PENGARUH MANAJEMEN LEAN PADA MONITORING STIMULASI OVARIUM TERKENDALI FERTILISASI IN VITRO DI KLINIK YASMIN RSUPN DR. CIPTO MANGUNKUSUMO JAKARTA

R. MUHARAM, Prof. dr. Iwan Dwiprahasto, M.Med.Sc, Ph.D

2020 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Latar belakang: Menilai indikator kepuasan pasien salah satunya dengan melihat waktu tunggu pelayanan. RSUPN Dr. Cipto Mangunkusumo memiliki klinik Yasmin yang melayani pelayanan teknologi reproduksi berbantu. Dalam pelayanan fertilisasi in Vitro salah satu tahapan yang dilakukan adalah monitoring stimulasi ovarium. Data dari klinik Yasmin menunjukkan rata-rata pasien menghabiskan waktu selama 22 jam 0 menit dengan 20 jam 7 menit merupakan waktu tunggu pada 3 kali kunjungan di Klinik Yasmin saat monitoring stimulasi ovarium. Untuk dapat meningkatkan pelayanan, dilakukan pendekatan lean yang berprinsip menghilangkan waste dan meningkatkan value added pasien. Tujuan: Mengidentifikasi waste dan solusinya dalam manajemen lean pada proses monitoring stimulasi ovarium terkendali pada Fertilisasi in Vitro Metode: Penelitian ini menggunakan pendekatan action research selama bulan Juni-September 2019. Diawali dengan melakukan pemetaan dan observasi waktu terhadap peserta penelitian. Hasil pemetaan ditampilkan dalam bentuk Current State Mapping untuk mengidentifikasi penyebab delay. Identifikasi waste pada pelayanan dilakukan menggunakan pendekatan manajemen lean. Beberapa intervensi dilakukan dengan metode kaizen untuk mengurangi waste dan meningkatkan value added pasien. Observasi dilakukan kembali setelah dilakukan intervensi. Hasil observasi ditampilkan dalam bentuk Future State Mapping dan dilakukan uji kuantitatif dengan Mann-whitney. Hasil dan Pembahasan: Setelah dilakukan intervensi, didapatkan penurunan waiting total pasien menjadi 6 jam 32 menit, dan terjadi peningkatan pada total VA pada sub proses yang dilakukan intervensi. Total nilai value added ratio (VAR) meningkat dari 9 % menjadi 22%. Dari hasil uji mannwhitney didapatkan signifikansi pada sub proses yang dilakukan intervensi. Kesimpulan: Terjadi kenaikan VAR 22% setelah intervensi. Terbukti manajemen lean meningkatkan VAR dan menurunkan waktu tunggu pada proses monitoring Stimulasi Ovarium Terkendali Fertilisasi In Vitro

Background: One indicator of patients satisfaction is the time of services. Dr. Cipto Mangunkusumo Hospital has Yasmin Clinic which serve In Vitro Fertilization program (IVF). One of the steps in IVF program is monitoring ovarium stimulation. Data from Yasmin Clinic has shown that IVF patients spend time around 22 hours 0 minute in the Clinic, in which 20 hours 7 minutes is the waiting time of the service. These times were counted based on all three visits for monitoring ovarium stimulation in Yasmin Clinic. To improve service, lean management was applied. The concept of lean management is to eliminate waste in the service and increase patients value added time Objective: to apply lean management approach in waste identification and determine the solutions in IVF ovarium stimulation monitoring Method: Action research design has conducted from June-September 2019. Patients time during monitoring ovarium stimulation service was observed and documented. The results were presented on Current State Mapping to determine the cause of delayed in the service. Waste on the service was identified using lean management approach. Solutions were applied using kaizen principles to reduce waste of delay and increase value added time. Observation to patient�s time was reassess after the intervention. The results was presented on Future State Mapping and analytical test was perfomed using Mann-Whitney Test. Result and Discussion: After the interventions, total patients waiting time was decreased to 6 hours 31 minutes. Total value added time (VA) was increased in the sub process which the intervention has been done. Total value added ratio (VAR) was increased from 9% to 22%. Mann Whitney Test result shows that there is a significant improvement in the sub process which the intervention has been done. Conclusion: After intervention it was found there is an increase of VAR by 22%. From statistical analysis Lean management proved can increase VAR and decrease waiting time on controlled ovarian stimulation for IVF patients.

Kata Kunci : Manajemen Lean, Fertilisasi in vitro, kaizen, VSM, Lean management, In Vitro Fertilization, Kaizen, VSM