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"ABSTRAKNama : Selly MarisdinaProgram Studi : Kajian Administrasi Rumah SakitJudul : Manajemen lean terhadap proses pelaksanaan CT Scan kepalapasien stroke iskemik di Instalasi Gawat Darurat RSUP Dr. Moh.Hoesin PalembangWaktu tunggu proses pelaksanaan CT Scan kepala pasien stroke iskemik diIntalasi Gawat Darurat RSUP Dr. Moh Hoesin belum standar. Tujuan penelitianadalah menerapkan manajemen lean terhadap proses pelaksanaan CT Scan kepalapasien stroke iskemik di IGD. Penelitian ini menggunakan metode operationalresearch. Hasil penelitian didapatkan lead time Current Visual Stream Map VSM adalah 175,41 menit. Pada Simulated VSM didapatkan penurunan lead timeyang signifikan menjadi 30,09 menit, peningkatan persentase Value AddedActivities dan penurunan Non Value Added activites. Disimpulkan bahwapenerapan manajemen lean telah berhasil memperbaiki waktu tunggu prosespelaksanaan CT Scan kepala pasien stroke iskemik di IGD.Kata kunci: lean, value added, non value added but neccessary, non value added,current, lead time value streaming map, simulated value streaming map

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ABSTRACTName Selly MarisdinaStudy Progam Hospital Adiministration ProgramJudul Lean management in Head CT Scan Proses of Ischemic StrokePatients inMohammad Hoesin Hospital PalembangThe waiting time of head CT Scan prosess of ischemic stroke patient inEmergency Departement of Mohammad Hoesin Hospital Palembang has not beenstandard yet. The objectives was to apply lean management in this process byoperational research. We found that lead time of Current Visual Stream Map is175,41 minutes and in Simulated VSM, there were a significant decrease of leadtime to 30,09 minutes, increase of Value added Activites percentage and decreaseof Non Value Added Activites. Lean management has been successfully improvedthe waiting time of head CT Scan proses of ischemic stroke patient in ED.Key word lean, value added, non value added but neccessary, non value added,current, lead time value streaming map, simulated value streaming map"

"ABSTRAKNama : Patiyus Agustiansyah/NPM 1506706023Program Studi : Kajian Administrasi Rumah SakitJudul : Analisis dan Implementasi Lean pada Persiapan OperasiKanker Ginekologi di RSUP dr. Mohammad HoesinPalembangIndonesia saat ini memiliki beban kanker ginekologi besar yaitu insidensi,morbiditas dan mortalitasnya. Salah satu penanganan kanker ginekologi adalahpembedahan yang akan membantu kesintasan pasien. Waktu tunggu penjadwalanoperasi kanker ginekologi hendaklah memperhatikan progresifitas kankersehingga waktu tunggu operasinya tidak melebihi 2 minggu. Waktu tungguoperasi menggambarkan mutu pelayanan rumah sakit.Tujuan penelitian ini adalah,untuk menganalisis waktu tunggu penjadwalan operasi kanker ginekologi diRSUP dr. Moehammad Hoesin Palembang dengan menggunakan prinsip Lean.Hasil penelitian menunjukan penegakan diagnosis selama 43.844 menit dan waktutunggu operasi selama 66.700 menit, dengan menerapkan prinsip lean makapenegakan diagnosis 10.328,5 menit dan waktu tunggu operasi 10.325 menit.Kesimpulan penelitian, pada current state terdapat 26 aktifitas; 12 aktifitas VA value added ratio / VAR waktu 0,46 ; VAR jarak 89,6 dan 14 aktifitas NVA waste pasien dan 4 waste aktifitas petugas. Aliran proses yang menghambat bottle neck terdapat di pendaftaran, di poliklinik, di pemeriksaan penunjang dandi bagian praoperatif waktu tunggu paling lama . Future State memiliki 15aktifitas VA VAR waktu 33 ; VAR jarak 95,8 dengan 8 aktifitas NVA waste aktifitas pasien dan 0 waste aktifitas petugas, dengan waktu tunggudiagnosis 10.328,5 menit sedangkan waktu tunggu penjadwalan operasi 10.325menit. Hasil perbandingan current state dengan future state didapatkanpeningkatan aktifitas value added sebanyak 7,7 dengan penurunan waktutunggu 81,3 dan penurunan jarak tempuh 0,42 . Analisis akar masalahpenyebab waktu tunggu lama penjadwalan operasi kanker ginekologi di RSMHdikarenakan kekurangan SDM registrasi, rekam medis, DPJP dan keterbatasaninfrastruktur CT scan, kamar operasi dan instrumen dan kelemahan mengelolaproses penjadwalan operasi tersebut. Saran peneliti adalah peningkatan kinerjadan penambahan SDM, membuat regulasi untuk memprioritaskan pelayananpasien kanker ginekologi, serta integrasi Sistem Informasi Manajemen RumahSakit di setiap unit pelayanan.Kata Kunci : prinsip lean, value added VA , non value added NVA , waste,waktu tunggu penegakan diagnosis, waktu tunggu operasi, kanker ginekologi

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ABSTRACTName Patiyus Agustiansyah NPM 1506706023Program Studi Hospital Administration StudyTitle Lean Analysis and Implementation of Gynecology CancerOperative Scheduling in General Hospital dr. MohammadHoesin RSMH PalembangIndonesia currently has gynecologic cancer burden in the incidence, morbidityand mortality. One of gynecological cancer treatment is surgery which will helpthe survival rate of patients. The waiting time of gynecological cancer surgeryscheduling should bu focused to cancer progression so the waiting time should notexceed 2 weeks. The waiting time operation illustrates the quality of hospitalservices.The purpose of this study was to analyze the waiting time of gynecologiccancer surgery scheduling in RSMH by using the principles of Lean. The resultsshowed that establishing diagnosed need 43,844 minutes and the waiting timeoperation was 66,700 minutes. By applying Lean then the diagnosis establishing10,328.5 minutes, and operations waiting times 10,325 minutes. The studyconclusion showing for 26 activities of current state with 12 VA activities VARtime 0.46 VAR range for 89.6 and 14 NVA activities with 14 patient rsquo swastes activities and 4 employee wastes activities. The process flow whichinhibits bottle neck were lies in the stage of registration, at the outpatient clinic,at the laboratory examination and at the preoperative division the longest waitingtime . The waiting time for diagnosis process were 43.844 minutes, while thewaiting time scheduling of operation process were 66.700 minutes. Future Statehas 15 VA VAR time of 33 VAR range of 95.8 with 8 NVA activities and 8patients waste activity and 0 employee waste activities. The waiting time for adiagnosis process were 10328.5 minutes, while the waiting time for operationscheduling process were 10.325 minutes. The comparison between the currentstate to the future state resulted increasement of the VA activity for 7.7 with areduction in waiting time for 81.3 and mileage decrease of 0.42 . Analysis ofroot problems revealed that the long waiting times for scheduling process ofgynecologic cancer surgery in RSMH were due to lack of human resourcesquantity registration, medical records, doctor in charge and the lack ofinfrastructure CT scan, operating rooms and instruments and managerialweaknesses in managing the process of scheduling the surgery. Researcherssuggest to improve the performance of existing recruitment human resources,make regulations of a priority of gynecologic cancer patients, as well as theintegration of Hospital Management Information System in each unit.Keywords lean principles, values added VA , non value added NVA , waste,value added ratio, waiting time for establishing diagnosis, surgery waiting times,gynecological cancer"

"[Instalasi gawat darurat (IGD) rumah sakit adalah bagian dari rumah sakit yang memberikan layanan terdepan. Di Rumah Sakit dr. Mohammad Hoesin (RSMH) Palembang sudah terdapat IGD berdasarkan SK Direktur Utama Rumah Sakit yang menetapkan struktur organisasi, tugas dan tanggung jawab, visi dan misi, dan prosedur tetap pelayanan gawat darurat. IGD RSMH Palembang dikepalai oleh seorang dokter spesialis bedah urologi dibantu oleh dua orang kepala ruangan.Standar pelayanan di IGD sudah menerapkan standar layanan sesuai dengan standar akreditasi KARS 2012. IGD keberadaannya di rumah sakit diatur oleh Kepmenkes RI No. 856/Menkes/SK/IX/2009 tentang Standar IGD. Kepemenkes ini mengatur tentang standarisasi pelayanan gawat darurat di rumah sakit, dalam Kepmenkes tersebutdiatur standar organisasi, sumber daya manusia, pelayanan, kelengkapan sarana prasarana di IGD. Di RSMH Palembang telah dilaksanakan dokter spesialis jaga on site di IGD sejak 30 Januari 2014 sebagai tindak lanjut Kepmenkes RI tersebut. Sejak dilaksanakan kebijakan dokter spesialis jaga on site di IGD masih dijumpai kepatuhan para dokter masih belum optimal dan walaupun mutu layananan semakin membaik sejalan dengan telah terakreditasi paripurna rumah sakit versi KARS 2012. Penelitian ini bertujuan untuk mengetahui bagaimana implementasi kebijakan dokter spesialis jaga on site di IGD sudah dilaksanakan sesuai dengan tujuan yang diharapkan sesuai dengan Kepmenkes. Penelitian dilakukan dengan metode kualitatif melalui wawancara mendalam pada informan. Informan yang diwawancarai adalah jajaran Direktur RSMH Palembang, Ketua Komite Medik, Kabag. Keuangan, Kepala ruangan IGD dan para dokter spesialis. Penilaian hasil wawancara menggunakan kerangka fikir model implementasi kebijakan George Edward III dengan variabelsumber daya, komunikasi, disposisi dan struktur organisasi.Dari hasil penelitian ini didapatkan implementasi kebijakan dokter spesialis jaga on site belum berjalan dengan baik, disebabkan karena faktor komunikasi, disposisi dan struktur organisasi belum berjalan baik dan masih banyak perlu dukungan sumber daya. Usulan yang diberikan adalah penambahan dan kompetensi tenaga sesuai standar, revisi SOP, penyediaan media komunikasi, perbaikan fasilitas,meningkatkan koordinasi dan fungsi pengawasan secara berkala, advokasi ke Kemenkes RI.;Emergency department (ED) is a part of hospital which giving advanced services. In dr. Mohammad Hoesin (RSMH) Palembang hospital already own an emergency department based on SK director of the hospital whom establishes the organizational structure, duties and responsibilities, vision and mission, and standard operating procedures emergency services. ED RSMH Palembang is lead by a specialist urology and assisted by two heads of the room. Standard service of ED has implementing service standards according to accreditation standards KARS 2012. ED in the hospital arranged Indonesian health minister No. 865/Menkes/SK/IX/2009 about ED standards. The head of health minister regulates the standardization of emergency services at the hospital, which managing standard organizations, human resources, services, completeness infrastructure in ED. RSMH Palembang has been implemented specialist doctors duty on site in the ER since January, 30th 2014 as a follow-up of the head of the Indonesian health minister. Ever since implemented a policy specialist on duty in the ER site still found the compliance of the doctors are still not optimal and although the quality of service has improved in line with acreditation hospital KARS version 2012. This research aims to determine how the implementation of policy specialists doctors on site in the ER has been implemented in accordance with the expected goals in accordance with the head of health minister. Research done with qualitative method by performing in-depth interviews on informants. Informants interviewed are RSMH Palembang board of directors, chairman of the medical committee, chief financial officer, head of the ED room and specialist doctors. Assessment interview results are using logical framework policy implementation model George Edward III with variable resources, communications, disposition and organizational structure. From the results of this study, the implementation of policy specialist doctorson site guard has not run well, due to the communication factor, disposition and organizational structure has not been going well and much needed resource support. The given proposal is the addition of appropriate power and competence standards, the revised SOP, provision of communication media, improvement of facilities,improving the coordination and monitoring functions regularly, advocacy to the head of the Indonesian health minister, Emergency department (ED) is a part of hospital which giving advancedservices. In dr. Mohammad Hoesin (RSMH) Palembang hospital already own anemergency department based on SK director of the hospital whom establishes theorganizational structure, duties and responsibilities, vision and mission, and standardoperating procedures emergency services. ED RSMH Palembang is lead by aspecialist urology and assisted by two heads of the room. Standard service of ED hasimplementing service standards according to accreditation standards KARS 2012.ED in the hospital arranged Indonesian health minister No.865/Menkes/SK/IX/2009 about ED standards. The head of health minister regulatesthe standardization of emergency services at the hospital, which managing standardorganizations, human resources, services, completeness infrastructure in ED. RSMHPalembang has been implemented specialist doctors duty on site in the ER sinceJanuary, 30th 2014 as a follow-up of the head of the Indonesian health minister. Eversince implemented a policy specialist on duty in the ER site still found thecompliance of the doctors are still not optimal and although the quality of service hasimproved in line with acreditation hospital KARS version 2012.This research aims to determine how the implementation of policy specialistsdoctors on site in the ER has been implemented in accordance with the expectedgoals in accordance with the head of health minister. Research done with qualitativemethod by performing in-depth interviews on informants. Informants interviewed areRSMH Palembang board of directors, chairman of the medical committee, chieffinancial officer, head of the ED room and specialist doctors. Assessment interviewresults are using logical framework policy implementation model George Edward IIIwith variable resources, communications, disposition and organizational structure.From the results of this study, the implementation of policy specialist doctorson site guard has not run well, due to the communication factor, disposition andorganizational structure has not been going well and much needed resource support.The given proposal is the addition of appropriate power and competence standards,the revised SOP, provision of communication media, improvement of facilities,improving the coordination and monitoring functions regularly, advocacy to the headof the Indonesian health minister]"

"Kelelahan merupakan gejala yang paling menyusahkan bagi pasien gagal jantung dan dapat memperburuk kondisi pasien gagal jantung. Intervensi yang dapat digunakan untuk menurunkan kelelahan pada pasien gagal jantung yaitu pemberian terapi komplementer dan alternatif. Tujuan penelitian ini yaitu mengidentifikasi pengaruh aromaterapi peppermint terhadap penurunan kelelahan pada pasien gagal jantung. Desain penelitian quasi eksperiment pretest posttest with control group. Metode pemilihan sampel menggunakan consequtive sampling dengan jumlah 50 responden, dibagi menjadi kelompok kontrol dan kelompok intervensi. Fatigue Severity Scale (FSS) digunakan untuk mengumpulkan data (intervensi dilakukan selama 7 malam). Sebelum dan sesudah intervensi, kuesioner diisi oleh semua pasien. Kelompok intervensi diberikan aromaterapi peppermint, sedangkan kelompok kontrol diberikan intervensi standar rumah sakit. Hasil penelitian menunjukkan pada kelompok intervensi terjadi penurunan yang bermakna (p < 0,05: α 0,05) pada skor kelelahan. Terdapat perbedaan yang bermakna antara kelompok intervensi dan kelompok kontrol setelah diberikan intervensi. Aromaterapi dengan minyak essensial peppermint dapat menurunkan kelelahan pada pasien gagal jantung, sehingga penggunaan wewangian ini dianjurkan.

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Fatigue is the most troublesome symptom for Heart Failure patients and can worsen the condition of heart failure patients. Intervention that can be used to reduce fatigue in Heart Failure patient is complementary and alternative therapy. The purpose of this study was to identified the effect of peppermint aromatherapy on reducing fatigue in Heart Failure patient. Study design was quasi experiment with pretest posttest control group. The sample selection used consequtive sampling method with 50 respondents, divided into intervention and control group. The intervention group was given peppermint aromatherapy, while the control group with standard hospital intervention. The results showed that in the intervention group there was a significant decrease (p < 0.05: α 0.05) in the fatigue score. There was a significant difference between the intervention group and the control group after being given the intervention. Aromatherapy with peppermint essential oil can reduce fatigue in heart failure patients, so the use of this fragrance is recommended."

"RSUP memiliki standar Emergency Respon Time2 (ERT2) yang merupakan waktu yang dibutuhkan untuk pasien untuk mendapatkan tindakan operasi cito yaitu < 120 menit (2 jam), yang diharapkan dapat dicapai sebagai dasar penilaian kinerja unit IGD dan kinerja Dirut RSUP Fatmawati. Data bulan januari-juni 2015, menunjukan terjadinya keterlambatan pelayanan preoperasi cito yaitu pasien dengan Cerebrovaskuler Stroke Hemorraghic Disease (CVD SH) hingga 7 jam 28 menit. Penelitian ini dilakukan secara kualitatif menggunakan pendekatan lean hospital dengan melihat alur proses tahapan preoperasi cito. Sampel berdasarkan Purposive Sampling. Hasil penelitian dengan value assessment yang dipetakan dengan value stream mapping (VSM) menunjukkan value added activity (VA) sebesar 10%, non value added activity (NVA) sebesar 90%. Analisis waste teridentifikasi enam jenis masalah yang dikelompokkan kedalam Fishbone Diagram menjadi empat yaitu man,material, methode dan environment. Rekomendasi perbaikan dilakukan dalam 2 tahap yaitu jangka pendek serta jangka menengah-panjang untuk mengeliminasi pemborosan (waste) dan membentuk skema future flowchart. Penelitian ini menunjukan penyebab keterlambatan berdasarkan hasil analisis kegiatan berdasarkan waktu dalam setiap tahapan.

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RSUP has a standard Emergency Response Time 2 (ERT2) which is taken for patients to get emergency surgery service. The standart time is < 120 minutes (2 hours), which is expected to be achieved as a basis for performance assessment and emergency unit RSUP Fatmawati CEO's performance. Based on data in January-June 2015 shows emergency service time that patients with preoperative cerebrovascular Hemorraghic Stroke Disease (CVD SH) up to 7 hours 28 minutes. with the longest time is 9 hours 28 minutes. This research uses qualitatively using a lean approach to by observing preoperative each step of emergency process. This research uses purposive sampling methode.

Results of research with value assessment with value stream mapping (VSM) activity shows the value added (VA) by 10%, non-value added activity (NVA) by 90%. Waste analysis identifies six types which are grouped into four Fishbone Diagram such as man, material, method and environment.

Recommendations for improvements carried out in two stages: short-term and medium-long term to eliminate waste and form a flowchart futures scheme. This research shows causes of delay based on the results of the analysis of time-based activities in each phase."

"Instalasi Gawat Darurat IGD adalah gerbang utama masuknya pasien gawat darurat,sehingga dibutuhkan pelayanan yang cepat, tepat, cermat dan alur proses yang lancardan bebas hambatan. Yang menjadi hambatan pelayanan pasien IGD adalah adanyabottleneck proses mulai dari pasien datang sampai dengan pasien keluar sehinggaberdampak pada turn arround time TAT melebihi dari standar yang dtetapkan olehrumah sakit yaitu le; 8 jam. Penelitian ini bertujuan untuk melakukan analisis alurproses pelayanan pasien gawat darurat dengan menggunakan lean six sigma tools.Desain penelitian ini adalah analisa kualitatif dengan metode observational actionprocess research dan kerangka acuan DMAI Define, Measure, Analyse, Improve .Pengambilan data dengan observasi alur proses pelayanan pasien, telaah dokumen danwawancara mendalam di Instalasi Gawat Darurat RSUP Nasional Dr. CiptoMangunkusumo. Hasil penelitian dari 369 pasien terdapat 166 44.98 memilikiTAT > 8 jam dengan rata ndash; rata waktu pelayanan pada saat datang 5.30 menit, triage4.09 menit, registrasi 7.10 menit, evaluasi dan tatalaksana awal 60.10 menit, zonapelayanan 535.14 menit, permintaan obat ke satelit farmasi 34 menit, pemeriksaanlaboratorium 66.47 menit, pemeriksaan radiologi 98 menit, dan pasien pulang 20.24menit, rawat 50.30 menit, rujuk 110 menit dan meninggal 72.50 menit. Persentase NonValue Added 59 dan perhitungan Six Sigma berada di level sigma 3 yangmemungkinkan terdapat 66.807 melebihi TAT dari 1 juta kesempatan. Hasil analis fishbone menunjukkan adanya bottelneck di setiap proses terutama di zona pelayanandengan penyebab yaitu menunggu diperiksa, menunggu hasil pemeriksaan penunjang,menunggu alat, obat dan alat kesehatan, menunggu disposisi, menunggu discharge danmenunggu ruang rawat. Penelitian ini menyimpulkan bahwa alur proses pelayananpasien IGD tergolong un-lean dan berada di level sigma 3 sehingga diperlukan upayaperbaikan terus menerus Kaizen dengan desain ulang pelayanan mulai dari pro aktiftriage, mengaktifkan zona hijau, advanced patient tracking, ruang intermediate warduntuk pasien boarding dan layanan ambulans melalui anggota tim gerak Lean SixSigma.

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Emergency Room ER is the main gate of emergency patients that required a fast,precise, and careful service. One of challenges in ER is bottleneck process start frompatients arrived until patients discharged. This may cause to the Turn Around Time TAT exceeds the standard of 8 hours.

This research aimed to analyse the flowprocess of patient's care in ER using Lean Six Sigma Tools. Design used in this studyis qualitative analysis by method of observational action process research andreference of DMAI Define, Measure, Analyze, and Improve. Data were collected byobservation to process of patient's care, document review and in depth interview inER of National Referral Hospital of Dr. Cipto Mangunkusumo.

Results of this study,166 44,98 from 369 patients have TAT 8 hours with average service time patients arrived 5.30 minutes, triage 4.09 minutes, registration 7.10 minutes,evaluation and initial treatment 60.10 minutes, service zone 535.14 minutes, takingmedicines to pharmacy 34 minutes, laboratory check 66.47 minutes, radiologyexamination 98 minutes, patients discharge 20.24 minutes, to be admission 50.30minutes, refer to another hospital 110 minutes, death 72.50 minutes. Percentage ofNon Value Added is 59 and calculation of Six Sigma is in Level Sigma 3 thatallows there to be 66,807 over TAT of 1 million occasions.

Fishbone analysis shows that there is bottleneck in each process, especially in service zone with varietiescauses of waiting to be checked assessed, waiting for laboratory check or radiologyexamination, waiting for medicines and medical devices, waiting for disposition,waiting to be discharged and waiting for admission.

This study concludes that theflow processes of patient's care in ER is classified as un lean and stand in level sigma3. Therefore it is required continuous improvement Kaizen by re design of servicesstart from pro active triage, green zone activation, advanced patient tracking, intermediate ward for boarding patients and ambulance service through Lean SixSigma team.Keyword Flow Process, Emergency Room, Lean Six Sigma."

"Pendahuluan: Agitasi merupakan kejadian umum yang dialami pasien di ruang intensif, bersifat fluktuatif, terjadi kapan saja baik siang maupun malam hari sejak hari pertama menjalani perawatan di ruang intensif serta bisa berlanjut pada hari-hari berikutnya. Salah satu intervensi yang dapat digunakan untuk menurunkan agitasi adalah pemberian terapi komplementer berupa terapi musik relaksasi dan aromaterapi citrus bergamot. Tujuan: Penelitian ini bertujuan untuk mengidentifikasi pengaruh terapi musik relaksasi dan aromaterapi citrus bergamot terhadap penurunan agitasi pasien di ruang perawatan intensif. Metode: Desain penelitian quasy eksperiment pre post test design with control group. Metode pemilihan sampel yakni consequtive sampling dengan jumlah sebanyak 50 responden, dibagi menjadi kelompok kontrol dan kelompok intervensi yang memenuhi kriteria inklusi berupa pasien berusia di atas 18 tahun, pasien dengan skala agitasi RASS ≥ 2, memiliki kemampuan mendengar yang baik dan berkomunikasi secara nonverbal (pada pasien terintubasi dapat dengan mengangkat jari, mengedipkan mata, atau menganggukkan kepala) jika ada pertanyaan peneliti pada saat pengumpulan data; GCS ≥ 9; tidak menggunakan sedasi minimal 3 jam sebelum perlakuan dan tidak menggunakan agen penghambat neuromuskuler. Instrumen penelitian dengan menggunakan Richmond Agitation Sedation Scale dalam mengumpulkan data agitasi sebelum dan setelah perlakuan. Hasil: Berdasarkan hasil analisis bivariat dengan uji Wilcoxon terdapat perbedaan rerata yang bermakna pada skor agitasi sesaat setelah (p<0,001: α:0,05) dan 3 jam setelah perlakuan (p=0,007: α:0,05). Hasil uji Mann Whitney menunjukkan bahwa terdapat perbedaan yang bermakna tingkat agitasi antara kelompok kontrol dan intervensi sesaat setelah dan 3 jam setelah perlakuan (p<0.001; α:0.05). Kesimpulan: Intervensi kombinasi terapi musik relaksasi dan aromaterapi citrus bergamot sebagai bagian dari terapi komplementer dapat digunakan untuk menurunkan agitasi pada pasien di ruang intensif.

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Agitation is a common occurrence experienced by patients in intensive care, is fluctuating, occurs at any time of the day or night since the first day of treatment in the intensive care unit and can continue in the following days. One intervention that can be used to reduce agitation is the provision of complementary therapy in the form of relaxation music therapy and citrus bergamot aromatherapy. Objective: This study aims to identify the effect of relaxation music therapy and bergamot citrus aromatherapy on reducing patient agitation in the intensive care unit. Methods: Quasy experimental research design pre post test design with control group. The sample selection method is consequtive sampling with a total of 50 respondents, divided into control groups and intervention groups who meet the inclusion criteria such as patients over 18 years of age, patients with RASS agitation scale ≥ 2, have good hearing ability and communicate nonverbally (in intubated patients can be by raising a finger, winking, or nodding the head) if there are researcher questions at the time of data collection; GCS ≥ 9; not using sedation at least 3 hours before treatment and not using neuromuscular blocking agents. The research instrument used the Richmond Agitation Sedation Scale in collecting agitation data before and after treatment. Results: Based on the results of bivariate analysis with Wilcoxon test, there is a significant mean difference in agitation score immediately after (p<0.001: α: 0.05) and 3 hours after treatment (p=0.007: α: 0.05). The Mann Whitney test results showed that there was a significant difference in the level of agitation between the control and intervention groups shortly after and 3 hours after treatment (p<0.001; α: 0.05). Conclusion: The combined intervention of relaxation music therapy and citrus bergamot aromatherapy as part of complementary therapy can be used to reduce agitation in patients in the intensive care unit."

"Instalasi Gawat Darurat (IGD) Rumah Sakit RK Charitas dituntut untuk segera meningkatan kualitas karena masih menghadapi berbagai permasalahan seperti terjadinya penumpukan pasien, lamanya waktu pelayanan, dan tingginya keluhan pasien. Lean thinking telah berkembang menjadi metode yang banyak digunakan di rumah sakit untuk mengatasi berbagai masalah. Penelitian ini bertujuan untuk (1) mengevaluasi arus pasien IGD saat ini, (2) untuk mengidentifikasi dan menghilangkan proses yang tidak bernilai, dan (3) mengusulkan future state value stream map (VSM). Penelitian ini dilakukan dengan pendekatan action research. Pengambilan data dilakukan dengan observasi langsung keseluruhan aktivitas di IGD untuk memetakan current state VSM, dan mengidentifikasi waste serta menentukan value added dan non value added activity. Simulasi dilakukan untuk mengurangi aktivitas non value added yang dapat dihindari sebagai dasar pengajuan future state VSM. Hasil penelitian ini menemukan 38 aktivitas yang dilakukan oleh pasien di IGD RS RK Charitas, rata-rata waktu yang dibutuhkan pasien adalah 405 menit dan kegiatan yang paling memakan waktu adalah menunggu transfer ke rawat inap. Setelah waste dieliminasi, seluruh proses aktivitas di IGD turun dari 38 menjadi 29 aktivitas saja serta terjadi peningkatan value added sebesar 17,97%. Keseluruhan hasil tersebut menjadi dasar untuk menyimpulkan bahwa penerapan lean thinking di IGD RS Charitas telah terbukti mereduksi waste dan meningkatkan value added. Penerapan future state VSM dalam jangka pendek, menengah dan panjang meliputi antara lain aplikasi 5S, membuat sistem informasi emergensi di unit radiologi dan mengubah layout triase adalah rekomendasi yang diajukan dari penelitian ini.

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Emergency department (ED) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called "lean thinking". This study aims to (1) evaluate the current patient flow in ED, (2) to identify and eliminate the non-valued added process, and (3) to propose a future state value stream map (VSM). It was a qualitative study. The first step is we observe the whole activity in ED and make a current state VSM, than we apply lean thinking to find waste and identify value added and non value added activity. The last step is to eliminate the avoidable non value added activity and propose the future VSM Among all the processes carried out in ED at RK Charitas Hospital, the most time consuming processes were to wait for an admission bed (boarding). After the waste is eliminated, the entire process of activity in the ER drops from 38 to 29 activities only. Value added activity increased by 17.97%. The application of lean thinking hopefully can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction. "

"Supervisi adalah suatu bentuk pengawasan yang bertujuan untuk meningkatkan kinerja petugas melalui proses yang sistematis meliputi pemberian motivasi, komunikasi dan bimbingan. Penelitian ini menggunakan desain observasional dengan pendekatan cross sectional dengan menggunakan stratified simple random sampling. Tujuan penelitian ini adalah untuk mengetahui hubungan antara fungsi supervisi kepala ruangan dengan kepatuhan perawat pelaksana dalam melakukan SOP identifikasi pasien Hasil penelitian mempergunakan uji Chi Square membuktikan ada hubungan yang bermakna antara motivasi, komunikasi dan bimbingan dengan kepatuhan perawat pelaksana menjalankan SOP identifikasi pasien. (p value < α). Kesimpulan dari penelitian ini, adalah fungsi supervisi kepala ruangan mempunyai peran yang sangat penting dalam meningkatkan kepatuhan perawat dalam melakukan identifikasi pasien sesuai dengan SOP.

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Supervision is a form supervisory that aim to improve the staf performance through a systematic process in the provision of motivation, communication and guidance. This study used an observational design with cross sectional approach using stratified random sampling. The purpose of this study was to determine the relationship between the function of head room supervision with the compliance of nurses in performing SOP patient identification. The result of this research using Chi Square test to prove there is a significant correlation between motivation, communication and guidance to compliance of nurses in implementating SOP of patient identification (p value < α). The conclusion of this study is that the functions of the supervision of head room have a very important role to improve the nurses complaince in conducting the patient identification based on the SOP."

"Tesis ini membahas mengenai sejauh mana budaya keselamatan pasien pada residen. Desain penelitian cross sectional dengan analisis mixed method. Subjek penelitian seluruh residen dengan instrumen kuisioner HSOPS. Hasil penelitian menyimpulkan dimensi budaya keselamatan pasien yang paling rendah adalah dimensi respon tidak menghukum terhadap kesalahan (18%). 12 dimensi keselamatan pasien tidak dipengaruhi oleh jenis kelamin dan tingkat kelas residen (p> 0,05), tetapi sebagian besar dipengaruhi oleh asal departemen.

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The tesis focus about the patient safety culture among the resident. This is a cross sectional design research with mix method analysis where all the residen of Medical Faculty of Sriwijaya University as the research subject with HSOPS quesionaire as an instrument. The lowest culture dimension is nonpunitive response to errors (18%). The twelve dimension of patient safety did not influenced by the gender and class level of resident (p>0.05), but majority influenced by the departement catagory"