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Abstrak :
ABSTRAK Waktu tunggu yang lama di rawat jalan akan menghambat pelayanan, dan akan berdampak pada antrian yang menumpuk, serta mengakibatkan pelayanan menjadi tidak efisien. Penelitian dengan metode kualitatif ini mengobservasi waktu yang digunakan oleh pasien selama berada di Rumah Sakit dan bertujuan untuk meningkatkan efisiensi pelayanan rawat jalan di Rumah Sakit Sumber Waras Ciwaringin dengan metode lean. Hasil penelitian menunjukkan, 90% waktu pelayanan merupakan kegiatan non value added dan hanya 10% yang merupakan kegiatan value added. Usulan perbaikan dengan metode lean, yang dilakukan secara simulatif, menghasilkan perbaikan pada proses pelayanan rawat jalan dengan menurunkan kegiatan non value added menjadi 70,59% dan meningkatkan kegiatan value added menjadi 29, 41%.

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ABSTRACT Long waiting times in the outpatient care would hamper the service, have an impact on queues and will end up with an inefficient service. This qualitative research, using the lean method, observed the time spent by the outpatients while in hospital with the aim to improve the efficiency of outpatient services at the Sumber Waras Hospital Ciwaringin with lean method. The results showed that 90% of the service time is non-value added activities and only 10% is counted as value added activities. Simulation is applied and has lead to improvement in the process of outpatient services by decreasing the non value added activities to 70,59% and increasing the value added activities to 29,41%.

Abstrak :
ABSTRAK
Penerapan Lean Manajemen Pada Pelayanan Rawat JalanPasien BPJS Rumah Sakit Hermina Depok Tahun 2017Lamanya waktu tunggu dalam pelayanan rawat jalan akan menghambat pelayanan,dan berdampak pada penumpukan antrean dan inefisiensi pelayanan. Penelitian inibertujuan menganalisis penerapan metode lean pada pelayanan rawat jalan pasienBPJS di rumah sakit Hermina Depok tahun 2017. Penelitian dengan metodekualitatif ini mengobservasi waktu pelayanan pasien rawat jalan BPJS untukmelihat dan memotret kondisi alur pelayanan pasien rawat jalan BPJS. Pada valuestream mapping pasien tanpa pemeriksaan penunjang, waktu proses cycle time tercepat adalah pada saat pasien di kasir yaitu 2,2 menit dan paling lama adalahpada saat pasien mendapat pemeriksaan dokter yaitu 12,6 menit. Waktu tunggu waiting time paling lama pada saat pasien menunggu obat di farmasi yaitu 96,2menit 1 jam 36 menit dan paling cepat adalah pada saat pasien menunggu di kasiryaitu 4,4 menit. Pada value stream mapping pasien dengan pemeriksaan penunjanglaboratorium, waktu proses cycle time tercepat adalah pada saat proses pasiendikasir 4,2 menit, dan paling lama pada saat pasien mendapat pemeriksaan dokteryaitu 12,6 menit. Waktu tunggu waiting time terlama pada saat pasien menunggudokter yaitu 126,2 menit 2 jam 6 menit dan paling cepat pada saat pasienmenunggu proses di kasir 2,2 menit. Pada value stream mapping pasien denganpemeriksaan penunjang radiologis, waktu proses cycle time tercepat pada saatproses pasien dikasir yaitu 4,8 menit, paling lama pada saat proses pemeriksaanradiologi yaitu 67,2 menit 1 jam 7 menit . Waktu tunggu waiting time terlamapada saat pasien menunggu dokter 95,6 menit 1 jam 35 menit , paling cepat padasaat proses pasien di kasir 4,4 menit. Hasil penelitian menunjukkan 90 waktupelayanan merupakan kegiatan non value added dan hanya 10 kegiatan yangvalue added, dengan jenis-jenis waste nya adalah defect, over production, waiting,transportation, inventory, motion, dan over processing. Analisis future state denganusulan perbaikan metode lean secara simulatif yaitu 5S, Kanban Inventory, visualmanagement menurunkan kegiatan non value added menjadi 78,30 danmeningkatkan kegiatan value added menjadi 21,70 .Rekomendasi dengan melakukan perbaikan jangka pendek, jangka menengah danjangka panjang melalui program pelaksanaan metode lean berkelanjutan.Kata kunci : Metode lean, rawat jalan, waktu tunggu, kegiatan value added,kegiatan non value added.

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ABSTRACT
The Aplication of Lean Method on Outpatient BPJSServices at Hermina Depok Hospital in 2017.The length of waiting time in the hospital outpatient service is important forefficient hospital service. Long waiting time leads to accumulating queue andinefficient service. This study was aimed to analyze the application of lean methodon outpatient BPJS services at Hermina Depok Hospital in 2017. This qualitativeresearch method investigated the time spent by BPJS outpatient patient by applyinglean method and observing the outpatient service flow condition. The first result,the value stream mapping VSM of patients without any adjunctive examinations i.e., laboratory or radiology , the fastest cycle time was observed at the receptiondesk 2.2 minutes and the longest at the doctor examination room 12.6 minutes .The longest waiting time was at drug prescription process at pharmaceutical unit 96.2 minutes or 1 hour,36 minutes and checkout was the fastest 4.4 minutes .Second result, the VSM with laboratory examination, the fastest time cycle was atthe reception desk 4.2 minutes , and the longest was observed at the doctorexamination 12.6 minutes . The longest waiting time at the doctor waiting room 2hours 6 minutes and checkout was the fastest 2.2 minutes . Third result, the VSMwith radiologic examination, the fastest cycle time was observed at the receptiondesk 4.8 minutes , the longest cycle time was at the radiology examination process 67.2 minutes or 1 hour, 7 minutes . The longest waiting time was observed at thedoctor examination room 95.6 minutes or 1 hour, 35 minutes and checkout wasthe fastest 4.4 minutes . The results showed that 90 service time was non valueadded activity and only 10 of value added activity. The wastes were defect, overproduction, waiting, transportation, inventory, motion, and over processing. Afterconducting future state analysis with the proposed improvement with simulativelean method 5S, Kanban Inventory, visual management , it was found that nonvalue added activity became 78,30 and value added activity became 21,70 .Future recommendation is important to organize short , medium and long termimprovements through implementation of sustainable lean method program.Keywords Lean method, outpatient waiting time, value added activity, non valueadded activity

Abstrak :
Pelayanan Obstetri Neonatal Emergensi Komprehensif (PONEK) yang cepat dan tepat sesuai standar waktu response time yang ditetapkan Kementerian Kesehatan Republik Indonesia, diharapkan dapat menurunkan angka kematian ibu dan angka kematian bayi. Dengan menggunakan metode lean, dapat dirumuskan upaya perbaikan untuk memperpendek waktu response time pada tindakan Seksio sesarea emergensi di RSUD dr. Doris Sylvanus Palangkaraya. Tujuan dari penelitian ini ialah mengetahui value stream mapping alur tindakan, mengidentifikasi kegiatan non value added, waste dan kegiatan value added pada setiap alur pelayanan serta merencanakan future state map alur tindakan Seksio sesarea emergensi. Penelitian ini menggunakan desain kualitatif dengan menggunakan metode lean melalui observasi dan telaah dokumen proses pelayanan dan juga wawancara kepada direksi, tim PONEK, pasien atau keluarga. Alur proses pelayanan PONEK di RSUD dr. Doris Sylvanus melibatkan sub unit terkait mulai dari triase sampai dimulainya tindakan di kamar operasi. Proses pelayanan yang terkait response time tindakan Seksio sesarea emergensi pada penelitian ini yaitu sejak penetapan keputusan tindakan, depo farmasi, BDRS/ PMI, kasir, transfer dan kamar operasi. Hasil penelitian ditemukan pada current state value streaming mapping tindakan seksio sesarea emergensi sebelum dan sesudah intervensi bahwa waktu yang digunakan untuk kegiatan non value added sebesar 41.17% menjadi 33,9% sedangkan kegiatan value added sebesar 58.83% menjadi 66,1% dengan total lead time 114,4 menit menjadi 49,2 menit sehingga masih diperlukan upaya perbaikan untuk memperpendek response time pelayanan PONEK di RSUD dr. Doris Sylvanus Palangkaraya. ......The Comprehensive Emergency Obstetrics and Newborn Care (CEmONC/PONEK) services are required to reduce maternal deaths and infant mortality in an easy and sufficient response time performance. Improving the response times in the behavior of caesarean sections at RSUD dr. Doris Sylvanus Palangkaraya by means, the lean method could be established in this research. The aims of this research are to determine the value stream mapping of the flow, value added activities, non-value added activities and waste in the flow of services, and to prepare the future map in PONEK 's unit of RSUD dr Doris Sylvanus for the operational flow. This research used a qualitative approach using lean methods, by reviewing and evaluating data, and by carrying out insightful interviews with PONEK management, the patient and the family, respectively. The PONEK services run by dr. Doris Sylvanus required few things to be considered such as triage, registration, midwife and doctor evaluation, assessments, acts, prescription, cashiers, transfers and operating rooms. Cesarean section response time systems at RSUD dr. Doris Sylvanus's PONEK facilities are based on some of the policy decisions on the pharmacy store, BDR/ PMI, cashier, relocation and surgical room. The results of this study showed that in the current state of the streaming value mapping, before and after intervention, 41.17% of the non valued added activities for the caesarean sections emergency have been used change to 33.9% while the value added activities were showed at 58.83 % change to 66.1% with the total lead time 114.4 minutes change to 49.2 minutes, so that appropriate steps were needed to shorten the caesarean sections response time mapping in PONEK service of dr. Doris Sylvanus Hospital, Palangkaraya.

Abstrak :
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%. ......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%.

Abstrak :
Biaya obat yang besar memerlukan pengelolaan yang tepat. Proses pengelolaanobat yang paling mengganggu dalam siklus pengelolaan obat di Instalasi FarmasiRSU Sari Mutiara Medan adalah proses pengadaan/pembelian obat. Obat Tingkatpemakaian dan pembelian obat kronis yang tinggi mewakili tingkat pemakaiandan pembelian obat secara keseluruhan. Peningkatan efisiensi pada prosespengadaan/pembelian obat kronis dapat memberikan gambaran peningkatanefisiensi pengelolaan obat secara keseluruhan. Penelitian dengan metode kualitatifini mengobservasi waktu yang digunakan selama proses pembelian obat darimulai pemesanan hingga obat diap didistribusikan, dan bertujuan untukmeningkatkan efisiensi pengelolaan obat di Instalasi Farmasi RSU Sari MutiaraMedan dengan menggunakan metode lean. Hasil penelitian dapat merumuskankegiatan pembelian obat yang beragam menjadi satu alur proses pembelian obat,dalam desain usulan perbaikan tampak pengurangan waktu tunggu, peningkatanpresentasi kegiatan value added dan reduksi presentasi kegiatan non value added.Dengan meningkatnya efisiensi proses pembelian/pengadaan obat diharapkanadanya domino effect pada proses pengelolaan obat lainnya. Dalam penelitian inidicapai kendali biaya dan kendali mutu melalui usulan perbaikan jangka pendekperencanaan kebutuhan obat dengan menggunakan analisis pareto dan VEN, sertametode error proofing dalam evaluasi akhir setiap proses pembelian obat.Penerapan kaizen merupakan usulan jangka panjang yang akan selalu diterapkandalam setiap analisis proses menggunakan metode lean. ......High cost of drugs need a proper management. Procurement purchase of thedrugs is the most disturbing management process in the drug cycle managementin the pharmacy unit of Sari Mutiara Medan Public Hospital. The highconsumption and purchase level of chronic drugs represent the high consumptionand purchase the whole drugs. Efficiency increasing of chronic drugsprocurement purchase is expected to represent the efficiency increasing of drugmanagement in generally. This qualitative research, using the lean method,observed the time spent from when the drug was ordered until the drug was readyto distribute, with the aim to increase the efficiency of drug management in thepharmacy unit of Sari Mutiara Medan Public Hospital. The results formulatevariation of purchasing flow to be one standard future state mapping, and itshows improvement in waiting time, increasing value added activity and reductionnon value added activity. Efficiency increasing of drugs procurement purchase isexpected to have a domino effect for the continuous drug management process.Cost and quality control in this research are obtained through the proposedshort term fixes using pareto and VEN in drugs demand planning and usingerror proofing method in every end evaluation of drugs procurement purchase.Kaizen is applied for the proposed long term fixes and for every flow analysisusing lean method.