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"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."

"Rumah sakit memiliki kewajiban untuk memberikan pelayanan kesehatan yang aman, bermutu, anti diskriminatif dan efektif. Salah satunya adalah pelayanan kefarmasian yang merupakan bagian integral sistem pelayanan RS yang bertanggung jawab memastikan ketersediaan obat yang aman, bermutu dan berkhasiat. KMK 129/Menkes/SK/II/2008 menyebutkan bahwa RS wajib memenuhi Standar Pelayanan Minimal (SPM) yang salah satunya adalah Waktu Tunggu Pelayanan Obat. RS Jantung Hasna Medika Cirebon melayani 4000-5000 kunjungan rawat jalan setiap bulan dengan 92% diantaranya pasien BPJS Kesehatan. Rerata pencapaian waktu tunggu obat racikan hanya tercapai ≤ 72% dan obat jadi ≤40%. Tujuan penelitian ini adalah untuk meningkatkan kecepatan pelayanan resep rawat jalan pasien BPJS Kesehatan di instalasi farmasi RS Jantung Hasna Medika Cirebon menggunakan Lean Hospital. Metode penelitian ini adalah operational research dengan pendekatan kualitatif dengan sumber data primer diambil melalui observasi langsung dengan teknik time and motion study, telaah dokumen, wawancara mendalam dan Focus Group Discussion (FGD). Hasil penelitian ditemukan 2 jenis waste yaitu 99,31% waste waiting dan 0,69% waste motion, setelah dilakukan intervensi berupa optimalisasi e-resep, 5S dan visual management serta continuous flow dan process balancing terjadi penurunan lead time dari 01:24:47 menjadi 00:25:30 detik atau menurun sebesar 59 menit 17 detik (69,93%). Kesimpulan penelitian ini bahwa Lean Hospital merupakan metode atau tool yang tepat untuk meningkatkan value to waste ratio dengan mengurangi pemborosan dan meningkatkan nilai tambah untuk pasien. Penelitian ini belum maksimal dikarenakan pilihan lean hospital tools sangat terbatas mengingat waktu yang juga terbatas. Sehingga saran peneliti adalah meminta manajemen RS untuk menjadikan penelitian ini sebagai langkah awal continuous improvement untuk dapat dilanjutkan menggunakan tools lain dan di unit pelayanan yang berbeda.

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Hospitals have an obligation to provide safe, high quality, anti-discriminatory and effective services. One of them is pharmacy services as an integral part of the hospital service system that is responsible for ensuring the availability of safe, high quality and efficacious drugs. KMK 129/Menkes/SK/II/2008 states that hospitals are required to meet the Standards of Minimum Services (SPM), one of which is the Waiting Time for Drug Services. RS Jantung Hasna Medika Cirebon serves 4000-5000 outpatient visits every month with 92% of them being BPJS Kesehatan patients. The average waiting time for concoction drugs was only achieved by 72% and non-concoction drugs achieved by 40%. The purpose of this study was to increase the speed of outpatient prescription services for BPJS Kesehatan patients at the pharmacy installation of the RS Jantung Hasna Medika Cirebon using Lean Hospital. This research method is operational research with a qualitative approach. Primary data sources taken through direct observation with time and motion study techniques, in-depth interviews and Focus Group Discussion (FGD). The results of the study found 2 types of waste, namely 99.31% waiting waste and 0.69% motion waste, after intervention in the form of optimizing e-prescription, 5S and visual management as well as continuous flow and process balancing there was a decrease in lead time from 01:24:47 to 00:25:30 or decreased by 59 minutes 17 seconds (69.93%). The conclusion of this study is that Lean Hospital is the right method or tool to increase the value to waste ratio by reducing wasting time and increasing additional value for patients. This research has not been maximized because the choice of lean hospital tools is very limited considering the time is short. The researcher's suggestion is to encourage the hospital management to use this research as the first step of continuous improvement by using other tools in another service units."

"Penelitian ini menggunakan metode Narrative Review tentang analisis konsep Lean Thinking terhadap perbaikan waktu tunggu pelayanan pasien Instalasi Rawat Jalan Rumah Sakit di Indonesia. Tujuan penelitian ini adalah untuk mengetahui gambaran implementasi konsep Lean Thinking dalam mengatasi waktu tunggu pelayanan pasien Instalasi Rawat Jalan Rumah Sakit. Agar memperoleh literatur layak uji, peneliti menggunakan pedoman PRISMA. Peneliti mendapatkan 12 literatur dengan metode penelitian kualitatif dan kuantitatif. Hasil penelitian menyimpulkan bahwa konsep Lean dapat membuktikan proses pelayanan rawat jalan Rumah Sakit di Indonesia masih belum Lean. Terdapat 7 literatur yang menunjukkan bahwa Lean efektif mengurangi lama waktu tunggu pelayanan pasien rawat jalan di Rumah Sakit dibuktikan dengan mengadopsi prinsip utama Lean, yaitu Standardize work dan Heijunka. Agar tercapai kondisi Lean, Rumah Sakit harus menyelaraskan implementasi antara 5 prinsip Lean (Customer value, value stream, flow, pull, perfection) dengan budaya organisasi, pola pikir, metode Lean, membudayakan 5 S, dengan melibatkan seluruh pihak di Rumah Sakit untuk menyelesaikan masalah secara konsisten dan berkesinambungan.

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This study uses the Narrative Review method concerning the analysis of the Lean Thinking concept towards improving the waiting time for patient services in the Outpatient Hospital in Indonesia. The purpose of this study was to describe the implementation of the Lean Thinking concept in overcoming the waiting time for patient services in the Hospital Outpatient Installation. In order to obtain test-worthy literature, researchers used the PRISMA guidelines. The researcher obtained 12 literatures using qualitative and quantitative research methods. The results of the study conclude that the Lean concept can prove that the outpatient service process of hospitals in Indonesia is still not Lean. There are 7 literatures that show that Lean is effective in reducing the waiting time of outpatient services at the hospital as evidenced by adopting Lean's main principles, namely Standardize work and Heijunka. In order to achieve the Lean condition, the Hospital must align the implementation of the 5 Lean principles (customer value, value stream, flow, pull, perfection) with organizational culture, mindset, Lean method, cultivate the 5 S, by involving all parties in the hospital to solve problems consistently and continuously."

"Rumah sakit telah dituntut memberikan pelayanan yang bermutu bagi pasien salah satunya waktu tunggu untuk mendapatkan pelayanan. Pada penelitian ini dengan menggunakan pendekatan Lean Hospital untuk mencari tahu penyebab pemborosan yang mengakibatkan waktu tunggu pelayanan resep obat jadi melebihi standar. Dapat diketahui adanya kegiatan yang tidak bernilai tambah sebesar 87,48% dan kegiatan yang bernilai tambah sebesar 12,52%. Berdasarkan hal tersebut diketahui telah terjadinya pemborosan kemudian dianalisis dengan menggunakan diagram tulang ikan dan diketahui terdapat berbagai akar masalah yang menyebabkan pemborosan ini kemudian diberikanusulan perbaikan yang diklasifikasikan kedalam tiga periode waktu pelaksanaan perbaikan untuk membuat pelayanan menjadi lebih efektif dan efisien sehingga dapat mengurangi waktu tunggu pasien untuk mendapatkan pelayanan resep obat jadi di Depo Farmasi Instalasi Rawat Jalan RSUP Fatmawati.

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Hospitals were charged quality providing for patients one of which is waiting time to get the service. In this research using Lean Hospital approach to find out the Hospitals were charged quality providing for patients one of which is waiting time to get the service. In this research using Lean Hospital approach to find out the waste in waiting times of jadi prescription service exceed standard. It can be seen non value added activity 87.48 % and value added activity 12.52 %. Based on it known to have the waste then analyzed by fishbone diagram and there are various the root of the problem that causes thewaste then given the improvement proposed classified into three periods the improvement to make service more effective and efficient to diminish waiting times patients of prescription service in Pharmaceutical Depot Outpatient Instalation RSUP Fatmawati."

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

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

"Lamanya waktu tunggu di pelayanan di instalasi farmasi rawat jalan Rumah Sakit Ari Canti masih belum sesuai target Standar Pelayanan Minimal, dimana standar pelayanan minimal (SPM) mewajibkan waktu tunggu obat non racikan ≤30 menit dan obat racikan ≤60 menit. Penelitian ini bertujuan untuk menganalisis waktu tunggu pelayanan obat rawat jalan JKN dengan lean hospital di RS Ari Canti Tahun 2023. Desain penelitian ini adalah operational research (OR). Tempat dari penelitian adalah Depo Farmasi Rawat Jalan di RS Ari Canti saat hari kerja pada bulan Mei-Juni 2023. Sampel dalam penelitian ini diambil sebanyak 98 resep obat yang dibagi ke dalam beberapa poliklinik di RS Ari Canti. Pengamatan langsung menggunakan lembar observasi VSM dan lembar waste, wawancara mendalam dengan infoman menggunakan lembar wawancara. Hasil penelitian menunjukkan bahwa total waktu dalam pelayanan kefarmasian pada kondisi current state adalah 53 menit 12 detik. Lead time untuk obat racikan selama 1 jam 2 menit 28 detik sedangkan pada resep obat non-recikan selama 51 menit 41 detik. Setelah dilakukan pengkajian ditemukan 10 aktivitas waste yang terdiri dari 56,89% waste waiting, 20,75% waste defect, 15,53% waste motion, dan 6,83% waste overprocessing. Setelah dilakukannya intervensi lean hospital berupa 5S, visual management, heijunka borda pareto dan PDCA terjadi penurunan lead time dari 53 menit 12 detik menjadi 19 menit 47 detik dengan persentase penurunan sebesar 62,80%. Kemudian lead time berdasarkan resep obat racikan pasca intervensi selama 42 menit 7 detik, sedangkan lead time resep obat non racikan selama 18 menit 47 detik. Nilai value to waste ratio juga terjadi peningkatan dari sebelumnya pre intervensi sebesar 40,90% menjadi 88,32% pasca intervensi. Kesimpulan penelitian ini alalah Lean Hospital merupakan metode atau tool yang tepat untuk meningkatkan value to waste ratio dengan mengurangi pemborosan dan meningkatkan nilai tambah untuk pasien. Manajemen dapat melakukan langkah awal continuous improvement seperti menghitung kebutuhan obat secara berkala untuk dapat memproyeksikan persiapan obat sesuai dengan permintaan. 

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The length of time waiting for service at the outpatient pharmacy installation at Ari Canti Hospital is still not in accordance with the Minimum Service Standard target, where the minimum service standard (SPM) requires waiting time for non-concoction drugs ≤30 minutes and for mixed drugs ≤60 minutes. This study aims to analyze the waiting time for JKN outpatient drug services with lean hospital at Ari Canti Hospital in 2023. The design of this research is operational research (OR). The location of the research was the Outpatient Pharmacy Depot at Ari Canti Hospital during weekdays from May to June 2023. The sample in this study was taken as many as 98 drug prescriptions which were divided into several polyclinics at Ari Canti Hospital. Direct observation using VSM observation sheets and waste sheets, in-depth interviews with informants using interview sheets. The results showed that the total time in pharmaceutical services in the current state was 53 minutes 12 seconds. The lead time for concoction drugs is 1 hour 2 minutes 28 seconds while for non-recipe drug prescriptions it is 51 minutes 12 seconds. After conducting the study, it was found that 9 waste activities consisted of 56,89% waste waiting, 20,75% waste defects, 15,53% waste motion, and 6,83% waste overprocessing. After the lean hospital intervention in the form of 5S, visual management, heijunka borda pareto and PDCA, the lead time decreased from 53 minutes 12 seconds to 19 minutes 47 seconds with a decrease percentage of 62.80%. Then the lead time based on post- intervention concoction drug prescription was 42 minutes 7 seconds, while the non- concoction drug prescription lead time was 18 minutes 47 seconds. The value to waste ratio also increased from the previous pre-intervention of 40.90% to 88.32% post- intervention. The conclusion of this study is that Lean Hospital is the right method or tool to increase the value to waste ratio by reducing waste and increasing added value for patients. Management can take initial steps for continuous improvement, such as calculating drug needs on a regular basis to be able to project drug preparations according to demand. "

"Produktivitas diukur sebagai rasio antara output dan input, dipengaruhi oleh efisiensi dan efektivitas. Rumah Sakit Universitas Indonesia (RSUI) mengukur produktivitas berdasarkan kualitas pelayanan dan pemenuhan kebutuhan pelanggan. Namun, RSUI belum memenuhi target nasional pada Indikator Nasional Mutu, terutama waktu tunggu rawat jalan yang dipengaruhi 50% oleh unit farmasi. Empat dari enam indikator kualitas di unit farmasi belum terpenuhi. Melihat target waktu tunggu obat nonracikan <30 menit selama tahun 2023 dari mutu unitnya hanya tercapai 84,36% dan waktu tunggu obat racikan <60 menit hanya tercapai 89,30%. Untuk mengatasi ini, penelitian dilakukan untuk mengimplementasikan konsep Lean Hospital untuk mengurangi pemborosan dan meningkatkan efisiensi. Rata-rata waktu tunggu obat non-racikan adalah 56,31 menit dan obat racikan 170,24 menit. Melalui pemetaan pada waste diidentifikasi: Motion, Inventory,dan Waiting. Implementasi solusi prioritas seperti sistem First In First Out, Lean 5S, penyesuaian tata letak, Two Bin System Kanban, dan inventarisasi obat yang tidak terpakai meningkatkan efisiensi siklus produksi, meningkatkan Process Cycle Efficiency menjadi 92,3% untuk obat non-racikan dan 92% untuk obat racikan. Waktu layanan menurun menjadi 17,25 menit untuk obat non-racikan dan 48,95 menit untuk obat racikan.

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Productivity is measured as the ratio between output and input, influenced by efficiency and effectiveness. The Universitas Indonesia Hospital (RSUI) measures productivity based on service quality and customer needs fulfillment. However, RSUI has not yet met the national targets for the National Quality Indicators, particularly the outpatient waiting time, which is influenced by 50% by the pharmacy unit. Four out of six quality indicators in the pharmacy unit have not been met. The target waiting time for non-compounded drugs of less than 30 minutes was only achieved 84.36% of the time in 2023, and the target waiting time for compounded drugs of less than 60 minutes was only achieved 89.30% of the time. To address this, a study was conducted to implement the Lean Hospital concept to reduce waste and increase efficiency. The average waiting time for non-compounded drugs was 56.31 minutes and for compounded drugs was 170.24 minutes. Waste mapping identified three main types of waste: Motion, Inventory, and Waiting. Implementing priority solutions such as the First In First Out system, Lean 5S, layout adjustments, Two Bin System Kanban, and unused drug inventory significantly improved production cycle efficiency, increasing Process Cycle Efficiency to 92.3% for non-compounded drugs and 92% for compounded drugs. Service times decreased to 17.25 minutes for non-compounded drugs and 48.95 minutes for compounded."

"[Rumah Sakit Umum Pusat Fatmawati merupakan rumah sakit rujukan nasional tipe A yang melayani salah satunya pelayanan bedah orthopedi. Pelayanan bedah orthopedi merupakan pelayanan terbanyak yang dilakukan di IBS, dan memiliki demand yang sangat tinggi. Demand yang tinggi menyebabkan lamanya waktu tunggu. Apalagi ditambah dengan tingginya kejadian penundaan operasi, terutama penundaan operasi orthopedi. Skripsi ini menganalisis standar waktuoperasi yang ada apakah sesuai dengan kejadian real di lapangan atau tidak dan meilai efektivitas pelayanan bedah orthopedi khusunya ORIF (Open Reduction Internal Fixation) dengan metode Lean Hospital. Didapatkan hasil bahwa standar operasi yang ada sesuai dengan lapangan bahkan kurang dari waktu standar yang ditentukan, akan tetapi banyak terdapat waste pada setiap aktivitas pelayananyang menghambat operasi. Waste di ruangan serah terima (36,4%). Non value added pada waktu aktivitas di ruangan ini sebanyak 1870 ?s atau 81,7%. Waste di ruangan persiapan (42,9%). Non value added pada waktu aktivitas di ruangan ini sebanyak 2460 ?s atau 89,1%. Waste pada saat persiapan operasi (21%). Non value added pada waktu aktivitas di ruangan ini sebanyak 1490 ?s atau 48,2%.Waste di pada saat operasi (29,4%). Non value added pada waktu aktivitas di ruangan ini sebanyak 900 ?s atau 12,4%. Waste di ruangan pemulihan atau recovery (12,5%). Non value added pada waktu aktivitas di ruangan ini sebanyak2390 ?s atau 47,8%. Berdasarkan hasil analisis ditemukan penyebab waste yang terjadi, dan dibutuhkan perbaikan segera untuk melancarkan jalannya pelayanan bedah serta penambahan value added pada pelayanan.

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Rumah Sakit Umum Pusat Fatmawati is the national referral hospital type A which serves one orthopedic surgical services. Orthopedic surgical care is a service of the highest in Central Surgery Installation, and has a very high demand. High demand led to long waiting times. Coupled with the high incidence of surgery delay, especially orthopedic surgery delay. This thesis analyzes the surgery standard is in accordance with real events or not, and assess the effectiveness of orthopedic surgical services especially ORIF (Open Reduction Internal Fixation) by the method of Lean Hospital. Showed that

surgical standards that are applicable to the field even less than the time specified standards, but there is a lot of waste in any activity that inhibits surgery services.

Waste in the handover room (36.4%). Non value added at the activity in this room as much as 1870 's or 81.7%. Waste in the preparation room (42.9%). Non value added at the activity in this room as much as 2460's or 89.1%. Waste at the time of preparation of the surgery (21%). Non value added at the activity in this room as much as 1490's or 48.2%. Waste at surgery process (29,4%). Non value

added at the activity in this room as much as 900's or 12,4%. Waste in the recovery room or recovery (12.5%). Non value added at the activity in this room as much as 2390's or 47.8%. Based on the analysis found the cause of waste that occurs, and needed urgent repairs to expedite the course of the surgical services and the addition of value in services., Rumah Sakit Umum Pusat Fatmawati is the national referral hospital type A

which serves one orthopedic surgical services. Orthopedic surgical care is a

service of the highest in Central Surgery Installation, and has a very high

demand. High demand led to long waiting times. Coupled with the high

incidence of surgery delay, especially orthopedic surgery delay. This thesis

analyzes the surgery standard is in accordance with real events or not, and assess

the effectiveness of orthopedic surgical services especially ORIF (Open

Reduction Internal Fixation) by the method of Lean Hospital. Showed that

surgical standards that are applicable to the field even less than the time specified

standards, but there is a lot of waste in any activity that inhibits surgery services.

Waste in the handover room (36.4%). Non value added at the activity in this

room as much as 1870 's or 81.7%. Waste in the preparation room (42.9%). Non

value added at the activity in this room as much as 2460 's or 89.1%. Waste at the

time of preparation of the surgery (21%). Non value added at the activity in this

room as much as 1490 's or 48.2%. Waste at surgery process (29,4%). Non value

added at the activity in this room as much as 900 ‘s or 12,4%. Waste in the

recovery room or recovery (12.5%). Non value added at the activity in this room

as much as 2390 's or 47.8%. Based on the analysis found the cause of waste that

occurs, and needed urgent repairs to expedite the course of the surgical services

and the addition of value in services.]"

"Waktu tunggu yang lama pada pelayanan rawat jalan akan mengurangi kepuasan pelanggan. Dari sisi karyawan, tidak mengetahui beban kerja sebenarnya menyebabkan karyawan mudah mengeluh dan meminta untuk diadakan tambahan karyawan yang sebenarnya bisa jadi tidak perlu. Penelitian ini menggunakan metode kualitatif. Peneliti melakukan observasi alur proses pelayanan rawat jalan dan waktu yang digunakan pasien untuk melakukan proses pengobatan di poliklinik paru RSUD Pasar Minggu dan melakukan analisis beban kerja dan penghitungan kebutuhan SDM dokter spesialis paru. Dari hasil observasi dilakukan analisis waste dan pemetaan Value Stream Map rawat jalan. Hasil penelitian pada Curent State Map menunjukkan 90% waktu pelayanan rawat jalan poliklinik paru merupakan kegiatan yang tidak bernilai tambah (waste) dan hanya 10 % yang merupakan kegiatan bernilai tambah (value added). Usulan perbaikan dengan metode lean dituangkan dalam Future State Map dan diproyeksi dapat menurunkan kegiatan non value added menjadi 69,2% dan meningkatkan kegiatan value added menjadi 30,7%. Menurunkan waktu tunggu dari awalnya 279 menit menjadi 72 menit

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Long waiting time on outpatient services will reduce customer satisfaction. From the employee side, not knowing the actual workload causes the employees to easily complain and ask to be held additional employees who may actually be unnecessary. In this study, the researcher observed the outpatient service process flow process and the time used by the patient to perform the treatment process at the Lung Polyclinic of RSUD Pasar Minggu and analyzed the work load and the calculation of the HR requirement of lung specialist doctor. From the results of observations conducted waste analysis and mapping Outstanding Output Value Stream Map. The results of the research on the Curent State Map shows 90% of the outpatient service time of pulmonary polyclinic is an activity that is not value added (waste) and only 8% is a value added activity. Proposed improvement by lean method, set forth in the Future State Map is projected to reduce non value added activities to 69.2% and increase value added activities to 30.7% and reduce waiting time from 279 minutes to 72 minutes."

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

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