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Abstrak :
Penelitian ini dilakukan berdasarkan pengamatan terhadap lamanya waktu pelayanan gawat darurat di Instalasi Gawat Darurat RSUP Sanglah Denpasar tahun 2012, dimana kondisi ini mempunyai potensi untuk terjadinya kejadian yang tidak diharapkan dan menurunkan kepuasan pasien. Peneilitian dilakukan dengan rancangan kuantitatif dan kualitatif. Dilakukan observasi terhadap 450 pasien dalam kurun waktu 14 Januari sampai 19 Januari 2013 dengan pendekatan Constraint Lean Six Sigma dicari penyebab, hambatan, pemborosan serta defek pada proses pelayanan pasien gawat darurat. Median waktu pelayanan gawat darurat sebesar 219 menit., penyebab lamanya waktu pelayanan oleh karena belum ada panduan praktek klinik kegawatdaruratan, hambatan pada pelayanan radiologi, pemborosan terjadi pada waktu tunggu antara penegakkan diagnosis ke tindakan dan antara tindakan ke keputusan untuk keluar dari Instalasi Gawat Darurat. Level kualitas sigma sebesar 2,9 sigma dengan nilai defek sebesar 86.762 DPMO. Diperlukan panduan praktek klinik untuk memandu proses pelayanan gawat darurat agar menjadi efektif,efisien dan aman untuk pasien dan proses bisnis rumah sakit. ......This research based on issues regarding the time of emergency service at Emergency Instalation Sanglah Hospital was too long in 2012, since that situation had increased the adverse event and decreasing patient satisfaction. Quantitative and qualitative design was performed by doing observation of 450 emergency patient beginning from January 14th until January 19th The median value of emergency service time was 219 minute due to the absence of clinical practice guideline.The constraint was at radiology examination, wasting time due to delay of waiting time from diagnosis to procedure and from procedure to discharge dispotition. Sigma Quality level for Emergency Service at 2,9 Sigma with defects Possibility was 86.762 DPMO. using Contstraint Lean Six Sigma approach to identify causes, constraints, wastes and defects in service process. This study suggest that clinical practice guidelines is needed to guidance emergency service process in effort to become more effective, efficient, safe for the patient and hospital business process.

Abstrak :
Penelitian ini bertujuan merancang usulan perbaikan efektivitas dan efisiensi pelayanan radiologi RS Pusat Otak Nasional dengan menerapkan metode constraint lean six sigma. Penelitian ini dirancang dengan desain kualitatif dan kuantitatif. Data kuantitatif didapat dari hasil observasi lamanya waktu pelayanan radiologi di RS Pusat Otak Nasional. Jumlah sampel penelitian sebanyak 30 sampel. Hasil penelitian ini yaitu rata-rata lead time pelayanan sebesar 2 jam 13 menit. Waktu NVA tertinggi terdapat pada siklus pengolahan ekspertise. Waktu NVA tertinggi terdapat pada jenis waste yaitu waiting dan processing. Penyebab utama NVA pada kedua waste tersebut adalah PACS system error dan waktu tunggu hasil baca foto/scaning. Hasil penelitian menemukan 7 sampel memiliki waktu tunggu pelayanan radiologi > 3 jam. Sebesar 57 dari total defect pelayanan dikontribusi oleh pemeriksaan di luar jam kerja dan hari libur. Usulan perbaikan yang diperlukan yaitu Standardize work berupa Standar Prosedur Operasional SPO pengiriman foto/scaning pemeriksaan CITO di luar jam kerja dan hari libur, evaluasi rutin alat PACS, dan penerapan radiology information system RIS yang terintegrasi. ...... This study aims to design a proposal to improve the effectiveness and efficiency of radiology service of National Brain Hospital by applying the method of constraint lean six sigma. This research is designed with qualitative and quantitative design. Quantitative data obtained from the observation of the length of time radiology services at National Central Medical Center. The sample size is 30 samples. The results of this study is the average service lead time of 2 hours 13 minutes. The highest NVA time is in the experimental processing cycle. The highest NVA time is in the type of waste that is waiting and processing. The main causes of NVA in both waste are PACS system error and waiting time of reading radiograph. The results of the study found 7 samples have radiology service waiting time 3 hours. 57 of the total service defect was contributed by after hours and holidays. The proposed improvements required are Standardize work in the form of Standard Operating Procedures SPO of sending radiograph CITO in after hours and holidays, routine quality control of PACS tools, and integrated radiology information system RIS application.

Abstrak :
Pelayanan Farmasi di Rumah Sakit XYZ bertujuan untuk meningkatkan kualitas layanan kesehatan dengan target 100% indikator waktu tunggu layanan terpenuhi. Namun, data dari laporan penjaminan mutu internal menunjukkan bahwa ketercapaian indikator mutu rata-rata waktu tunggu obat non-racikan di Depo Farmasi Rawat Jalan dengan sistem pembayaran BPJS masih diatas 30 menit, atau belum tercapai sesuai dengan standar yang ditetapkan oleh Kementerian Kesehatan Republik Indonesia. Oleh karena itu, penelitian ini bertujuan untuk mencari letak pemborosan, variasi, dan hambatan yang menyebabkan lamanya waktu tunggu pelayanan dengan pendekatan Constraint Lean Six Sigma. Berdasarkan hasil penelitian, ditemukan bahwa rata-rata lead time yang dibutuhkan dalam satu proses pelayanan resep obat non racikan adalah 80,27 menit dengan jenis kegiatan pemborosan yang paling banyak dengan total 94% dari keseluruhan waktu kegiatan Non-Value Added adalah waiting (3.790 sekon). Selain itu, terdapat tiga jenis pemborosan lainnya yaitu overproduction (89 sekon), poor process design (76 sekon), dan defects (67 sekon) yang masing-masing menyumbang 2% dari total waktu Non-Value Added yang ada dalam keseluruhan lead time. Hambatan terjadi pada proses dispensing dan serah obat karena terjadi penumpukan resep yang disebabkan oleh kurangnya jumlah tenaga teknis kefarmasian dan apoteker serta kurang maksimalnya sistem informasi dalam menunjang keseluruhan sistem proses. Melihat masalah ini, dibutuhkan tambahan tenaga kefarmasian dan juga pengembangan sistem informasi dengan keseluurhan data sudah terdigitalisasi dan terintegrasi agar lebih mudah untuk digunakan oleh seluruh tenaga kefarmasian dalam rangka mempercepat proses pelayanan resep obat non-racikan. Semakin cepat pelayanan resep, akan semakin meningkat juga kepuasan masyarakat terhadap pelayanan kesehatan yang diberikan. ......Pharmacy services at XYZ Hospital aim to improve the quality of health services with a target of 100% service waiting time indicators being met. However, data from the internal quality assurance report shows that the achievement of the quality indicator of the average waiting time for non-compounded drugs at the Outpatient Pharmacy Depot with the BPJS payment system is still above 30 minutes, or has not been achieved in accordance with the standards set by the Ministry of Health of the Republic of Indonesia. Therefore, this research aims to find the location of waste, variations, and bottleneck that cause the long waiting time for services with the Constraint Lean Six Sigma approach. Based on the results of the study, it was found that the average lead time required in one non-compounded prescription service process was 80.27 minutes with the most wasteful activity type totaling 94% of the overall Non-Value Added activity time was waiting (3,790 seconds). In addition, there are three other types of waste, namely overproduction (89 seconds), poor process design (76 seconds), and defects (67 seconds), each of which accounts for 2% of the total Non-Value Added time in the overall lead time. Bottlenecks occur in the dispensing and drug handover process due to the accumulation of prescriptions caused by the lack of technical pharmaceutical personnel and pharmacists and not yet optimized information systems in supporting the entire process system. Seeing this problem, additional pharmaceutical personnel are needed and also the development of the information system with the entire data already digitalized and integrated so that it is easier to be used by all pharmaceutical personnel in order to speed up the process of non-prescription drug prescription services needed to be done. The faster the prescription service, the more patient satisfaction will increase.