PENERAPAN LEAN PADA UNIT FARMASI DAN UNIT LABORATORIUM RUMAH SAKIT LMC LOMBOK TIMUR

YOSEFIN MORING L, Dr. dr. Andreasta Meliala, DPH, M. Kes, MAS; Dr. Firman, SE, MPH

2022 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Latar belakang: Perubahan sistem pembiayaan dan pelayanan di era Jaminan Kesehatan Nasional (JKN) sangat mempengaruhi lingkungan rumah sakit, dimana RS dituntut untuk melaksanakan pelayanan yang berbasis kendali mutu dan kendali biaya. Di antara unit unit penunjang di Rumah Sakit LMC Lombok Timur unit Farmasi dan Unit Laboratorium adalah unit dengan high cost serta high volume. Kedua unit ini banyak sekali tantangan yang harus dihadapi. Dalam pelaksanaannya, managemen sudah melakukan berbagai langkah perbaikan namun keluhan dari pasien masih ada. Oleh karena itu managemen Rumah Sakit LMC mencoba melakukan pendekatan baru dengan penerapan Lean Managemen. Tujuan: Mengidentifikasi input dalam proses pelayanan, mendeskripsikan proses penerapan Lean dan menilai dampak dari penerapan Lean di Unit Farmasi dan Unit Laboratorium Rumah Sakit LMC Lombok Timur. Metode: Penelitian ini menggunakan metode penelitian Action Research dengan pendekatan Participatory Action Research (PAR). Tahapan Action Research yang digunakan, yaitu meliputi: a) Rencana tindakan; b) Pelaksanaan tindakan; c) refleksi dan d) observasi terhadap tindakan serta implikasi bagi perbaikan program kegiatan yang diteliti. PAR dipilih karena potensi kolaboratif dan partisipatifnya. Hasil: Ada perbedaan rerata lead time sebelum dan sesudah intervensi lean healthcare dalam pelayanan Unit Farmasi dan Unit Laboratorum. Lead time Unit Farmasi resep obat racikan menurun sekitar 4 menit atau 20%, sedangkan lead time resep obat non racikan menurun sekitar 8 menit atau 54%. Ukuran efisiensi, kedua jenis resep mengalami peningkatan VAR yaitu obat racik dari 44% menjadi 48% dan Obat Non racikan dari 28% menjadi 42%. Pada Unit Laboratorium rata-rata lead time proses pemeriksaan laboratorium mengalami penurunan. Pemeriksaan darah lengkap plus pemeriksaan kimia awalnya 70,8 menjadi 51,8. Pemeriksaan darah lengkap saja, awalnya 38,7 turun menjadi 12,4 menit. Ukuran efisiensi yaitu VAR memberikan informasi pemeriksaan kimia maupun darah lengkap mengalami peningkatan nilai VAR. Artinya kedua proses terjadi peningkatan efisiensi proses. Tools yang digunakan adalah visual management dan penerapan e_RM. Hasil penelitian ini memberi gambaran implementasi lean management proses pelayanan di instalasi farmasi dan unit laboratorium. Meskipun hanya dilakukan di dua unit terbatas, namun dampaknya dapat memberikan inspirasi bagi implementasi lean pada unit lainnya. Persepsi staf terhadap implementasi Lean juga berbeda dengan persepsi sebelum staf ikut terlibat di dalamnya. Setelah implementasi lean, staf menjadi partisipan aktif dalam penelitian, mempersepsikan bahwa mengimplementasikan lean sebagai hal yang sangat siap, bisa untuk di implementasikan. Hal ini sebabkan karena staf ikut terlibat, melihat bahkan merasakan manfaat langsung dari implementasi lean. Kesimpulan: Secara input (fasilitas, SDM, upaya mutu dan jumlah pasien), Unit Farmasi dan Unit Laboratorium RS LMC Lombok Timur telah mendukung penerapan Lean dalam proses pelayanan. Penerapan Lean yang dilaksanakan di Unit Farmasi dan Unit Laboratorium bisa dilaksanakan dengan melibatkan partisipasi aktif staf. Penerapan Lean telah mempercepat waktu proses di pelayanan resep racik dam non racik, peneriksaan lab DL dan DL plus Kimia. Penerapan Lean juga telah meningkatkan efisiensi proses resep racik dan non racik serta pemeriksaan DL plus kimia darah. Pada awal pengenalan Lean staf ragu dalam menerapkan Lean. Mayoritas mempersepsikan lean di RS LMS pada kondisi hampir siap. Sedangkan pasca penerapan, hampir semua responden mempersepsikan implementasi lean di RS LMC sebagai sangat siap

Background: Changes to the financing systems and services in the era of Jaminan Kesehatan Nasional (JKN) have significantly impacted local hospitals, who are expected to provide service on the basis of grade and control payment. In particular, Laboratory and Pharmacy of the LMC Hospital East Lombok are experiencing high cost and high volume. Consequently the hospital management has attempted a new approach, that is the implementation of Lean Management. Purpose: To identify input of the service process, to describe the implementation process of Lean Management and evaluate its impact on the Laboratory and Pharmacy of the LMC Hospital East Lombok. Methods: This research uses the Action Research methods with the Participatory Action Research approach. The Action Research stage covers: a) plan of action; b) implementation of action; c) reflection and d) observation of actions and their implication on the improvement of the program. The Participation Action Research is chosen for its potential in collaboration and participation. Results: There is a difference in the mean lead time before and after lean healthcare intervention in the Pharmacy Unit and Laboratory Unit services. The lead time of the Pharmacy Unit for prescription drugs decreased by about 4 minutes or 20%, while the lead time for prescription drugs for non-concoctions decreased by about 8 minutes or 54%. Likewise, the efficiency measure, both types of prescriptions experienced an increase in VAR, namely concoction drugs from 44% to 48% and non-concoction drugs from 28% to 42%. In the Laboratory Unit, the average lead time for the laboratory examination process has decreased. Complete blood count plus chemistry was initially 70.8 to 51.8. While on a complete blood count alone, initially 38.7 dropped to 12.4 minutes. The efficiency measure, namely VAR, provides information that for chemical and complete blood tests there is an increase in the VAR value. This means that in both processes there is an increase in process efficiency. The tools used are visual management and the application of e_RM. The results of this study provide an overview of the implementation of lean management in the service process in pharmaceutical installations and laboratory units. Although it was only carried out in two limited units, the impact could provide inspiration for lean implementation in other units. The staff's perception of Lean implementation is also different from the perception before the staff was involved in it. After the implementation of lean, the staff became active participants in the research, perceiving that implementing lean as a very ready thing, could be implemented. This is because staff are involved, see and even feel the direct benefits of lean implementation. Conclusion: In terms of inputs (facilities, human resources, quality efforts and number of patients), the Pharmacy Unit and Laboratory Unit of LMC Hospital East Lombok have supported the implementation of Lean in the service process. Lean implementation carried out in the Pharmacy Unit and Laboratory Unit can be carried out by involving the active participation of staff. Lean implementation has accelerated the processing time in the service of blended and non-mixed prescriptions, DL and DL lab tests plus Chemistry. The implementation of lean has also increased the efficiency of the blended and non-mixed recipe processes as well as the DL plus blood chemistry checks. At the beginning of the introduction of lean the staff hesitated in implementing lean. The majority perceive lean in LMS Hospital in a almost ready condition. While post-implementation, almost all respondents perceive lean implementation at LMC Hospital as "very ready"

Kata Kunci : kendali mutu kendali biaya, highcost unit, high volume unit, penerapan Lean, action research, quality control cost control, highcost unit, high volume unit, Lean implementation, action research