Dampak Implementasi Lean Hospital terhadap Lead Time Pelayanan Resep di Satelit Farmasi Rawat Jalan Terpadu RSUPN Dr. Cipto Mangunkusumo

Wangi Firdausi, Prof. Wakhid Slamet Ciptono, MBA, MPM., Ph.D.; Prof. Dr. apt. Satibi, M.Si.

2025 | Tesis | Magister Manajemen Farmasi

Waktu tunggu atau lead time merupakan salah satu satu indikator yang menggambarkan kualitas pelayanan resep di instalasi farmasi rumah sakit. Saat mengambil alih pelayanan kefarmasian dari apotek mitra di tahun 2023, Satelit Farmasi Instalasi Pelayanan Rawat Jalan Terpadu (IPRJT) RSUPN Dr. Cipto Mangunkusumo (RSCM) belum memenuhi capaian waktu tunggu pelayanan resep yang ditargetkan. Konsep lean hospital telah banyak digunakan untuk mengurangi waste dan memperbaiki lead time suatu proses. Penelitian ini bertujuan untuk mengidentifikasi waste, menurunkan lead time dan meningkatkan efisiensi proses berupa persentase Value Added Ratio (VAR) di Satelit Farmasi IPRJT.
Penelitian dilakukan dengan desain action research dan menggunakan pendekatan naratif kuantitatif yang didukung oleh analisis deskriptif kualitatif. Implementasi lean hospital pada penelitian ini meliputi identifikasi value pasien menggunakan kuesioner Model Kano, pemetaan alur dengan Value Stream Mapping, identifikasi waste dan solusi eliminasi waste dengan observasi dan Focus Group Discussion (FGD), dan evaluasi hasil implementasi. Sampel pasien untuk pengisian kuesioner value dan sampel resep untuk menghitung lead time diambil dengan metode consecutive sampling. Sampel petugas untuk mengikuti FGD diambil dengan metode purposive sampling. Uji perbedaan rata-rata lead time sebelum dan setelah pelaksanaan implementasi dilakukan dengan Independent Sample T Test.
Hasil penelitian menunjukkan waste yang teridentifikasi adalah waiting, inventory, motion, defect, dan extra-processing. Solusi eliminasi waste berupa koordinasi dan sosialisasi, pengaturan SDM, penerapan 5S dan visual management, desain ulang layout ruangan, dan pengadaan sarana. Setelah implementasi lean hospital, lead time pelayanan resep obat non racikan menurun dari 13.231 detik menjadi 9.947 detik dan nilai VAR meningkat dari 8,21% menjadi 12,31%. Lead time pelayanan resep obat racikan juga menurun dari 14.501 detik menjadi 9.362 detik dan nilai VAR meningkat dari 15,10% menjadi 23,01%. Independent Sample T Test menghasilkan nilai p-value < 0>lean hospital terbukti menurunkan lead time dan meningkatkan VAR pelayanan resep di Satelit Farmasi IPRJT RSCM.

Lead time, or waiting time, is one of the indicators reflecting the quality of prescription services in hospital pharmacies. Upon taking over pharmaceutical services from third-party partner pharmacy, the pharmacy unit servicing the Integrated Outpatient Service Installation (IPRJT) of Dr. Cipto Mangunkusumo Hospital (RSCM) had not yet achieved the targeted performance for prescription service waiting time. The lean hospital concept has been widely applied to reduce waste and improve process lead time. This study aims to identify existing waste, reduce lead time, and enhance process efficiency, as measured by the Value-Added Ratio (VAR) percentage, within the IPRJT pharmacy unit.
This study employed an action research design with a quantitative narrative approach, supported by qualitative descriptive analysis. The implementation of the lean hospital framework in this study included several stages: identifying patient-perceived value using the Kano Model questionnaire, mapping process flows using Value Stream Mapping (VSM), identifying waste and developing elimination strategies through direct observation and Focus Group Discussions (FGDs), and evaluating the implementation impact. Patient samples for value identification and prescription samples for lead time measurement were collected using consecutive sampling, while pharmacy staff participants for FGDs were selected using purposive sampling. The Independent Sample T-Test was used to examine differences in the mean lead time before and after lean implementation.
The findings revealed several types of waste: waiting, inventory, motion, defects, and extra-processing. Waste elimination strategies included staff coordination and communication, human resource reallocation, application of the 5S methodology and visual management, room layout redesign, and facility enhancement. Following the lean hospital implementation, lead time for non-compounded prescriptions decreased from 13,231 seconds to 9,947 seconds, and the VAR increased from 8.21% to 12.31%. Similarly, lead time for compounded prescriptions decreased from 14,501 seconds to 9,362 seconds, while the VAR rose from 15.10% to 23.01%. The Independent Sample T-Test yielded a p-value < 0>

Kata Kunci : action research, lean hospital, farmasi rawat jalan, lead time, efisiensi proses