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"Penelitian ini menganalisis alur proses pelayanan pasien poliklinik spesialis penyakit dalam rawat jalan di RSUD Kota Bogor tahun 2016 dengan konsep lean hospital. Hasil penelitian ini value added activity sebesar 3,7 % dan non value added sebesar 96,3 % hal ini menunjukkan tingginya pemborosan. Dari analisis melalui diagram tulang ikan dan 5 Why didapatkan hambatan : lamanya menunggu di pendaftaran, keterlambatan rekam medik, hambatan pada kedisiplinan dokter, serta hambatan pada lamanya mengambil obat. Melalui design usulan perbaikan terjadi peningkatan kegiatan yang mempunyai nilai tambah bagi pasien dari 3,7 % menjadi 38,4 % dan penurunan kegiatan yang tidak mempunyai nilai tambah dari 96,3 % menjadi 61,6 %.

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A study was conducted to analyze the process flow of patient internist specialist policlinic outpatient services in the Public Hospitals Bogor 2016 by concept of lean. The research showed value added activity by 3.7%, and non value added activity by 96.3% showed a high waste. Fishbone diagram and 5 why analysis obtained obstacles : the long wait at registration, medical records delays, discipline doctors, as well as constraints on the length of taking the drug. Through design improvements proposed was expected to increase value added activity from 3,7 % to 38,4 % and decline non value added activity from 96,3 % to 61,6 %."

"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. Penelitian ini menganalisis alur pelayanan di rawat jalan Poliklinik Spesialis sebagai data untuk perbaikan di Rumah Sakit X yang merupakan Rumah Sakit Swasta Kelas B Pendidikan. Dengan menggunakan metodologi penelitian operational research, dilakukan observasi dan wawancara mendalam memperlihatkan bahwa kegiatan non value added bisa samapai 80% dan kegiatan value added hanya 20%. Data tersebut menunjukan bahwa telah terjadi pemborosan (waste) dan hasil analisis akar masalah menggunakan Root Cause Analysis (RCA) memperlihatkan ada beberapa faktor yang menyebabkan inefisiensi pelayanan rawat jalan poliklinik spesialis. Usulan perbaikan untuk mengurangi pemborosan dibagi menjadi tiga tahap, antara lain jangka pendek, jangka menengah dan jangka panjang diharapkan meningkatkan pelayanan rawat jalan dan kepuasan pasien.

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One way to improve efficiency, improve service quality and improve patient safety in the United States by using the concept of Lean Thinking is applied in hospitals become Lean Hospital. This study analyzes the service flow in Outpatient Clinic Specialists as the data for improvement in Hospital X which is a Class B Private Hospital Education. Using the methodology of operational research studies, conducted in-depth observation and interviews show that the non-value added activities can be up to 80% and value added activity is only 20%. The data shows that there has been a waste (waste) and the results of the analysis of the roots of the problem using Root Cause Analysis (RCA) demonstrates that there are several factors that cause inefficiencies in ambulatory care specialist clinic. the proposed improvements to reduce waste is divided into three stages, including the shortterm, medium-term and long-term is expected to improve outpatient care and patient satisfaction."

"Lean adalah upaya terus menerus untuk menghilangkan pemborosan (waste) dan meningkatkan nilai tambah (value added) produk, baik barang ataupun jasa kepada pelanggan. Penelitian ini menganalisis alur proses pelayanan resep dan mendesain usulan perbaikannya dengan mengaplikasikan lean thinking. Dengan desain penelitian operational research, dilakukan observasi, wawancara mendalam dan telaah dokumen. Hasil penelitian menunjukan kegiatan non value added 64% dan value added 36%. Data tersebut menunjukkan telah terjadi pemborosan (waste). Simulasi usulan perbaikan dilakukan untuk meminimalkan pemborosan dan terbukti ada peningkatan value added yang menunjukkan ada efisiensi pelayanan.

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Lean is a continuous effort to eliminate waste and increase the value added of product, whether goods or services to customers. This study analyzes the service process flow of prescription and designing the proposed improvement by applying lean thinking. With the design of operational research studies, observations, in-depth interviews and review documents. The results showed non-value added activities 64% and 36% value added. The data shows there has been a waste. Simulation of the proposed improvements were made to minimize waste and proved there was an increase in the value added showed efficiency."

"ABSTRAKDampak Jaminan Kesehatan Nasional di poliklinik spesialis Obstetric dan GynecologyRS. Annisa Citeureup Bogor adalah meningkatnya jumlah kunjungan pasien rawatjalan sebesar 61% pada awal tahun 2014. Semakin banyaknya jumlah pasien akanberakibat pada lamanya waktu tunggu. Tahapan penelitian ini menggunakan 5 (lima)prinsip lean untuk mendapatkan perbaikan yang berkelanjutan sehingga mampumeningkatkan efisiensi alur proses pelayanan di poliklinik spesialis Obstetric danGynecology. Hasil value assesment pada pasien tunai didapatkan 85% kegiatan yangtidak bernilai tambah dan 14% kegiatan yang bernilai tambah, sedangkan pada pasienJaminan Kesehatan Nasional didapatkan prosentase kegiatan yang tidak bernilaitambah sebesar 88% dan 11% untuk kegiatan yang bernilai tambah. Metode leandinilai mampu meminimalisir pemborosan, hasil future state value stream mapdidapatkan penurunan kegiatan yang tidak bernilai tambah menjadi 38,09%

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ABSTRACTThe impacts of the National Health Insurance at the Obstetric and Gynecologyspecialist polyclinic RS. Annisa Citeureup Bogor is increase frequency of outpatientvisits by 61% at the beginning of 2014. The increasing number of patients will resultin long waiting times. This research uses 5 (five) lean principles to get continuousimprovement to improve the efficiency of service process flow in Obstetric andGynecology specialist clinic. Result of assessment value in patients with cash paymentwas 85% non value-added activities and 14% value-added activities, while in theNational Health Insurance patients, the percentage of non value added activities was88% and 11% for value-added activities. Lean method is considered able to minimizewaste, the results of the future state value stream map can reduce activities that do notadd value to 38.09%"

"[ABSTRAKRumah Sakit Ibu dan Anak Ummi (RSIA Ummi) memiliki pelayanan unggulan pada poliklinik kandungan. Jumlah kunjungan pada poliklinik kandungan RSIA Ummi terus meningkat setiap tahunnya. Peningkatan jumlah pasien menyebabkan waktu tunggu pelayanan menjadi semakin lama, ditambah alur proses pelayanan yang kompleks menimbulkan kebingungan pada pasien. Penelitian ini menganalisis pelayanan poliklinik kandungan di Instalasi Rawat Jalan RSIA Ummi dengan Konsep Lean Thinking. Dengan menggunakan metode Lean Thinking memperlihatkan adanya non value added activity sebesar 86% dan value added activity sebesar 14%. Hal ini menunjukkan bahwa terdapat cukup banyak waste (pemborosan). Selain itu dari analisis fishbone diagram menunjukkan delapan akar masalah. Usulan ide perbaikan dibagi menjadi 3 tahap, yaitu jangka pendek, jangka menengah, dan jangka panjang, yang di dalamnya terdapat juga ide perbaikan untuk mengurangi waste (pemborosan) dan membuat aliran proses menjadi lebih efektif dan efisien.ABSTRACTMother and Child Hospital (RSIA) Ummi has a superior service at the obstetric and Gynecology polyclinic. The visitation number of the obstetric and Gynecology polyclinic in RSIA Ummi keep increasing every year. The increasing number of patients makes the waiting time services become longer. Beside that, the complex service flowchart causes confusion for patients. This research analyzes the content of polyclinic service at the Outpatient Installation RSIA Ummi with Lean Thinking Concept. By using Lean Thinking showed non-value added activity by 86% and value added activity by 14%. This shows that there are quite a lot of wastes. Addition of fishbone diagram analysis showed that there are eight roots of the problem. The writer proposed ideas for improvement that are divided into three stages, namely short term, medium term and long term, in which there is also the idea to reduce waste and to make the service flowchart becomes more effective and efficient.;Mother and Child Hospital (RSIA) Ummi has a superior service at the obstetric and Gynecology polyclinic. The visitation number of the obstetric and Gynecology polyclinic in RSIA Ummi keep increasing every year. The increasing number of patients makes the waiting time services become longer. Beside that, the complex service flowchart causes confusion for patients. This research analyzes the content of polyclinic service at the Outpatient Installation RSIA Ummi with Lean Thinking Concept. By using Lean Thinking showed non-value added activity by 86% and value added activity by 14%. This shows that there are quite a lot of wastes. Addition of fishbone diagram analysis showed that there are eight roots of the problem. The writer proposed ideas for improvement that are divided into three stages, namely short term, medium term and long term, in which there is also the idea to reduce waste and to make the service flowchart becomes more effective and efficient., Mother and Child Hospital (RSIA) Ummi has a superior service at the obstetric and Gynecology polyclinic. The visitation number of the obstetric and Gynecology polyclinic in RSIA Ummi keep increasing every year. The increasing number of patients makes the waiting time services become longer. Beside that, the complex service flowchart causes confusion for patients. This research analyzes the content of polyclinic service at the Outpatient Installation RSIA Ummi with Lean Thinking Concept. By using Lean Thinking showed non-value added activity by 86% and value added activity by 14%. This shows that there are quite a lot of wastes. Addition of fishbone diagram analysis showed that there are eight roots of the problem. The writer proposed ideas for improvement that are divided into three stages, namely short term, medium term and long term, in which there is also the idea to reduce waste and to make the service flowchart becomes more effective and efficient.]"

"Rumah sakit merupakan suatu sarana yang memberikan pelayanan dibidang kesehatan bagi masyarakat luas, oleh karena itu rumah sakit dituntut untuk memiliki pelayanan yang bermutu sesuai dengan standar yang ditetapkan untuk menjaga kualitas layanan yang diberikan. Pemerintah telah menetapkan Standar Pelayanan Minimal Rumah Sakit dalam Keputusan Mentri Kesehatan No.129 Tahun 2008 sebagai suatu acuan dalam penyelenggaraan pelayanan rumah sakit. Instalasi Rawat Jalan  Rumah Sakit Vania merupakan pelayanan prioritas bagi Rumah Sakit Vania karena volume kunjungan pasien terbanyak. Poliklinik Dokter Spesialis Penyakit dalam merupakan layanan spesialistik dengan jumlah pasien tertinggi selama tahun 2019 hingga tahun 2022 dengan rata-rata jumlah kunjungan 1500-1700 pasien per bulan. Dari hasil laporan capaian  mutu dan observasi didapatkan bahwa waktu tunggu proses pelayanan rawat jalan di Rumah Sakit Vania belum mencapai standar sesuai dengan acuan Standar Pelayanan Minimal bahwa waktu tunggu rawat jalan maksimal ≤60 menit  sedangkan waktu tunggu pelayanan resep yaitu ≤30 menit untuk obat non racikan dan ≤60 menit obat racikan. Penelitian ini bertujuan untuk melakukan analisis waktu tunggu rawat jalan Poliklinik Spesialis Penyakit Dalam dengan pendekatan Lean Hospital untuk dapat memperbaiki mutu layanan. Metode Penelitian ini adalah operasional research dengan pendekatan kualitatif. Pengambilan data dilakukan pada bulan Juni 2022 di Instalasi Rawat Jalan dengan bservasi langsung. Sampel yang diambil berjumlah 41sampel dari berbagai jaminan. Dilanjutkan dengan wawancara dengan informan dan telaah dokumen.Hasil : Pasien dengan cara bayar Jaminan Kesehatan Nasional yang melakukan pendaftaran online memiliki Lead Time sebesar 1 jam 47 menit 59 detik, dengan Value Added  35%, Non Value Added 65 %, pasien dengan cara bayar Jaminan Kesehatan Nasional yang melakukan pendaftaran onsite/manual memiliki Lead Time sebesar 2 jam 12 menit 21 detik, dengan Value Added 32%, Non Value Added 68 %, Pasien Non Jaminan Kesehatan Nasional yang melakukan pendaftaran onsite/manual memiliki Lead Time sebesar 1 jam 12 menit 30 detik, dengan Value Added 74%, Non Value Added 26 %. Pada analisis kegiatan non value added terdapat 13 kegiatan yang dinilai sebagai waste, tertinggi ada pada kategori waste waiting. Root cause analysis dilakukan dengan metode 5 why’sKesimpulan : Dengan metode lean hospital dapat mengetahui capaian waktu tunggu pelayanan rawat jalan dan resep, waste dan akar penyebab masalah hingga desain rancangan perubahan sebagai upaya perbaikan dan

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The hospital is a facility that provides services in the health sector for the wider community, therefore hospitals are required to have quality services in accordance with established standards to maintain the quality of services provided. The government has set Minimum Service Standards for Hospitals in the Decree of the Minister of Health No.129 of 2008 as a reference in the implementation of hospital services. The Vania Hospital Outpatient Installation is a priority service for Vania Hospital because of the highest volume of patient visits. The Internal Medicine Specialist Polyclinic is a specialist service with the highest number of patients from 2019 to 2022 with an average number of visits of 1500-1700 patients per month. From the results of the quality achievement report and observations, it was found that the waiting time for the outpatient service process at Vania Hospital had not reached the standard according to the Minimum Service Standard reference that the maximum outpatient waiting time was 60 minutes while the waiting time for prescription services was 30 minutes for non-concoction drugs. and 60 minutes of concoction drugs. This study aims to analyze the outpatient waiting time of the Internal Medicine Specialist Polyclinic with a Lean Hospital approach to improve service quality.

Methods: This research is operational research with a qualitative approach. Data collection was carried out in June 2022 at the Outpatient Installation with direct observation. The samples taken amounted to 41 samples from various guarantees. Followed by interviews with informants and reviewing documents.

Results: Patients by paying for the National Health Insurance who register online have a Lead Time of 1 hour 47 minutes 59 seconds, with Value Added 35%, Non Value Added 65%, patients by paying Health Insurance Nationals who register onsite/manual have a Lead Time of 2 hours 12 minutes 21 seconds, with Value Added 32%, Non Value Added 68%, Non-National Health Insurance Patients who register onsite/manual have a Lead Time of 1 hour 12 minutes 30 seconds, with Value Added 74%, Non Value Added 26%. In the analysis of non-value added activities there are 13 activities that are considered as waste, the highest is in the category of waste waiting. Root cause analysis was carried out using the 5 why's method. Conclusion: With the lean hospital method, we can find out the achievement of waiting time for outpatient and prescription services, waste and root causes of problems to design changes as an effort to improve and future state mapping."

"ABSTRAKPenelitian ini menganalisis pelayanan rekam medis rawat jalan di RSUD GunungJati Kota Cirebon. Tujuan dilakukannya penelitian ini adalah untuk mengetahuilama waktu yang dibutuhkan dalam proses pelayanan rekam medis rawat jalanserta mengidentifikasi hambatan. Jenis penelitian yang digunakan adalahpenelitian kualitatif. Hasil penelitian menunjukkan bahwa rata-rata lama waktuyang dibutuhkan adalah 151 menit. Proses terlama terdapat di tahap pencarianrekam medis rawat jalan. Waktu yang dibutuhkan untuk proses pelayanan rekammedis rawat jalan yaitu > 10 menit, dipengaruhi oleh minimnya pelatihan tentangpenyimpanan, serta belum optimalnya lemari penyimpanan rekam medis dibagianpenyimpanan

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ABSTRACTThis research analyzed the outpatient medical record services at RSUD GunungJati Cirebon. The purposes of this study were to determine the length of time ittakes in a series of processes of outpatient medical record services and to identifyobstacles. The type of research employed was qualitative research. The resultsshowed that the average length of was 151 minutes. The longest process occurredin the search stage of outpatient medical records. The time required in the processof outpatient medical record services was still within the old category, i.e. >10minutes, which was affected by the lack of training on storage, and the nonoptimumuse of medical record storage cabinets in the storage section"

"Proses pelayanan pasien rawat jalan di poliklinik spesialis RS Hermina Daan Mogot masih belum optimal, ditunjukan dengan beberapa penyelenggaraan yang belum sesuai dengan peraturan, serta waktu tunggu pasien poli spesialis belum sesuai dengan standar yang telah ditentukan. Penelitian ini dilakukan untuk mendapatkan hasil analisis proses pelayanan pasien rawat jalan di poliklinik spesialis dengan metode lean six sigma. Jenis penelitian ini adalah operational research, dengan desain penelitian kuantitatif dan kualitatif. Hasil penelitian digambarkan dengan value stream mapping yang memperlihatkan lead time proses pelayanan pasien rawat jalan sebesar 149,66 menit dengan value added 17,87 menit (11,94%) dan non value added 141,54 menit (88,06%). Proses paling lama (bottleneck) yaitu kegiatan menunggu dipanggil masuk ke ruang poli. Waste paling besar yaitu waste waiting sebesar 91,84 menit atau 69,69% dari total waste yang ditemukan. Berdasarkan analisis fishbone diagram diketahui bahwa akar penyebab masalah yang paling banyak berasal dari kategori man. Berdasarkan analisis tersebut diberikan usulan berupa pembuatan standarisasi kerja, perhitungan pola ketenagaan, memaksimalkan ketepatan datang dokter, dan pemberian reward.

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The process of outpatient service at specialist polyclinic RS Hermina Daan Mogot is not optimal enough, indicated by the process is not in accordance with existing regulations, and the waiting time of specialist polyclinic patients is not in accordance with the prescribed standards. The aim of this research is to get an analysis result of outpatient service at specialist polyclinics with lean six sigma method. This type of research is operational research, with quantitative and qualitative research design. The results of this research are described with the value stream mapping that showed lead time of outpatient service process for 149,66 minutes, with value added 17,87 minutes (11,94%) and non value added 141,54 minutes (88,06%). The longest process occurs on waiting to be called into the polyclinic room. The biggest waste is waiting for amount 91,84 minutes or 69,69% of the total waste. Based on fishbone diagram analysis, it is known that the root causes of the problem are mostly from the man category. Based on the analysis, an improvement proposal will be given in the form of work standardization, calculation of workforce patterns, maximize the accuracy of coming doctors and giving rewards."

"ABSTRAKPelayanan rawat jalan merupakan salah satu andalan bagi rumahsakit dalam meningkatkan pemasukan bagi unit-unit lainnya. Tujuan penelitan ini adalah untuk mempercepat pelayanan rawat jalan di Poliklinik Spesialis Penyakit Dalam RSUD Koja dengan mengetahui lead time waktu tunggu pelayanan rawat jalan dan mengetahui cycle time (value added dan non value added) di masing-masing tahapan pelayanan rawat jalan serta membuat simulasi penerapan Lean Hospital untuk menghilangkan atau meminimalisasi pemborosan (waste). Desain penelitian ini dilakukan dengan operational research melalui pendekatan Lean Hospital. Waktu tunggu pelayanan rawat jalan di Poliklinik Spesialis Penyakit Dalam RSUD Koja sebesar 71.18 menit yang berarti masih melebihi standar yang ditetapkan oleh Kementrian Kesehatan dalam Keputusan Menteri Kesehatan Nomor 129/Menkes/SK/II/2008 tentang Standar Pelayanan Minimal Rumah Sakit. Demikian pula waktu tunggu di unit farmasi sebesar 256.8 menit (obat racik) dan 154.27 menit (obat jadi).Waktu tunggu di unit pelayanan laboratorium sudah sesuai dengan standar dariKementrian Kesehatan yaitu ≤ 140 menit. Penerapan upaya perbaikanpelayanan rawat jalan di Poliklinik Spesialis Penyakit Dalam RSUD Kojaadalah dengan menghilangkan waste waiting, defect/rework, transportation,overprocessing dan overproduction di masing-masing tahapan pelayanan.Kesimpulan penelitan ini adalah dengan menghilangkan atau meminimalisirpemborosan (waste) dan membuat desain perpanjangan pelayanan rawat jalandapat mengurangi waktu tunggu pelayanan rawat jalan di Poliklinik SpesialisPenyakit Dalam RSUD Koja.

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ABSTRACTOutpatient care is one of the mainstays for hospitals in increasing income for other units. The purpose of this research is to accelerate the outpatient service inPolyclinic Specialist Disease Inside Koja Hospital by knowing the lead time waiting time of outpatient service and knowing the cycle time (value added and non value added) in each stage of outpatient service and make simulation of Lean application Hospital to eliminate or minimize waste (waste). This research design is done by operational research through Lean Hospital approach. Outpatient service waiting time in Polyclinic Specialist of Internal Disease of Koja Hospital amounted to 71.18 minutes which means it still exceeds the standard set by Ministry of Health in Decree of Minister of Health Number 129 / Menkes / SK / II/ 2008 regarding Minimum Service Standard of Hospital. Similarly, waiting time in the pharmacy unit is 256.8 minutes (racik drug) and 154.27 minutes (finished medicine). The waiting time in the laboratory service unit is in accordance with the Ministry of Health's standard of ≤ 140 minutes. Implementation of outpatient service improvement efforts in Polyclinic Specialist Disease In RSUD Koja is to eliminate waste waiting, defect / rework, transportation, overprocessing and overproduction in each stage of service. The conclusion of this research is to eliminate or minimize waste and make the design of service outpatient extension can reduce waiting time of outpatient service in Polyclinic Specialist of Disease in Koja Hospital."

"Pelayanan kefarmasian adalah pelayanan langsung dan bertanggung jawab kepada pasien yang berkaitan dengan sediaan farmasi yang bertujuan untuk meningkatkan mutu kehidupan pasien yang dilaksanakan oleh Instalasi Farmasi. Salah satu standar mutu di Instalasi Farmasi berdasarkan SPM adalah waktu tunggu pelayanan obat. Standar waktu tunggu pelayanan obat yang ditetapkan oleh RS Hermina Bogor adalah obat jadi ≤10 menit dan obat racik ≤20 menit. Dalam pelaksanaannya, standar tersebut masih belum tercapai. Lean Six Sigma merupakan salah satu metode untuk memperbaiki suatu proses dalam berbagai industri salah satunya rumah sakit. Penelitian ini bertujuan untuk menganalisa waktu tunggu pelayanan obat dengan menggunakan metode Lean Six Sigma di Instalasi Farmasi rawat jalan RS Hermina Bogor. Penelitian ini menggunakan kerangka kerja DMAIC. Analisis dilakukan dengan sampel 30 resep obat jadi dan 30 resep obat racik. Penelitian dilakukan secara kuantitatif dengan observasi waktu tunggu pelayanan resep obat dan secara kualitatif dengan wawancara dan telaah dokumen. Hasil penelitian menunjukkan rata-rata waktu tunggu pelayanan resep obat jadi 21 menit dengan 37,4% kegiatan value added dan 62,6% kegiatan non value added, serta waktu tunggu pelayanan resep obat racik 48 menit dengan 36,2% kegiatan value added dan 63,8% kegiatan non value added. Dilakukan analisis akar penyebab masalah dan usulan perbaikan. Usulan perbaikan yang diberikn antara lain, perhitungan kebutuhan tenaga di tiap shift, menghitung beban kerja, merevisi kembali minimal stok apotek, dan menerapkan 5S pada area kerja.

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Pharmacy services are direct and responsible services to patients related to pharmaceutical preparations which aim to improve the quality of life of patients carried out by Pharmacy Installation. One of the quality standards in Pharmacy Installation based on SPM is the waiting time for medicine services. The standard waiting time for drug services set by the Hermina Bogor Hospital for the non coction prescription is ≤10 minutes and for the concoction prescription is ≤20 minutes. In its implementation, these standards have not yet been reached. Lean Six Sigma is one method to improve a process in various industries, one of them is a hospital. This study aims to analyze the waiting time for prescription using the Lean Six Sigma method in the Pharmacy Installation Hospital Hermina Bogor. This study uses the DMAIC framework. The analysis was carried out with the non concotion and the concoction prescription each 30 sample. The study was conducted quantitatively by observing the waiting time for prescription and qualitatively by interviewing and reviewing documents. The results showed that the average waiting time for the non concoction is 21 minutes with 37.4% of value added and 62.6% activities for non value added activities, as well as waiting time for the concoction is 48 minutes with 36.2% value added and 63.8% of non value added activities. Analyze the root cause of the problem and the proposed improvements. Proposed improvements include the calculation of labor requirements in each shift, calculating workloads, revising a minimum of the pharmacy stock, and implementing 5S in the work area."