IMPLEMENTASI PENDEKATAN LEAN MANAGEMENT PADA PROSES PENGADAAN PERSEDIAAN DI RUMAH SAKIT PUSAT PERTAMINA

Puspita Fadma Sari, Prof. Dr. Dra. Erna Kristin, M.Si., Apt.; Dr. Firman, SE., MPH

2023 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar Belakang Alokasi dana besar pada persediaan berpotensi menimbulkan idle money dan biaya yang tidak sedikit untuk pemesanan dan penyimpanan, serta risiko kerugian untuk setiap inventory yang kedaluwarsa. Di sisi lain, kondisi stock-out berdampak pada hilangnya pendapatan, menyebabkan lamanya waktu tunggu pelayanan, serta dapat membawa konsekuensi serius pada keselamatan pasien. Di RS Pusat Pertamina, dana yang dialokasikan untuk pembelian persediaan mengambil porsi 20?ri struktur biaya rumah sakit. Inventory turn over ratio (ITOR) di semester pertama tahun 2022 berkisar pada 1,13-1,60, kemudian bergerak menjadi 1,8-1,98 pada tengah tahun kedua. Angka kekosongan obat obat kurang dari 1% karena pencatatan yang belum memadai. Implementasi lean management diharapkan dapat menjadi solusi terhadap berbagai permasalahan tersebut.
Metode Penelitian ini adalah penelitian implementasi dengan desain action research, dengan mengintervensi seluruh data jumlah pemesanan obat, jumlah obat terjual, harga beli rata-rata, dan lead time periode Januari s.d Maret 2023 (pre intervensi) dan periode 2 Mei s.d 23 Juni 2023 (post intervensi). Data yang tidak lengkap dieksklusi. Focused group discussion dilakukan dengan staf Instalasi Farmasi yang terlibat dalam proses pengadaan obat.
Hasil Penelitian ini mengidentifikasi kecenderungan peningkatan inventory value post intervensi (p-value 0.251) yaitu sebesar rata-rata 16,11%, dengan ITOR 2,6. Namun, insiden kekosongan obat mengalami penurunan signifikan sebesar 58% di akhir siklus action research (AR) pertama (p-value 0.002). Efektivitas proses (value added ratio; VAR) keseluruhan pre intervensi adalah 5%, di akhir siklus AR pertama 4%, dan di akhir siklus AR kedua 8%. Khusus sub proses evaluasi kebutuhan obat, di awal pengukuran diperoleh VAR 82%, menjadi 75% selama penerapan rumus perencanaan kebutuhan obat yang baru, dan 90% setelah dilakukan perbaikan terhadap rumus tersebut.
Kesimpulan Inventory value meningkat secara tidak signifikan setelah implementasi lean management, dengan perputaran persediaan masih dalam rentang yang dipersyaratkan, namun berhasil menurunkan insiden kekosongan obat secara signifikan. Efisiensi waktu proses teridentifikasi dari peningkatan nilai VAR.

Background Large expenditures on inventory can lead to idle cash, and considerable costs for ordering and storage, as well as the risk of losing money for each expired inventory. Stock-out conditions, on the other hand, can lead to lost revenue, long waiting times for services, and serious consequences for patient safety. The inventory purchase fund at Pertamina Central Hospital was in responsible for 20% of the hospital's expenditures. The inventory turnover ratio increased to 1.8-1.98 in the second half of 2022 from 1.13-1.60 in the first half of the year. Due to insufficient records, there were less than one per cent of incidents involving stock outs. These issues are expected to be resolved by the adoption of a lean management strategy.
Method This implementation research was carried out using an action research design by intervening all data on the volume of drug orders, the volume of drug sales, the average cost per purchase, and the lead time for the periods beginning in January and ending in March 2023 (pre-intervention) and May 2 and ending on June 23, 2023 (post-intervention). The absence of data led to its exclusion. With pharmacy installation staff who have involvement in the drug procurement process, focused group discussions were conducted.
Result With an average increase of 16.11% and an ITOR of 2.6, this study found a tendency toward rising inventory value after intervention (p-value = 0.251). At the conclusion of the first action research (AR) cycle, however, the frequency of medicine shortages considerably decreased by 58% (p-value 0.002). The value added ratio (VAR), which measures overall process effectiveness, was 5% prior to intervention, 4% at the end of the first AR cycle, and 8% at the end of the second AR cycle. More specifically, the VAR for the sub-process of assessing reorders was 82% prior to the intervention, 75% throughout the implementation of the new formula, and 90% following the formula's enhancements.
Conclusion Lean management implementation resulted in an insignificant rise in inventory value, while inventory turnover remained within an acceptable range. Drug shortages significantly decreased in frequency throughout this time. Increasing VAR implies improvements in efficiency of processing.

Kata Kunci : Lean management, persediaan, perencanaan kebutuhan obat, perputaran persediaan, kekosongan obat, inventory turn over ratio, planning for medicine requirements, inventory procurement, out of stock, and drug shortages