Reducing Dispensing Time by Applying the Lean Hospital Approach in the Outpatient Pharmacy Department of SMC Telogorejo Hospital in Semarang Indonesia

Cicilia Tyasti Wahyunengsih; Titien Siwi Hartayu

doi:10.24071/jpsc.0010115

Reducing Dispensing Time by Applying the Lean Hospital Approach in the Outpatient Pharmacy Department of SMC Telogorejo Hospital in Semarang Indonesia

Cicilia Tyasti Wahyunengsih^(1*), Titien Siwi Hartayu⁽²⁾,

(1) Sanata Dharma University
(2)
(*) Corresponding Author

Abstract

The outpatient pharmacy department is the last service unit visited by patients. One common concern is the delay in receiving medicine. Improvements in medicine dispensing time were made with a lean hospital. This study aims to analyze the impact of lean hospital interventions on waiting times and Value Added Ratio (VAR). This quasi-experiment was conducted with a non-equivalent control group before-after design. The study population included non-compounded medicine prescriptions with out-of-pocket healthcare from April to July 2024. The sample was 1,266 prescriptions. Direct observation gathered data for value stream mapping in non-compounded medicine dispensing, recording time for prescription screening, preparation, final checks, and delivery, including patient education. Activity time was considered value-added time. Value-added time divided by Cycle Time (CT) was used to calculate VAR. Critical waste identified by the root-cause analysis was conducted through in-depth interviews using the fishbone diagram guide. Data before and after intervention were analyzed using the Mann-Whitney U-test. Inventory waste significantly affected dispensing times. The lean hospital strategy improved the efficiency of pharmaceutical services by reducing the dispensing time from 19.68 to 16.18 minutes (p < 0.001) and increasing the VAR from 51.34% to 57.21% (p < 0.001) with an automated medicine planning system.

Keywords

Dispensing time; Lean hospital; Outpatient pharmacy; Value added ratio; Waste inventory

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References

Amiruddin, E.E., Alfreda, V., Meilani, N., 2023. Faktor yang mempengaruhi waktu tunggu pelayanan resep rawat jalan di Puskesmas Betoambari. Jurnal Keperawatan Profesional (KEPO), 4(2), 144–150.

Arthur, J., 2011. Lean Six Sigma for Hospitals. McGraw Hill, New York.

Atikah, N., Parhatiwi, S.N., Pertiwi, A.D., Utami, E.F., Firman, F., 2021. Identifikasi waste: DOWNTIME pada pelayanan resep rawat jalan di Instalasi Farmasi Rumah Sakit Islam Siti Hajar Mataram. Jurnal Ilmiah Farmasi, 17(2), 107–115.

Ferdi, Nuraini, A., Nugroho, D., 2023. Peningkatan kualitas pelayanan farmasi melalui pendekatan Lean Management di iinstalasi farmasi rawat jalan rumah sakit Umum M. Yunus Bengkulu. Jurnal Manajemen dan Administrasi Rumah Sakit Indonesia (MARSI), 7(2), 108–124.

Gasperz, V., Fontana, A., 2016. A Lean Six Sigma for Manufacturing and Service Industries: Waste Elimination and Continuous Cost Reduction, 2nd ed. Gramedia Pustaka Utama, Jakarta.

Graban, M., 2012. Lean Hospital: Improving Quality, Patient Safety, and Employee Engagement, 2nd ed. CRS Press, New York.

Graban, M., Swartz, J., 2013. The Executive Guide to Healthcare Kaizen: Leadership for a Continuously Learning and Improving Organization. Boca Raton, FL: CRC Press, Taylor & Francis Group.

Hammoudeh, S., Amireh, A., Jaddoua, S., Nazer, L., Jazairy, E., Al-Dewiri, R., 2021. The impact of Lean Management implementation on waiting time and satisfaction of patients and staff at an outpatient pharmacy of a comprehensive cancer center in Jordan. Hospital Pharmacy, 56(6), 737–744.

Nurlaila, Marchaban, M., Yuniarti, E., 2022. Penggunaan Lean Hospital untuk meningkatkan efisiensi pelayanan resep rawat jalan RSU PKU Muhammadiyah Delanggu. Majalah Farmaseutik, 18(2), 113–121.

Rahayu, D.S., Sunarni, T., Saptarini, O., Farmasi, P.I., Farmasi, F., Setiabudi, U., Farmasi, P.I., Farmasi, F., Setiabudi, U., Farmasi, P.I., Farmasi, F., Setiabudi, U., 2020. Pendekatan Lean Hospital untuk mengidentifikasi waste kritis pelayanan obat di Instalasi Farmasi Rawat Jalan RSUD X Manna Tahun 2020. Media Ilmu Kesehatan, 9(3), 231–236.

Sari, I.M.P., Pribadi, F., 2018. Pendekatan Lean Hospital untuk Mengidentifikasi Waste Kritis di Instalasi Farmasi Rawat Jalan Rumah Sakit Umum Daerah (RSUD) Wates. Muhammadiyah University.

Suryana, D., 2018. Upaya Menurunkan Waktu Tunggu Obat Pasien Rawat Jalan dengan Analisis Lean Hospital di Instalasi Farmasi Rawat Jalan RS Atma Jaya. Jurnal Administrasi Rumah Sakit Indonesia, 4(2), 110–121.

Winarno, N., Marchaban, M., Yuniarti, E., 2022. Penggunaan Lean Hospital untuk meningkatkan efisiensi pelayanan resep rawat jalan RSU PKU Muhammadiyah Delanggu. Majalah Farmaseutik, 18(2), 113–121.

Wulandari, K., Widodo, G., Rahmawati, I., 2023. Peningkatan kepuasan pasien terhadap kualitas pelayanan instalasi farmasi rawat jalan menggunakan pendekatan Lean Hospital. Jurnal Penelitian Kesehatan Suara Forikes, 14(7), 218–225.

Yani, F., Maraiyuna, S., Vonna, A., 2022. Evaluasi waktu tunggu setelah redesign dan penerapan Lean Pharmacy pada pelayanan farmasi rawat jalan. Journal of Medical Science, 3(1), 19–30.

Yanong, D.W., Erna Kristin, Firman, 2023. Implementasi Lean Thinking untuk menurunkan waktu tunggu pelayanan obat di instalasi farmasi rawat jalan, Rumah Sakit Panti Rini. Jurnal Manajemen Pelayanan Kesehatan (The Indonesian Journal of Health Service Management), 26(2), 44–52.

Yuganingsih, T., Widodo, G.P., Saptarini, O., 2021. Pendekatan Lean Hospital untuk meminimalkan waste di instalasi farmasi rawat jalan di Rumah Sakit Umum Daerah Pandan Arang Boyolali. Jurnal Penelitian Kesehatan Suara Forikes, 12(November), 53–56.

DOI: https://doi.org/10.24071/jpsc.0010115