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"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."

"Indikator Standar Pelayanan Minimal waktu tunggu pelayanan obat pada di depo farmasi rawat jalan RSUD Koja belum mencapai standar. Selisih terbesar antara pencapaian dengan standar terjadi pada pelayanan obat jadi pasien BPJS. Penelitian ini dilakukan untuk menganalisis waktu tunggu pelayanan obat jadi di depo farmasi rawat jalan dengan pendekatan Lean Six Sigma. Jenis penelitian ini adalah operational research dengan pendekatan kualitatif dan kuantitatif. Hasil penelitian menyatakan rata-rata waktu tunggu adalah 1 jam 21 menit 48 detik dengan kegiatan value-added sebesar 7,40% dan non- value-added sebesar 92,60%. Kategori waste terbesar ada pada kategori waiting, dan disusul oleh kategori lainnya yaitu motion, defects, overprocessing, human potential, dan inventory. Proses yang menjadi bottleneck adalah proses persiapan obat. Akar penyebab utama pada bottleneck yang dianalisis dengan fishbone adalah kategori man. Usulan perbaikan terdiri dari realisasi perhitungan beban kerja, 5S, standarisasi pekerjaan, visual management, kaizen, perbaikan sistem, counter nomor antrian obat, perluasan ruangan, serta poli cepat dan perubahan layout. Dari usulan perbaikan, didapatkan hasil future state map yang menunjukkan waktu tunggu mengalami penurunan menjadi 49 menit 8 detik dengan value-added sebesar 12,38% dan non-value-added sebesar 87,62%.

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The waiting time for medicine services in outpatient pharmacy RSUD Koja has not reached the standard. The biggest difference between achievement and standard occurs in the service of noncompounding medicine for BPJS patients. This study was conducted to analyze the waiting time of outpatient medicine services using Lean Six Sigma approach. This research is operational research with qualitative and quantitative approaches.

The results of this research that the average of waiting time is 1 hour 21 minutes 48 seconds with 7.40% of value-added and 92.49% of non-value-added. The biggest waste category is waiting, followed by other categories, such as motion, defects, overprocessing, human potential, and inventory. The bottleneck of medicine service is the process of medicine preparation with the root cause of problem using fishbone diagram is man category.

The suggestion for process improvements consist of realization of workload calculations, 5S, standardization of work, visual management, kaizen, software repairs, machine for queue number, room expansion, poli cepat and layout changes. Based on that suggestions, future state map results show that waiting time decreased to 49 minutes 8 seconds with 12.38% of value-added and 87.62% of non-value- added."

"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."

"This research discribes about time service analysis of compounding and non compounding medicines in hermina with lean sigma approach ininstallation of outpatient in hermina depok. Pharmacy time service is the important part of the hospital excellent services and lean six sigma is a methodology of decreasing the waste and variation. Thjs reaserch is a an operational research where the researcher did a direct counting in each process of compounding and non compounding prescriptions. Lean six sigma method which has been used were define, measure, analyze and improve. This reaserch aims to propose a better visual management application, 5s culture, lay out changing and electronic prescription and heijunka prescription as a long term porpuse. Using of lean six sigma method could decrease the waste of non compounding prescription service from 43 procedures to 32 procedures with time allocation from 31 minutes and 51 seconds to 16 minutes 34 seconds. For the compounding prescription could also decrease the procedures, from 32 steps to 46 steps with time allocationfrom 47 minutes and 31 seconds to 25 minutes and 7 seconds."

"Penelitian ini bertujuan untuk meningkatkan efisiensi waktu pelayananinstalasi farmasi rawat jalan dalam rangka peningkatan mutu pelayanan rumahsakit. Metode penelitian yang digunakan adalah metode penelitian gabungan mixed method dengan melakukan wawancara mendalam serta observasi waktutunggu pelayanan obat yang selanjutnya dianalisis dengan menggunakan analisisunivariat. Hasil penelitian menunjukkan bahwa waktu tunggu pelayanan obatracik dan paten di rumah sakit ini melebih standar waktu yang ditetapkan,ditemukan beberapa penghambat seperti ketersediaan sumber daya manusia, saranaprasarana dan fasilitas kerja yang merupakan hambatan terbesar dalam pelayananini. Disarankan kepada rumah sakit untuk dapat redisain layout farmasi,menghitung ulang pola ketenagaan serta pengaturan tugas sesuai dengankompetensinya.

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This study aims to improve the efficiency of service time of outpatientpharmacy installation in order to improve the quality of hospital services. Theresearch method used is the method of combined research mixed method byconducting in depth interviews and observation of drug service waiting time whichthen analyzed by using univariate analysis.

The result of the research shows that the waiting time for the service of racikand patent medication in this hospital exceeds the standard time set, found someobstacles such as availability of human resources, infrastructure and work facilitieswhich is the biggest obstacle in this service.

It is advisable to the hospital to be ableto redesign the pharmacy layout, recalculate the pattern of the workforce as well asthe arrangement of tasks in accordance with its competence."

"Pelayanan resep obat merupakan serangkaian aktivitas mulai dari penerimaan penerimaan resep, pengkajian resep, pemberian harga obat, penyiapan obat, pengemasan, dan pemberian etiket, pemeriksaan kembali, penyerahan obat kepada pasien. Waktu tunggu pelayanan resep obat jadi belum dapat memenuhi standar yang ditetapkan oleh Rumah Sakit (≤10 menit) dan standar yang ditetapkan Pemerintah dalam Kepmenkes RI Nomor 129 Tahun 2008 (≤30 menit). Penelitian ini dilakukan dengan tujuan memberikan rekomendasi perbaikan pada waktu tunggu proses pelayanan resep obat jadi menggunakan pendekatan Lean Six Sigma meliputi tahap Define, Measure, Analyze, dan Improve. Desain penelitian berupa kualitatif dan kuantitatif dengan jenis penelitian operational research. Hasil pengmatan pada waktu tunggu pelayanan obat jadi digambarkan dengan Value Stream Mapping (VSM) yang memperlihatkan rata-rata waktu keseluruhan proses pelayanan resep obat jadi selama 35,94 menit dengan kegiatan bernilai tambah (value-added activi) 11,2 menit (31,26%), kegiatan tidak memberi nilai tambahan (non-value-added activities) 24,74 menit (68,83%). Pemborosan (waste) paling banyak terjadi adalah menunggu (waiting) dari seluruh pemborosan (waste) yang ditemukan. Berdasarkan hasil analisis pada setiap aktivitas pemborosan (waste) dalam proses pelayanan resep obat jadi maka dihasilkan usulan perbaikan berupa visual management, 5S, membuat jadwal pemeliharaan peralatan, melakukan pengadaan peralatan penunjang, menambah fitur dalam sistem e-press, membuat gudang khusus, menghitung beban kerja petugas, dan mengadakan layar tampilan status resep, dan melakukan perbaikan berkelanjutan. Dihasilkan Future VSM dengan leadtime proses pelayanan resep obat jadi menjadi 20,42 menit.

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Prescription drug service is a series of activities from receipt prescription, review of prescription, administration of drug prices, preparation, packaging, checking, and delivery of drugs to patients. The waiting time for prescription drug services has not been able to meet the standards set by the Hospital (≤10 minutes) and the standards set by the Government in Kepmenkes RI Nomor 129 Tahun 2008 (≤30 minutes). The aim of this research is to provide recommendations for improvements of the prescription service waiting time using Lean Six Sigma approach which consists of Define, Measure, Analyze and Improve phase. The research design is qualitative and quantitative with the type of operational research. The results of this research were described with the the value stream mapping that shows the average time for entire process is 35.94 minutes, with value-added activities 11.2 minutes (31.26%) and non-value-added activities 24.74 minutes (68.83%). The most waste occur is waiting. Based on that analysis, the researcher provide recommendations for improvement that is visual management, 5S, schedule maintenance of equipment, procuring supporting equipment, adding features in the e-presscription system, create a warehouse, calculate the workload of pharmacy staff, and implement continuous improvement. Resulting in future VSM with leadtime of the process of prescribing service time is 20.42 minutes."

"Jumlah pasien BPJS yang meningkat mempengaruhi lama waktu pelayanan di Instalasi rawat jalan pasien BPJS Rumah Sakit Hermina Bekasi. Masalah ndash; masalah yang mempengaruhi lama waktu pelayanan rawat jalan dapat diidentifikasi dengan mengetahui seluruh proses bisnis dalam proses pelayanan menggunakan metode Lean Six Sigma. Penelitian ini adalah penelitian kualitatif dengan desain deskriptif dengan tahapan DMAIC Define, Measure, Analize, Improve, dan Control.Hasil penelitian ini mengemukakan bahwa selama proses pelayanan , rata-rata lama proses pelayanan yaitu 200 menit dengan persentasi kegiatan yang bernilai value added sebesar 17 dan kegiatan NVA sebesar 83. Adapun waste terbesar yaitu waiting menunggu dalam perpindahan setiap tahap dalam pelayanan. Penyebab lamanya waktu tunggu antara lain kurangnya ketersediaan SDM, sistem informasi rumah sakit yang belum terintegrasi, serta sarana dan prasarana yang belum memedai.Penelitian ini juga memberikan usulan perbaikan berupa pengajuan sistem informasi terintegrasi untuk proses pendaftaran, melakukan perbaikan lingkungan kerja menggunakan metode 5 S, mengajukan pembuatan SPO untuk dokter, perubahan layout ruangan di depo farmasi, serta memasang jadwal jam pengambilan obat.

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The increasing number of BPJS patients affects the length of service time in the outpatient installation of BPJS at Hermina Bekasi Hospital. Issues affecting the length of outpatient service can be identified by knowing all business processes in the service process using the Lean Six Sigma method. This research is a qualitative research with descriptive design with stages of DMAIC Define, Measure, Analize, Improve, and Control.

The results of this study suggest that during the service process, the average length of service process is 200 minutes with a percentage of valuable activities value added of 17 and NVA activity of 83. The largest waste is waiting in the transfer of each stage in the service. Causes of long waiting time include lack of availability of human resources, hospital information systems that have not been integrated, and facilities and infrastructure that have not been adequate.

The research also proposed improvements in the form of integrated information system application for registration process, improvement of work environment using 5 S method, proposed SPO making for doctors, room layout changes in pharmacy depot, and installing schedule of drug taking hours. Keywords Waiting time outpatient services lean six sigma."

"Penelitian ini membahas tentang proses pemulangan pasien rawat inap dengan pendekatan lean six sigma terhadap pasien dengan metode pembayaran asuransi swasta dan jaminan perusahaan di instalasi rawat inap RS Hermina Bogor. Tujuan dari penelitian ini adalah mendapatkan hasil analisis kegiatan yang tidak memberikan nilai tambah (non value added) sehingga pemborosan (waste) dapat diidentifikasi dan segera dapat diminimalisasi atau dihilangkan. Penelitian ini bersifat kualitatif dan kuantitatif. Adapun metode penelitian kualitatif dilaksanakan dengan observasi, wawancara mendalam, dan telaah data sekunder. Sedangkan metode penelitian kuantitatif dilaksanakan dengan perhitungan statistik waktu pada proses pemulangan pasien rawat inap. Penelitian ini juga menggunakan pendekatan time and motion studies, yakni mengukur keahlian dan kecepatan karyawan dalam proses pemulangan pasien rawat inap. Berdasarkan hasil penelitian, didapatkan rata-rata waktu proses pemulangan pasien rawat inap di RS Hermina Bogor adalah 289 menit dengan kegiatan value added 35 menit (12,17%) dan non value added 254 menit (87,83%). Proses yang membutuhkan waktu paling lama terjadi pada cycle LPRWI 1, yaitu 110 menit. Sedangkan proses yang memiliki waste waktu paling lama terjadi pada cycle Administrasi, yaitu 95 menit. Penerapan lean dalam penelitian ini dapat menurunkan presentase kegiatan non value added sebesar 19,31%, yakni menjadi 67,83%.

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This research discusses about inpatients discharge process with a lean six sigma approach to patients with private insurance and company guarantees payment methods at the inpatient installation of Hermina Bogor Hospital. The purpose of this research is to get the results of the analysis of non value added activities so that waste can be identified and immediately can be minimized or eliminated. This research is qualitative and quantitative. The qualitative research method is carried out by observation, in-depth interviews, and review of secondary data. While the quantitative research method is carried out by calculating time statistics in inpatients discharge process. This research also uses a time and motion studies approach, which measures the skills and speed of employees in the inpatients discharge process. Based on the results in this research, it was found that the average time of inpatients discharge process at Hermina Bogor Hospital was 289 minutes with 35 minutes (12.17%) value added activities and 254 minutes (87.83%) non value added activities. The process that took the longest time occurs in the LPRWI 1 cycle, which is 110 minutes. While the process that has the longest waste time occurs in the Administrative cycle, which is 95 minutes. Lean application in this research can reduce the percentage of non value added activities by 19.31%, ie to 67.83%."

"Penelitian bertujuan untuk mengidentifikasi alur proses pelayanan dengan menggunakan pendekatan lean six sigma dan memberikan usulan perbaikan di Instalasi Radiologi RS Hermina Tangerang. Penelitian ini merupakan penelitian operasional (operational research) dengan desain penelitian kuantitatif dan kualitatif yang didapatkan dari hasil observasi, wawancara mendalam, dan telaah dokumen. Sasaran penelitian adalah pemeriksaan radiologi konvensional sebanyak 31 sampel. Hasil yang didapatkan dari pengukuran value stream mapping (VSM) adalah rata-rata lead time per pasien 2 jam 26 menit 42 detik pada shift pagi siang dan 12 jam 34 menit 53 detik pada shift malam. Bottleneck terletak pada siklus pengolahan ekspertise dikontribusi oleh sebagian besar waste of waiting, yaitu menunggu foto dibaca oleh dokter spesialis radiologi. Akar penyebab masalah adalah tidak ada jam praktek dokter spesialis radiologi pada shift malam hari serta belum diterapkan standarisasi waktu tunggu pelayanan radiologi untuk semua jenis pasien. Usulan perbaikan yang diberikan adalah dilakukannya standardized work, visual management, dan just in time sehingga diestimasikan lead time dapat dikurangi sebesar 26,47% (1 jam 47 menit 52 detik) pada shift pagi dan siang, serta shift malam 49,35% (6 jam 22 menit 28 detik).

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The purpose of this study is to identify the service process flow using lean six sigma approach and giving improvement suggestions in radiology instalation at Hermina Tangerang Hospital. This is a quantitative and qualitaive operational research which the data was collected from observation result, in-depth interview, and document review. Target research of the study was the coventional radiology examinations with 31 samples. The result based on value stream mapping (VSM) measurement showed the average lead time per patient is 2 hours 26 minutes 42 seconds in the day shift and 12 hours 34 minutes 53 seconds in the night shift. The bottleneck is located in the expertise processing cyle which dominantly contributed by waste of waiting by waiting the image to be interpreted by the radiology specialist doctor. The root cause of the problem was the unavailability of the radiology specialist doctor in the night shift and there is no standardization of patients waiting time in the radiology services.  The improvement suggestions are the radiology department needs to apply a standardized work, visual management, and just in time, so that it is estimated that the lead time can be reduced 26,47% (1 hour 47 minutes 52 seconds) in the day shift and 49,35% in the night shift (6 hours 22 minutes 28 seconds)."

"Waktu tunggu yang dibutuhkan dalam roses pemulangan pasien (discharge planning) pasien rawat inap dengan jaminan asuransi pribadi atau perusahaan di RS Hermina Daan Mogot belum memenuhi standar yang ditetapkan Kepmenkes No. 129 Tahun 2008 yaitu tidak lebih dari 2 jam. Metode yang diterapkan pada penelitian ini yaitu metode kualitatif dan kuantitatif dengan melakukan observasi, wawancara mendalam, telaah dokumen, serta perhitungan waktu tunggu 13 pasien asuransi dan jaminan perusahaan dalam menyelesaikan proses pemulangan pasien.Hasil yang didapatkan dari penelitian ini yaitu rata-rata lamanya proses pemualangan pasien asuransi dan jaminan perusahaan adalah 287,3 menit dengan aktivitas yang termasuk VA yaitu 31,3 menit (10,9%) dan aktivitas yang termasuk NVA yaitu menit 256,2 menit (89,3%). Proses paling lama yang dilalui pasien dengan aktivitas waste jenis waiting yaitu keluarga pasien menuggu diberi arahan untuk mengurus administrasi pulang di kamar rawat inap.Usulan perbaikan yang diberikan untuk mengatasi permasalah tersebut yaitu melakukan standardize work, petugas administrasi melakukan keliling ke unit perawatan, menerapkan sistem UDD, mengajukan permohonan kepada pihak penunjang umum rumah sakit untuk menambahkan fasilitas, adanya list dari setiap asuransi dan perusahaan mengenai terapi apa yang dijamin, meningkatkan penggunaan SIMRS, menerapkan sistem Electronic Health Record (EHR), dan melakukan analisis kebutuhan SDM farmasi klinis.

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The waiting time needed in the process of discharge planning for inpatients with personal insurance or company guarantees at Hermina Daan Mogot Hospital has not met the standards set by Kepmenkes No. 129 of 2008 which is no more than 2 hours. The method applied in this study is qualitative and quantitative methods by conducting observations, in-depth interviews, document review, and calculation of waiting times for 13 patients of insurance and company guarantees in completing the return process of patients.

The results obtained from this study are that the average length of the patient's insurance and insurance company process is 287.3 minutes with activities including VA, which is 31.3 minutes (10.9%) and activities including NVA, namely 256.2 minutes (89.3%). The longest process that the patient goes through with waiting type waste activity is that the patients family is given directions to take care of the administration going home in the inpatient room.

Proposed improvements are given to overcome this problem, namely to do standardize work, administrative officers traveling around to the care unit, implementing the UDD system, submitting requests to the general hospital support to add facilities, the list of insurance companies and companies on what therapy is guaranteed, increasing use of SIMRS, implementing Electronic Health Record (EHR) systems, and analyzing clinical pharmacy HR requirements."