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"Penelitian ini bertujuan menggali lebih dalam ketersediaan dokter spesialis serta upaya yang dilakukan untuk memenuhi kebutuhan tenaga dokter spesialis pada Rumah Sakit Umum Kelas C milik Pemerintah di daerah terpencil. Penelitian kualitatif dilakukan dengan pendekatan studi kasus di Rumah Sakit Umum Daerah Haji Abdoel Madjid Batoe (RSUD HAMBA) Kabupaten Batanghari Provinsi Jambi dan RSUD Malingping Kabupaten Lebak, Provinsi Banten. Hasil penelitian menunjukkan bahwa ketersediaan dokter spesialis baik di RSUD HAMBA maupun RSUD Malingping masih belum memadai. Kedua RS masih kekurangan tenaga spesialis baik dari segi jenis dan jumlah, sehingga mengakibatkan belum optimalnya pelayanan kesehatan. Berbagai upaya dilakukan oleh Pemerintah Daerah (Pemda) setempat, namun masih terdapat kendala, antara lain letak geografis, kondisi infrastruktur dan perekonomian daerah yang masih belum memadai, kurangnya kompensasi baik yang bersifat finansial maupun non finansial, selain tentunya kebijakan dan komitmen Pemda setempat, yang masih perlu ditingkatkan. Kesimpulan penelitian ini adalah suasana kerja yang nyaman serta kebijakan dan komitmen Pemda sangat berperan terhadap peningkatan motivasi dan retensi dokter spesialis di daerah. Perlu dirumuskan kebijakan dan regulasi yang spesifik mengenai standar pola rekrutmen, penempatan, serta hak dan kewajiban dokter spesialis secara komprehensif.

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This research aims to explore an availability of medical doctor specialist and the pulfillment efforts of medical doctor specialist of the C Class Hospital (CCH) in remote areas. This qualitative research has been conducted within case studies approach in both Haji Abdoel Madjid Batoe General Hospital (HAMBA GH) of the Batanghari Regency in Muara Bulian, Jambi Province and Malingping General Hospital (Malingping GH) of the Banten Province located at Malingping District as well. In fact, both in HAMBA GH and Malingping GH there are limited medical doctor specialist permanently. Meanwhile, there are so many factors that influence availability of medical doctor specialist in remote areas, specifically in Batanghari Regency and Malingping District, including geographical position, conditions of the remote area, availability of infrastructures and public facilities, economic factor, work environment, financial and non-financial compensation and also the government commitment and policy to support all efforts of medical doctor spescialist's pulfillment in remote areas. This research concludes that work environment, compensation, government policies and regulations are dominantly influenced pulfillment efforts of medical doctor specialist in CCH in remote areas. It needs to design particular policies and regulations about standard of recruitment pattern, placement allocation, budgeting, also medical doctor specialist's rights and responsibilities comprehensively, to solve this crucial problem."

"Setiap fasilitas kesehatan diwajibkan melakukan pengukuran dan evaluasi mutu sesuai dengan indikator secara rutin. Menurut PMK No. 129 tahun 2008, SPM waktu tunggu di unit rawat jalan yaitu ≤ 60 menit. RSUI merupakan RS-PTN kelas B yang berlokasi di Depok. Hasil capaian indikator waktu tunggu rawat jalan RSUI masih dibawah 80% dan berdasarkan studi pendahuluan data rekam medik, waktu tunggu di poli penyakit dalam yaitu 122 menit. Poli penyakit dalam termasuk kedalam Indikator minimal ketersediaan pelayanan di unit rawat jalan dan memiliki jumlah pasien yang besar di RSUI namun sering mendapat keluhan waktu tunggu. Penelitian dilakukan secara time motion di poli penyakit dalam dengan membagi jenis pembayaran yaitu BPJS Kesehatan, Asuransi, dan Umum. Pengambilan data melalui observasi, wawancara, telaah dokumen, dan CDMG. Kriteria inklusi pasien yaitu pasien accidental jam 07.00-14.00 yang sudah membuat perjanjian dan bersedia diikuti selama pelayanan. Analisis data menggunakan metode Lean Six Sigma dengan tahapaan DMAI dan RCA Hasil penelitian yaitu perhitungan terbesar berada pada proses pelayanan registrasi pasien BPJS dengan VA 7,88% dan NVA 92,12%, serta pelayanan di ruang konsul dokter penyakit dalam dengan VA 14,20% dan NVA 85,80%. Rekomendasi yang dapat diberikan kepada rumah sakit dibagi menjadi jangka pendek dan jangka panjang.

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Every health facility is required to carry out quality measurements and evaluations according to indicators on a regular basis. According to PMK No. 129 of 2008, the SPM waiting time in the outpatient unit is ≤ 60 minutes. RSUI is a class B PTN Hospital located in Depok. The achievement indicator for outpatient waiting time at RSUI is still below 80% and based on a preliminary study of medical record data, the waiting time at the internal medicine polyclinic is 122 minutes. Internal medicine poly is included in the minimum indicator of service availability in the outpatient unit and has many patients at RSUI but often gets complaints of waiting time. The research was carried out in time motion in the internal medicine polyclinic by dividing the types of payments, namely BPJS Health, Insurance and General. Data collection through observation, interviews, document review, and CDMG. The patient inclusion criteria were accidental patients at 07.00-14.00 who had made an appointment and were willing to be followed during the service. Data analysis used the Lean Six Sigma method with DMAI and RCA stages. The results of the study showed that the largest calculation was in the BPJS patient registration service process with VA 7.88% and NVA 92.12%, as well as services in the consulting room of internal medicine doctors with VA 14.20% and NVA 85.80%. Recommendations that can be given to hospitals are divided into short term and long term."

"Pelayanan rawat jalan merupakan garda utama layanan rumah sakit, apabila kesehatan pasien secara maksimal ditangani di pelayanan poliklinik maka tidak diperlukan lagi pelayanan lanjutan seperti rawat inap. Akan tetapi, waktu tunggu yang lama di pelayanan rawat jalan dapat menghambat kelancaran pelayanan dan menjadikan pasien tidak memberikan kepuasan yang tinggi. Metode Lean Hospital yang telah berhasil diterapkan di beberapa rumah sakit nasional maupun internasional diharapkan dapat menghilangkan hambatan dan menambah aktivitas yang bernilai pada proses pelayanan pasien. Tujuan penelitian ini adalah untuk mengidentifikasi alur pelayanan, letak hambatan dan akar penyebab masalahnya. Penelitian dilakukan pada Instalasi Rawat Jalan Poliklinik Spesialis Penyakit Dalam bulan Mei 2019. Jenis penelitian ini adalah penelitian deskriptif kualitatif menggunakan data observasi, wawancara dan telaah dokumen. Sampel diambil secara purposif hingga tercapai keadaan jenuh sejumlah 30 pasien. Analisa data menggunakan flowchart dalam mengidentifikasi alur pelayanan, kemudian Value Stream Mapping untuk mengidentifikasi kegiatan bernilai, menemukan waste serta mengidentifikasi hambatan dan The Five Whys untuk menganalisa akar penyebab hambatan. Penelitian ini menerapkan metode Lean Thinking sampai membuat alur dan Model BAS yaitu Baseline, Assess, dan Suggest Solution dari Model BASICS. Hasil penelitian menunjukkan alur pelayanan pasien rawat jalan secara langsung melibatkan 5 unit; 85.91% waktu pelayanan merupakan kegiatan non value added dan hanya 14.08% kegiatan value added. Total Waiting Time 2 jam 4 menit; Total Cycle Time 20 menit; Total Lead Time 2 jam 24 menit 30 detik. Waste yang terjadi adalah waste of waiting (35%), overproduction (29%), defects (22.5%), transportation (7%), overprocessing (6.2%). Hambatan utama terletak pada bagian Farmasi Rawat Jalan. Dari hasil observasi didapatkan hambatan waktu terbesar ada pada bagian farmasi. Dari analisa The Five Whys didapatkan akar penyebab masalah terbanyak ada pada jumlah sumber daya manusia dan penerapan e-prescription yang belum optimal. Usulan perbaikan dengan lean tools pada proses pelayanan rawat jalan diharapkan dapat menurunkan kegiatan non value added menjadi 60.25% dan meningkatkan kegiatan value added menjadi 39.74%.

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Outpatient services are the main guard of hospital services, if the patient’s health is maximally handled in these services then further services such as hospitalization are no longer needed. However, long waiting time in outpatient services can hamper the smooth running of services and make patients did not give their high satisfaction. The Lean Hospital method that has been successfully implemented in hospitals worldwide is expected to eliminate barriers and add valuable activities to the patient service process. The purpose of this study is to identify the service flow, location of the obstacles and the root causes of the problems. The study was conducted at the Outpatient Services Internal Medicine Specialist in May 2019. This research is a qualitative descriptive study using observational data, interviews and document review. Samples were taken by purposively by using patient sample until reached data saturation to 30 respondents. Flowcharts were used to identifying process flow, then using Value Stream Mapping to identify value-added activities, find waste and identify obstacles and The Five Whys to analyze the root causes of obstacles. This research applied the Lean Thinking Method until creating flow and applied BAS from BASICS Model, Baseline, Assess, and Suggest Solution. Results from this study showed that Outpatient Services Internal Medicine Specialist process including 5 units directly; 85.91% process time is non-value added activities and only 14.08% value-added activities. Total Waiting Time 2 hours 4 minutes; Total Cycle Time 20 minutes; Total Lead Time 2 hours 24 minutes 30 seconds. Waste observed as a list: waste of waiting (35%), overproduction (29%), defects (22.5%), transportation (7%), and overprocessing (6.2%). The main obstacle lies in the Outpatient Pharmacy section. From the results of observations, the biggest time constraints are in the pharmaceutical department. From the analysis of The Five Whys, the root causes of the most problems were found in the number of human resources and the application of e-prescription that was not optimal. The proposed improvements using lean tools at the outpatient services expected to decrease non-value added activity to 60.25% and increase value-added activities to 39.74%."