds (5.7 days), of which 99% consisted of non-value-added activities, predominantly waiting waste, accounting for 137 hours, 37 minutes, and 3 seconds. The baseline inventory value was IDR 12,223,885,423.40, comprising 343 overstock items valued at IDR 301,047,282, 88 stockout items, 35 non-moving items valued at IDR 34,775,208, and 9 expired items valued at IDR 1,613,710. Root cause analysis identified several contributing factors, including suboptimal utilization of the Hospital Management Information System (HMIS) for inventory management, a high variation of me-too brands in the hospital formulary, variations in staff knowledge and competencies, the absence of regulations governing purchase order follow-up with distributors, limited understanding among purchasing staff regarding clinical service requirements, restrictions on purchase order approval hours, inadequate supervision during the receiving process, delays in transferring medicines to designated storage locations, the absence of visual management tools to support FEFO/FIFO implementation, and non-compliant placement of look-alike, sound-alike (LASA) medicines. Lean Six Sigma interventions included the implementation of standardized work, workflow reorientation, a kanban system during the planning stage, optimization of the Indonesian 5R workplace organization principles in the pharmacy logistics warehouse, and visual management to strengthen FEFO/FIFO implementation. Conclusion: The implementation of Lean Six Sigma successfully reduced drug inventory management lead time, inventory value, the number of inventory items, drug purchasing expenditure, overstock value, stockout incidents, non-moving medicines, and expired medicines, thereby improving the efficiency of internal pharmaceutical supply chain management.
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B-2622
Depok : FKM-UI, 2026
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:

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.

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B-2553
Depok : FKM-UI, 2025
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Rizky Nita Noer; Pembimbing: Masyitoh; Penguji: Puput Oktamianti, Umi Aisyiyah
S-8941
Depok : FKM UI, 2016
S1 - Skripsi   Pusat Informasi Kesehatan Masyarakat
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Clara Niken Larasati; Pembimbing: Helen Andriani; Penguji: Wiku Bakti Bawono Adisasmito, Taufik Santoso, Maria Immaculata Windarti
Abstrak:
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.
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B-2607
Depok : FKM-UI, 2026
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Magdalena; Pembimbing: Masyitoh; Penguji: Purnawan Junadi, Helma Meuthia
Abstrak: Penelitian ini bertujuan merancang usulan perbaikan efektivitas dan efisiensi pelayanan radiologi RS Pusat Otak Nasional dengan menerapkan metode constraint lean six sigma. Penelitian ini dirancang dengan desain kualitatif dan kuantitatif. Data kuantitatif didapat dari hasil observasi lamanya waktu pelayanan radiologi di RS Pusat Otak Nasional. Jumlah sampel penelitian sebanyak 30 sampel. Hasil penelitian ini yaitu rata-rata lead time pelayanan sebesar 2 jam 13 menit. Waktu NVA tertinggi terdapat pada siklus pengolahan ekspertise. Waktu NVA tertinggi terdapat pada jenis waste yaitu waiting dan processing. Penyebab utama NVA pada kedua waste tersebut adalah PACS system error dan waktu tunggu hasil baca foto/scaning. Hasil penelitian menemukan 7 sampel memiliki waktu tunggu pelayanan radiologi > 3 jam. Sebesar 57% dari total defect pelayanan dikontribusi oleh pemeriksaan di luar jam kerja dan hari libur. Usulan perbaikan yang diperlukan yaitu Standardize work berupa Standar Prosedur Operasional (SPO) pengiriman foto/scaning pemeriksaan CITO di luar jam kerja dan hari libur, evaluasi rutin alat PACS, dan penerapan radiology information system (RIS) yang terintegrasi.
Kata Kunci : Pelayanan Radiologi; Constraint; Lean Six Sigma; Waste

This study aims to design a proposal to improve the effectiveness and efficiency of radiology service of National Brain Hospital by applying the method of constraint lean six sigma. This research is designed with qualitative and quantitative design. Quantitative data obtained from the observation of the length of time radiology services at National Central Medical Center. The sample size is 30 samples. The results of this study is the average service lead time of 2 hours 13 minutes. The highest NVA time is in the experimental processing cycle. The highest NVA time is in the type of waste that is waiting and processing. The main causes of NVA in both waste are PACS system error and waiting time of reading radiograph. The results of the study found 7 samples have radiology service waiting time > 3 hours. 57% of the total service defect was contributed by after hours and holidays. The proposed improvements required are Standardize work in the form of Standard Operating Procedures (SPO) of sending radiograph CITO in after hours and holidays, routine quality control of PACS tools, and integrated radiology information system (RIS) application.
Keyword : Radiology Service; Constraint; Lean Six Sigma; Waste
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S-9858
Depok : FKM UI, 2018
S1 - Skripsi   Pusat Informasi Kesehatan Masyarakat
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Elina Waiman; Pembimbing: Anhari Achadi; Penguji: Masyitoh, Wahyu Sulistiadi, Jocelyn Adrianto, Noer Triyanto Rusli
Abstrak:
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
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B-2294
Depok : FKM-UI, 2022
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Reny Astuty Sumarsono; Pembimbing: Masyitoh; Penguji: Helen Andriani, Santi Purna Sari, Relia Sari, Camelia Nanie Sriyati Phaing
Abstrak:
Latar Belakang : Waktu tunggu obat merupakan salah satu indikator penting rumah sakit dalam menilai mutu pelayanan kepada pasien. Lamanya waktu tunggu dapat memengaruhi tingkat kepuasan pasien yang berobat di rumah sakit. Berdasarkan Key Performance Indicator (KPI), standar waktu tunggu pelayanan obat non-racikan adalah  ≤ 10 menit dengan target pencapaian 90%, sedangkan untuk obat racikan ≤ 30 menit dengan target pencapaian 80%. Pencapaian waktu tunggu obat non-racikan pada tahun 2024 sebesar 62,57% dan tahun 2025 sebesar 63,17%. Sementara itu, pencapaian waktu tunggu obat racikan pada tahun 2024 sebesar 36,58% dan tahun 2025 sebesar 29,13%. Hasil tersebut menunjukkan bahwa pencapaian waktu tunggu pelayanan obat masih berada dibawah target yang telah ditetapkan. Tujuan : Menurunkan waktu tunggu obat non racikan dan racikan dengan menggunakan konsep Lean Six Sigma di Instalasi Farmasi Rawat Jalan Rumah Sakit Swasta Tipe B di Tangerang Selatan 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 202 pasien yang berobat dan mendapat obat di rumah sakit. Pemilihan sampel didasarkan pada shift dan jenis penjaminan yang telah ditetapkan. Hasil : Hasil        penelitian dengan pendekatan Lean Six Sigma berhasil mengidentifikasi Lead time waktu tunggu obat non-racikan di Rumah Sakit Swasta Tipe B di Tangerang Selatan yaitu sebesar 14 menit 16 detik dimana 72% merupakan kegiatan non-value added yang didominasi oleh waste tipe waiting sebesar 6 menit 3 detik (59%). Untuk Lead time waktu tunggu obat racikan 47 menit 1 detik dimana 64% merupakan kegiatan non-value added yang didominasi oleh waste tipe waiting sebesar 19 menit 19 detik (64%). Analisis akar masalah dilakukan menggunakan Pareto dan Five Whys. Penerapan lean six sigma dalam proses waktu tunggu obat racikan berhasil mengurangi lead time untuk waktu tunggu obat non-racikan sebesar 44,74% dari 14 menit 16 detik menjadi 7 menit 53 detik, pada tahap kontrol sebesar 6 menit 32 detik. Lead time waktu tunggu obat racikan menurun sebesar  42,61% dari 47 menit 1 detik menjadi 26 menit 59 detik, pada tahap kontrol lead time sebesar 22 menit 45 detik.  Terjadi penurunan waste total dari sebelum intervensi dengan setelah dilakukan intervensi pada obat non-racikan yaitu sebesar 72,98% dan obat racikan sebesar 72,17%. Penurunan waktu non-value added obat non-racikan dari 10 menit 18 detik menjadi 2 menit 47 detik, sedangkan untuk obat racikan dari 30 menit 18 detik menjadi 8 menit 26 detik. Kesimpulan        : Terdapat penurunan waktu tunggu obat racikan dan non-racikan di Rumah Sakit Swasta Tipe B di Tangerang Selatan setelah penerapan Lean Six Sigma. Penurunan waktu tunggu obat masih dibawah target KPI yang ditetapkan oleh Rumah Sakit Swasta Tipe B di Tangerang Selatan.

Background: A Drug waiting time is one of the key indicators used by hospitals to assess the quality of patient care services. Prolonged waiting times can significantly affect patient satisfaction. Based on the Key Performance Indicators (KPIs), the standard waiting time for dispensing non-compounded medications ≤10 minutes, with a target achievement rate of 90%, while the standard waiting time for compounded medications  ≤ 30 minutes, with a target achievement rate of 80%. The achievement rate for non-compounded medication waiting time was 62.57% in 2024 and 63.17% in 2025. Meanwhile, the achievement rate for compounded medication waiting time was 36.58% in 2024 and 29.13% in 2025. These results indicate that the performance of medication dispensing waiting times remains below the established targets. Objective: Reduction of Waiting Times for Non-Compounded and Compounded Medications Through the Lean Six Sigma Approach in the Outpatient Pharmacy Department of a Type B Private Hospital in Tangerang Selatan. Methods: This study employed an operational research design integrating quantitative and qualitative methods. Observations were conducted using a time-motion study to analyze the outpatient pharmacy workflow. A stratified random sampling technique was used to select a total of 202 outpatients who received medications from the hospital. Participants were stratified according to predetermined work shifts and payer categories. Results: The Lean Six Sigma approach successfully identified a lead time of 14 minutes and 16 seconds for non-compounded medications in the outpatient pharmacy department of a Type B private hospital in Banten Province, of which 72% consisted of non-value-added activities, predominantly waiting waste, accounting for 6 minutes and 3 seconds (59%). The lead time for compounded medications was 47 minutes and 1 second, with 64% classified as non-value-added activities, mainly waiting waste, totaling 19 minutes and 19 seconds (64%). Root cause analysis was conducted using the Pareto principle and the Five Whys method. Implementation of Lean Six Sigma reduced the lead time for non-compounded medications by 44.74%, from 14 minutes and 16 seconds to 7 minutes and 53 seconds, with a sustained lead time of 6 minutes and 32 seconds during the control phase. For compounded medications, the lead time decreased by 42.61%, from 47 minutes and 1 second to 26 minutes and 59 seconds, with a control-phase lead time of 22 minutes and 45 seconds. Total waste decreased by 72.98% for non-compounded medications and 72.17% for compounded medications following the intervention. Non-value-added time for non-compounded medications was reduced from 10 minutes and 18 seconds to 2 minutes and 47 seconds, while for compounded medications it decreased from 30 minutes and 18 seconds to 8 minutes and 26 seconds. Conclusion: There was a reduction in the waiting times for both compounded and non-compounded medications of a Type B private hospital in Banten Province following the implementation of Lean Six Sigma. However, despite this improvement, the medication waiting times remained below the Key Performance Indicator (KPI) target established by the hospital.
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B-2604
Depok : FKM-UI, 2026
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Nisle Purada Sihombing; Pembimbing: Adik Wibowo; Penguji: Suprijanto Rijadi, Mardiati Nadjib, F.X. Santoso Soemidjo
Abstrak: Penelitian ini bertujuan menganalisis proses discharge pasien rawat inap di RS St. ElisabethBekasi dengan menggunakan pendekatan Lean Six Sigma melalui metode kualitatif denganpengamatan pada 6 unit yang terlibat. Pendekatan Six Sigma mencoba mengurangi variasiwaktu pada setiap tahapan discharge di masing-masing unit tersebut, pendekatan Leanmengidentifikasi aktifitas yang tidak menambah nilai dan berusaha menguranginya. Hasilpenelitian diperoleh, rat-rata waktu proses discharge pasien rawat inap adalah 238 menit danfaktor yang paling berperan untuk menurunkan waktu tersebut adalah disiapkannya instruksipemulangan pasien oleh dokter, sehari sebelum pasien dipulangkan.
With the aim of streamlining the inpatient's discharge process at the Elizabeth HospitalBekasi, this study analyzed the efficiency of discharge process using the Lean Six Sigmamethod. Six Sigma method tries to reduce time variation in each step of the discharge processfollowed by identifying the appropriate time. The Lean method identifies the non valuesactivities (waste) to be reduced. For that, qualitative approach using observation wasimplied. The study resulted with 238 minute as average total timing of discharge and thegreatest impact to reduce it will be the one day earlier written discharge instruction preparedby the physician.
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B-1631
Depok : FKM UI, 2014
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Lili Susanti; Pembimbing: Ede Surya Darmawan; Penguji: Helen Andriani, Acim Heri Iswanto, Vica Claudia Budiono
Abstrak:
Proses distribusi obat ke rawat inap merupakan salah satu proses kritis dalam pelayanan rumah sakit yang berpengaruh terhadap kesinambungan terapi dan mutu pelayanan pasien. Di RSIA Bina Medika, proses distribusi obat pasien baru rawat inap masih menghadapi permasalahan berupa panjangnya lead time pelayanan yang disebabkan oleh dominasi aktivitas non value-added, khususnya aktivitas menunggu dan koordinasi lintas unit. Penelitian ini bertujuan untuk menganalisis dan meningkatkan efektivitas waktu distribusi obat ke rawat inap menggunakan pendekatan Lean Six Sigma. Penelitian ini menggunakan desain before–after study dengan kerangka kerja DMAIC (Define, Measure, Analyse, Improve, Control). Pengumpulan data dilakukan melalui observasi langsung dan pencatatan waktu proses pada sistem informasi rumah sakit (SIMRS) terhadap 25 resep pasien baru rawat inap sebelum dan sesudah intervensi. Analisis data meliputi Value Stream Mapping, analisis Pareto, analisis akar masalah menggunakan metode 5 Whys, serta uji statistik non-parametrik Mann–Whitney U. Hasil penelitian menunjukkan bahwa pada kondisi pre-intervensi, aktivitas non value-added mencapai 82,65% dari total waktu proses, dengan pemborosan utama berasal dari aktivitas menunggu perawat ke farmasi dan menunggu verifikasi resep. Rata-rata lead time distribusi obat sebelum intervensi masih tinggi dengan variasi waktu proses yang besar. Setelah dilakukan intervensi berupa penataan ulang alur kerja, perbaikan pembagian tugas tenaga kesehatan, serta penerapan standar operasional prosedur distribusi obat berbasis SIMRS, terjadi penurunan lead time distribusi obat yang bermakna secara statistik (p < 0,05). Penurunan signifikan terutama terjadi pada aktivitas non value-added utama, termasuk menunggu perawat ke farmasi, konfirmasi resep ke dokter, dan aktivitas komunikasi manual, sementara aktivitas value-added tetap stabil. Kesimpulan penelitian ini menunjukkan bahwa penerapan Lean Six Sigma efektif dalam meningkatkan efisiensi proses distribusi obat ke rawat inap  sehingga dapat dijadikan pendekatan strategis dalam upaya peningkatan mutu pelayanan farmasi rumah sakit secara berkelanjutan.

The inpatient medication distribution process is a critical component of hospital services that affects the continuity of therapy and overall quality of care. At RSIA Bina Medika, the distribution process for newly admitted inpatients experienced prolonged lead times due to the dominance of non–value-added activities, particularly waiting and cross-unit coordination. This study aimed to analyze and improve the effectiveness of inpatient medication distribution time using the Lean Six Sigma approach. A before–after study design was applied using the DMAIC (Define, Measure, Analyse, Improve, Control) framework. Process time data were collected through direct observation and hospital information system (SIMRS) records from 25 newly admitted inpatient prescriptions before and after the intervention. Data analysis included Value Stream Mapping, Pareto analysis, root cause analysis using the 5 Whys method, and non-parametric statistical testing using the Mann–Whitney U test. The results showed that prior to intervention, non–value-added activities accounted for 82.65% of the total process time, with the main sources of waste being waiting for nurses to collect medications and waiting for prescription verification. The average medication distribution lead time before intervention was relatively high with considerable process variation. Following interventions involving workflow restructuring, improved task allocation among healthcare staff, and the implementation of a SIMRS-based standard operating procedure for medication distribution, a statistically significant reduction in lead time was observed (p < 0.05). Significant reductions were primarily observed in major non–value-added activities, including waiting for nurses, prescription clarification, and manual communication, while value-added activities remained stable. This study concludes that the application of Lean Six Sigma effectively improves the efficiency of inpatient medication distribution and can serve as a sustainable quality improvement strategy for hospital pharmacy services. Keywords: Lean Six Sigma, medication distribution, inpatient, lead time, hospital pharmacy
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B-2594
Depok : FKM-UI, 2026
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Pratiwi Ananta A; Pembimbing: Helen Andriani; Penguji: Ede Surya Darmawan, Vetty Yulianty Permanasari, Ervina Mariani, Yyli Riviyanti
Abstrak:
Penelitian yang dilakukan di gudang obat farmasi RSUD Kota Makassar ini membahas kegiatan proses penyimpanan barang, yang dinilai penulis masih terdapat permasalahan yang merupakan pemborosan atau waste. Penelitian ini diakukan dengan menggunakan jenis penelitian kualitatif melalui pendekatan action reseach dengan fokus pada proses penyimpanan dan pendistribusian barang dengan metodologi lean. Lingkup penelitian mencakup proses penerimaan barang, penyusunan dan penyimpanan, penerimaan permintaan (Ampra) dari depo farmasi dan penyerahan barang ke depo. Hasil penelitian menunjukkan bahwa proses penyimpanan obat di gudang farmasi belum sesuai standar dan masih terdapat kegiatan yang tidak mendatangkan nilai tambah (non value added). Pada kegiatan penerimaan didapat komposisi value added di banding non value added sebesar 60% : 40%. Sedangkan pada proses penerimaan permintaan (Ampra) barang dari depo sampai penyerahan barang permintaan didapatkan komposisi value added disbanding non value added sebesar 30% : 70%. Hal ini menunjukkan bahwa sistem penyimpanan gudang yang sekarang ini belum dalam kondisi lean. Pemborosan (waste) yang terjadi antara lain: overproduction / duplication (rework), delay / waiting (penundaan), transportation (transportasi yang berlebihan), processes, inventories (persediaan tidak tepat/ berlebihan), motions (gerakan tidak perlu), defect (cacat) / Error Transaction, dan Human Potential / Defective Design. Untuk mengurangi waste tersebut maka dilakukan implementasi dengan menggunakan lean tools, seperti 5S (seiri, seiton, seiso, seiketsu, shitsuke), visual management, kanban, dan kaizen. Setelah dilakukan implementasi tersebut didapatkan hasil future state mapping terjadi penurunan yang signifikan pada proses penerimaan barang sampai penyimpanan barang, yaitu hasil perhitungan VSM (Value Stream Map) komposisi value added dibanding non value added sebesar 73% : 27%. Sedangkan pada proses penerimaan permintaan barang dari depo sampai penyerahan barang permintaan didapatkan komposisi value added dibanding non value added sebesar 38% : 62%. Kesimpulan penelitian ini Lean Hospital merupakan metode atau tool yang tepat untuk menurunkan nilai non value added dengan mengurangi waste dan meningkatkan nilai tambah untuk pelanggan. Saran dari peneliti adalah mendorong rumah sakit untuk melanjutkan sebagai langkah awal dalam perbaikan berkelanjutan, yang harus disertai dengan pemenuhan kebutuhan sumber daya manusia (SDM) dan fasilitas pendukung.

The research conducted in the pharmacy warehouse of the Regional General Hospital of Makassar City addresses the activities of the goods storage process, which the author considers to still have issues constituting waste. This qualitative research employs an action research approach with a focus on the storage and distribution processes using lean methodology. The scope of the study encompasses the receiving of goods, arranging and storing, receiving requests (Ampra) from the pharmacy depot, and delivering goods to the depot. The research findings indicate that the drug storage process in the pharmacy warehouse does not meet standards, and there are still activities that do not add value (non-value added). In the receiving activity, the composition of value-added compared to non-value-added is 60%:40%. Meanwhile, in the process of receiving requests (Ampra) from the depot to the delivery of requested goods, the composition of value-added compared to non-value-added is 30%:70%. This indicates that the current warehouse storage system is not in a lean condition. The waste that occurs includes overproduction/duplication (rework), delay/waiting, excessive transportation, inefficient processes, excessive inventories, unnecessary motions, defects/error transactions, and human potential/defective design. To reduce these wastes, implementation is carried out using lean tools such as 5S (sort, set in order, shine, standardize, sustain), visual management, kanban, error proofing, and kaizen. After the intervention, the future state mapping results showed a signifikan decrease in the process from receiving goods to storing them, with the Value Stream Map (VSM) calculation indicating a composition of value added compared to non-value added at 73%:27%. Meanwhile, in the process of receiving requested goods from the depot to delivering them, the composition of value added compared to non-value added was found to be 38%:62%. The conclusion of this study is that Lean Hospital is an appropriate method or tool to reduce non-value-added aspects by minimizing waste and enhancing value for patients. The researcher's recommendation is to encourage the hospital to continue as an initial step in continuous improvement, which should be accompanied by meeting the needs of human resources (HR) and supporting facilities
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B-2427
Depok : FKM-UI, 2024
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
:: Pengguna : Pusat Informasi Kesehatan Masyarakat
Library Automation and Digital Archive