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Abstrak :
Proses pemulangan pasien di Rumah Sakit Masmitra saat ini masih belum optimal, oleh karena belum ada alur yang menggambarkan proses pemulangan pasien secara menyeluruh. Dengan mengaplikasikan Konsep Lean, dilakukan pemetaan aliran nilai kondisi sekarang (Value Stream Map) yang menunjukkan bahwa pada proses pemulangan pasien terdapat 41 kegiatan dan hanya 51 % bersifat Value Added, dan tentu saja mempunyai implikasi adanya pemborosan. Dari hasil analisis akar masalah diperoleh ide-ide perbaikan, kemudian dilakukan desain ulang kedalam alur proses baru yang dianggap ideal menghasilkan total hanya 17 kegiatan, 83 % diantaranya bersifat Value Added. Dengan diterapkannya Konsep Lean di RS Masmitra, diharapkan efisiensi juga akan terjadi bila pekerjaan dilakukan sesuai dengan apa yang dibutuhkan oleh pasien, tepat waktu, tepat ukuran dan tepat sasaran.

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The process discharge of patients in hospital Masmitra is still not optimal, because there is no groove that describes the process of returning the patient as a whole. By applying the concept of Lean, value stream mapping current conditions which shows that the process of returning patients there were 41 activities and only 51% are value added, and of course has implications for wastage. From the analysis of the root causes of acquired ideas repair, and then carried into the re-design of the new process flow is considered ideal to produce a total of only 17 activities, 83% of which is value added. With the implementation of Lean Concept in RS Masmitra, expected efficiency will also occur when the work is done in accordance with what is required by the patient, right time, the right size and right on target.

Abstrak :
Tesis ini membahas tentang faktor - faktor yang menyebabkan waktu tunggu layanan Laboratorium RSUD Cengkareng tidak mencapai target dengan menggunakan konsep lean. Penelitian ini bersifat analitik dengan pendekatan kualitatif melalui observasi dan telaah dokumen, kemudian dilanjutkan dengan wawancara mendalam kepada informan. Hasil penelitian digambarkan dalam current state VSM menunjukkan bahwa 19% total waktu layanan merupakan waktu yang dibutuhkan untuk kegiatan value added sedangkan 81% total waktu layanan merupakan waktu yang digunakan untuk kegiatan non value added (waste). Penelitian ini menyarankan pelaksanaan kegiatan 5S, visual mangement di laboratorium dan perencanaan pengadaan sistem yang terintegrasi serta pemanfaatan pneumatic tube. ......This thesis discusses the factors that led to the waiting time Cengkareng Hospital Laboratory services do not reach the target by using lean concepts. This research is an analytical qualitative approach through the observation and study of the document, followed by in-depth interview to the informant. The results of the study are described in the current state VSM showed that 19% of the total service time is the time required for value added activities, while 81% of the total service time is the time spent on non-value added activities (waste). This study suggests the implementation of 5S, visual mangement in the laboratory , procurement planning of the integrated system and utilization of pneumatic tube.

Abstrak :
Implementasi konsep lean bertujuan mengurangi pemborosan yang terjadi pada suatu proses, pemborosan tersebut berupa uang, waktu, dan sumber daya manusia yang didiskripsikan menjadi 9 pemborosan yaitu: Produksi berlebih; persediaan berlebih; Kelambatan; perpindahan produk yang tidak perlu; perpindahan pekerja yang tidak perlu; proses yang tidak diperlukan; kecacatan produk; sumber daya yang tidak dimanfaatkan; sumber daya yang salah digunakan. Sebagai obyek penelitian ini adalah perusahaan yang bergerak dalam bidang pengolahan susu bubuk, sedangkan fokus penelitian pada proses pengemasan susu bubuk (milk powder packaging), pada proses ini terjadi pemborosan akibat produk cacat karena gagal perapat. Penelitian ini bertujuan mengetahui sumber-sumber produk cacat karena gagal perapat (sealing), kemudian menyusun usulan rencana tindakan perbaikan untuk mengurangi produk cacat tersebut. Data penelitian yang telah dikumpulkan kemudian di analisa secara kuantitatif dan kualitatif dengan menggunakan tools of quality. Dari hasil penelitian terdapat 11 penyebab gagal perapat, dan yang menjadi penyebab utama adalah kondisi dari sealer dan pisau pemotong, serta karakteristik produk setengah jadi, sehingga diusulkan rencana tindakan perbaikan sebanyak 13 tindakan perbaikan yang lebih difokuskan pada peningkatan keterampilan dan kepedulian operator, standarisasi mesin dan ukuran kemasan, perawatan mesin, sehingga dengan tindakan perbaikan yang dilakukan tersebut akan menghasilkan pengurangan produk cacat karena gagal sealing sebesar 71.5% atau pengurangan sebesar 10.75 ton susu bubuk perbulan. ......The aim of Implementation lean concept is to reduce the waste that happened at one particular process, the wastes come form of money, time, and human resource which identified to 9 wastes, that are: Overproduction; Over inventory; Waiting time; product transportation; worker motion; over processing; product defect; resource which not exploited; wrong resource used. As this research object is the company in the field of milk powder processing, while research focus at process of milk powder packaging, at this process is happened waste by product defect because of not properly sealing. This research aim to know the root cause of defect product, then compile the proposal improvement action plan to reduce the defect product. By using tools of quality, The collected data was studied by analysis quantitatively and qualitative. From research result, there are 11 cause of not properly sealing, and becoming the root cause is condition from sealer and cutter knife, and also semi finished product characteristic, so that proposed the improvement action plan as much 13, but action plan more focussed to upgrade of skill and operator awareness, standarization of machine and size of pouch, machine maintenance, so that with the improvement action plan conducted, the company will get cost saving because of wastes reduction, the defect product reduction is 71.5% or the company will get saving 10.75 ton of milk powder every months.

Abstrak :
Jaminan Kesehatan Nasional yang dimulai tanggal 1 Januari 2014 merupakan bentuk transformasi sekaligus reformasi pelayanan kesehatan di Indonesia. Dalam pelaksanaannya, instalasi farmasi dituntut untuk meningkatkan mutu pelayanannya secara berkelanjutan sehingga pelayanan kefarmasian dapat menjadi efisien dan efektif dalam biaya. Lean merupakan sebuah sistem manajemen yang sepenuhnya berfokus pada efisiensi, dengan tujuan mengurangi biaya, siklus waktu layanan dan persediaan. Penelitian dilakukan pada bulan April - Mei 2016 di Instalasi Farmasi Rawat Jalan dengan titik fokus pada alur proses resep obat non puyer, menggunakan metode action research dengan melakukan pendekatan kualitatif dan kuantitatif. Hasil penelitian menggunakan konsep lean diketahui bahwa waktu proses untuk pengerjaan resep obat non puyer lebih besar dari waktu tempo yang ada. Hal ini menunjukkan instalasi farmasi rawat jalan belum mampu memenuhi kebutuhan pasien, adanya kekurangan jumlah sumber daya manusia pada shift siang, diperlukan tambahan sumber daya pendukung untuk membantu kelancaran pelayanan serta perlu dilakukan desain ulang pada alur proses pengerjaan resep obat non puyer. Desain baru tersebut dapat menghasilkan peningkatan persentase aktivitas value added sebanyak 22,73% yaitu dari 35,89% menjadi 58,62%. Untuk menjamin alur proses pelayanan baru dapat berjalan secara konsisten dan berkelanjutan, diusulkan ide perbaikan yang dibagi kedalam tiga tahap, yaitu jangka pendek, jangka menengah dan jangka panjang. ...... The National Health Insurance which was launched on January 1, 2014, is a form of transformation and reformation of health services in Indonesia. In implementation of the JKN, Hospital Pharmacy Installation is forced to improve its quality service sustainably in order to achieve cost effective and efficient service. Lean is a management system that fully focuses on effiency with the objectives to reduce stock, service cycle time and cost. Research was conducted on outpatient pharmacy installation service at Anna Medika Bekasi Hospital in April to May 2016. It focuses on prescription process flow of non-pulvis medicine using action research method with qualitative and quantitative approach. Lean concepts has been applied in this research. The result shows that the cycle time required for processing prescription of non-pulvis medicine is longer than the takt time. It indicates that outpatient pharmacy installation service is unable to fullfil the patient demand, there is lack of human resources on day shift, additional resources are required to support the service and process flow of nonpulvis medicine needs to be redesigned. This new design could result to increment 22.73% of value added activities from 35,89% to 58,62% To ensure the new process flow runs consistently and sustainably, some improvements, which are divided into short, medium and long term, are suggested.

Abstrak :
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. ......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.

Abstrak :
Fenomena tingginya angka rujukan pasien yang diterima oleh rumah sakit di era Jaminan Kesehatan Nasional mengakibatkan penumpukan pasien yang berobat ke rumah sakit. Salah satu konsep yang dapat digunakan di era JKN untuk dapat memberikan kualitas pelayanan bagi pasien rujukan agar lebih efektif dan optimal, melakukan efisiensi biaya dan juga berorientasi kepada nilai walaupun dengan keterbatasan anggaran dan sumber daya yang dihadapi rumah sakit adalah dengan mengaplikasikan konsep Lean dalam pelayanan kesehatan. Penelitian ini menunjukkan bahwa faktor penentu belum optimalnya pelayanan pasien rujukan JKN di poliklinik disebabkan oleh waktu tunggu berkas rekam medik lama, waktu tunggu dokter spesialis lama, serta pasien yang menumpuk dan berkerumun menunggu antrian. Berdasarkan Karakteristik Sistem Rujukan WHO, kurangnya SDM rekam medik, profesionalitas dokter, kurangnya kerjasama dan komunikasi pra rujukan, kelengkapan fasilitas sarana prasarana dan sumber daya pendukung yang kurang memadai, serta belum sempurnanya aplikasi SIMRS juga menyebabkan belum optimalnya pelayanan pasien rujukan JKN di poliklinik. Berdasarkan Current State Value Stream Mapping didapatkan aktivitas value added pada proses pelayanan hanya 7,32 % sampai 17,75 %, sedangkan aktivitas non value added mencapai 82,25 % sampai 92,6 %. Dengan memotong alur pelayanan, mengeliminasi waste yang ditemukan, dan implementasi tools Lean 5S, Visual Management, Eror Proofing, dan Heijunka diharapkan pada Estimate Future State Value Stream Mapping akan menghasilkan penurunan waktu pelayanan sampai 87 menit, dan meningkatkan aktivitas value added sampai 34,95%.

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The phenomenon of high rates of referral of patients received by the hospital in the era of National Health Insurance resulted in a buildup of patients treated at the hospital. One concept that can be used in the era JKN to be able to provide quality care for the patients referral to be more effective and optimal, cost efficiency and also oriented to value although with limited budgets and resources faced by hospitals is to apply the concept of Lean in healthcare. This study shows that the decisive factor is not optimal patient care referral JKN in polyclinic are caused by long waiting time for medical record file, long waiting time specialist doctors, and patients who accumulate and clump waiting queue. Based Referral System Characteristics WHO, lack of human resources in medical records, physician professionalism, lack of cooperation and communication pre references, complete infrastructure facilities and supporting resources are inadequate, and incomplete application SIMRS also lead to non-optimal patient care referral JKN in polyclinic. Based on the Current State Value Stream Mapping, value added activities in the service only 7.32 % to 17.75 %, while the non-value added activity reached 82.25 % to 92.6 %. By cutting the service flow, eliminate waste were found, and implementation tools of Lean 5S, Visual Management, Error Proofing , and Heijunka expected at Estimate Future State Value Stream Mapping will result in reduced service time to 87 minutes , and increase value added activities until 34.95 %.

Abstrak :
[ABSTRAK
Rumah 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. ABSTRACT
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., 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.]

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

Abstrak :
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. Di Rumah Sakit Atma Jaya yang merupakan Rumah Sakit Swata Kelas B Pendidikan, penelitian ini menganalisis alur pelayanan resep di Instalasi Farmasi Rawat Jalan sebagai data untuk perbaikan. Dengan menggunakan Root Cause Analysis RCA, metodologi penelitian operational research, dilakukan observasi dan wawancara mendalam memperlihatkan bahwa kegiatan non value added bisa sampai 85% dan kegiatan value added hanya 15% pada penyiapan obat non racikan. Sedangkan untuk obat racikan kegiatan non value added sekitar 68% dan value added sebesar 32% nilainya. Data tersebut menunjukan bahwa telah terjadi pemborosan waste. Usulan perbaikan untuk mengurangi pemborosan antara lain penggantian SIM RS yang baru dan menggiatkan fungsi Tim Kendali Mutu di Instalasi Farmasi. Bila perbaikan ini telah di implementasi, diharapakan terjadi peningkatan efisiensi di Instalasi Farmasi Rawat Jalan dan meningkatkan kepuasan pasien. ......One option to increase efficiency, service quality and patient safety in the United States of America is by using the Lean Thinking concept, which are implemented in Hospitals to become a Lean Hospital. In Atma Jaya Hospital, a class B study private hospital, the research analyses the workflow of prescription sevice in outpatient pharmacy departement to act as data for improvement analysis. Also, by utilizing Root Cause Analysis RCA, operational research methology, in depth observation and interviews are conducted at compounding and non compounding medicine storage of Outpatient Patient Departement, the result shows non value added activities reaches 85%, while value added activities are only 15% on non compounding medicine storage. While, on compounding medicine storage, non value added and value added activities are at 68% and 32% respectively. These data clearly shows that great inefficiencies has occurred. Solution is suggested to increase the efficiency in the department, changing Hospital Information System and activate the Quality Control Team function. If these steps are implemented, we can expect the overall efficiency in the Outpatient Pharmacy Departement to improve significantly and resulted in higher patient satisfaction.