HERI%

1. ROADMAP LEAN

LEAN%
1. PENGANTAR
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HERI%

1%
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2%
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3%
 HERI%

1. ROADMAP LEAN

LEAN%
Implementation
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HERI%

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HERI%

4%
 HERI%

Roadmap
Implementasi Lean
1.  Asesment Oprs RS
2.  Pelatihan tim leader/ duta manajemen
3.  Setting “performance dashboard”
4.  Membuat pilot project
5.  Audit waste dan VSM
6.  Implementasi “A3”
7.  Organisasi tempat kerja “5s”
8.  Sistem Just-in-time
9.  Pelatihan “staf”
10.  Gemba Kaizen
11.  Sustainability
12.  Audit pelaksanaan

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HERI%

GOALs of Lean

1.  Goal #1 : Improve quality

2.  Goal #2 : Eliminate waste

3.  Goal #3 : Reduce lead time

4.  Goal #4 : Reduce total cost

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HERI%

5%
 HERI%

The Five Steps

1.  Value
2.  Value Stream

3.  Flow
4.  Pull Planning

5.  Perfection
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HERI%

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HERI%

6%
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HERI%

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HERI%

7%
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HERI%

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8%
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9%
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10%
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11%
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12%
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13%
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14%
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HERI%

2. PENGANTAR LEAN

LEAN%
2. K ON S E P L E A N
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HERI%

15%
 HERI%

Konsep Lean

•  Metode mutahir dalam mengelola

organisasi untuk meningkatkan
produktivitas, efisiensi, efektivitas,
keselamatan, mutu layanan

•  Merujuk pada kinerja organisasi

kelas dunia

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HERI%

Konsep Lean
•  Perusahaan Jepang dan Amerika
sudah menggunakan metode ini
sejak setengah abad yang lalu
•  Konsep penerapan lean dapat
terlihat
•  Industri penerbangan (Boeing) dan
Otomotif (Toyota) ; contoh
organisasi yang sudah menerapkan

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HERI%

16%
 HERI%

Lean Manufacturing
•  Dimulai dari kesukesan pabrik
mobil jepang, Toyota
•  Taiichi Ohno, pendiri Toyota !
mengeliminasi pemborosan
(NVA) total
•  Metode Lean meningkatkan
kinerja org dgn fokus pada
eliminasi pemborosan

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HERI%

Lean Manufaktur
•  Lean fokus pada pengawasan
pada aliran barang dan proses
kerja
•  Tujuannya nilai tambah bagi
pelangan
•  Penerapan lean pada tiap
organisasi sangat bervariasi

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HERI%

17%
 HERI%

Lean Tools
“Rumah Sakit”
1.  Value Stream Mapping,
2.  Quick Changeover/ Setup Reduction,
3.  Kaizen,
4.  Cellular/ Flow Manufacturing,
5.  Visual Workplace
6.  5S
7.  Total Productive Maintenance (TPM)
8.  Pull/ Kanban Systems

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HERI%

Lean
1.  Mendefinisikan nilai dari perspektif pelanggan
akhir dalam bentuk ; layanan, kapabilitas,
harga dan waktu
2.  Identifikasi aliran nilai atas suatu layanan dan
mengeliminasi pemborosan yang ada
3.  Mendesain proses layanan yang cepat dan
berkualitas tanpa “pemborosan”
4.  Mendisian kebutuhan pelanggan sesuai
harapan pelanggan
5.  Mengejar kesempurnaan

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HERI%

18%
 HERI%

LEAN ….
Meningkatkan …
•  Efisiensi biaya; persediaan
dan layanan
•  Produktivitas dan mutu;
optimalisasi SDM dan proses
kerja

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HERI%

LEAN%PRINCIPLE%

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HERI%

19%
 HERI%

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HERI%

Bangunan Lean

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HERI%

20%
 HERI%

Pelayanan Dokter
(Ratnamiasih, I., 2012)

•  Pelayanan dokter
merupakan indikator bagi
kepuasan pasien.

•  Pelayanan dokter dan

pelayanan perawat
ditentukan oleh faktor
komitmen mereka terhadap
pekerjaan maupun kepuasan
mereka terhadap pekerjaan
mereka

Patient Judgement
System
(Aday, L.A., Cornelius, L.J.
2005)

•  Terdapat sebuah alat ukur

yang disebut Patient
Judgement System

•  Dipakai untuk menilai

kepuasan pasien atas
pelayanan rawat inap

21%
 HERI%

HERI

Indikator Kepuasan
(Fritzen, S. 2005)

!  PJS ; 10 indikator
1.  admisi,
2.  perawatan harian,
3.  informasi,
4.  pelayanan perawat,
5.  pelayanan dokter,
6.  pelayanan staff pendukung,
7.  pola hidup,
8.  pelepasan,
9.  tagihan, dan
10.  proses total.
!  Selain indikator tersebut,
1.  ketersediaan obat,
2.  waktu tunggu, dan
3.  bebas kerja administratif

22%
 HERI%

Logistik Farmasi(Agency for

Health Care Research and
Quality. 2009)
•  Ketersediaan obat di rawat
inap termasuk masalah

•  Banyak rumah sakit yang masih

menggunakan metode
manual untuk mengumpulkan
dan melaporkan data obat

Faktor Lingkungan
(Koerner, M.M. 2000)

•  Kepuasan pasien atas

pelayanan rawat inap bukan
satu-satunya faktor yang
menentukan keinginan
menggunakan kembali
pelayanan rawat inap di masa
datang.

•  Ada faktor lain yaitu faktor

lingkungan

23%
 HERI%

Faktor
Lingkungan(Farrell, J.M.
et al. 2009)

•  Faktor ini mencakup

kedekatan lokasi dan
perparkiran.

•  Faktor lingkungan lain

berupa kecepatan pindah
dari ruang gawat darurat
ke ruang rawat inap.

Kualitas Pelayanan Rawat Inap

(Chou, J., Peaty, N., Strickland, J.M. 2013)

!  Implementasi lean di Wake

Forest Baptist Medical Center
(WFBMC) : bagian farmasi rawat
inap
!  Meningkatkan pengiriman obat
tepat waktu meningkat dari 38%
menjadi 59% pada bulan
pertama,
!  61% pada bulan kedua, dan
!  63% pada bulan ketiga.

24%
 HERI%

HERI

Implementasi lean yang

dilakukan WFBMC
1.  Kamar pasien dibuat dalam zona seluler berbentuk U sehingga
meminimalkan jarak tempuh
2.  Mengurutkan shift pagi untuk memenuhi semua aspek kerja dengan satu
pasien sebelum berpindah ke pasien lain.
3.  Pelaporan pada semua pasien dibuat terstandarisasi sehingga dapat
dilakukan oleh semua yang melakukan pekerjaan tersebut
4.  Kotak pasokan distok ulang sesuai yang dibutuhkan saja dengan sistem
kanban
5.  Pembuatan catatan terstandar yang berisi semua kebutuhan pasien
sebelum meninggalkan ruangan dan berpindah ke pasien lain
6.  Penyimpanan obat di samping tempat tidur pasien
7.  Sistem bendera visual dalam kotak obat pada titik penggunaan yang
menunjukkan kebutuhan penyediaan baru pasokan tepat waktu

Nelson-Peterson, D.L.,
Leppa, C.J. 2007
•  Implementasi di Virginia Mason
Medical Center (VMMC)

•  Pada bulan ketiga setelah

implementasi, jarak berjalan staff
menurun dari 5.818 langkah
menjadi 846 langkah,
•  Waktu yang dibutuhkan untuk
memenuhi satu siklus kerja pagi
perawat untuk semua pasien
menurun dari 240 menit menjadi
126 menit,
•  Persentase panggilan dalam
periode empat jam menurun dari
5,5% menjadi 0%,
•  Persentase waktu perawat untuk
kegiatan perawatan yang tidak
menambah nilai menurun dari 68%
menjadi 10%, dan
•  Waktu mencari dan
mengumpulkan bahan dan
perlengkapan menurun dari 20
menit menjadi 3 menit

25%
 HERI%

Hines S, Luna, K, Lofthus J, et al.

2008

•  Implementasi lean di Cincinnati

Children Hospital berhasil
menghemat 208 hari
perawatan dan menghemat
$60.480 untuk membiayai
pasien Medicaid

Kesamaan
Prosedur(Edmonson, 2003)

•  Instalasi bedah central di suatu

rumah sakit dicirikan oleh
prosedur yang hampir sama

•  Perbedaan kecil hanya

terletak pada penyesuaian
kecil

•  Perbedaan akibat pilihan

dokter bedah atau variasi dari
pasien

26%
 HERI%

Keselamatan pasien
(Tvedt C, et al, 2011)
!  Masalah efisiensi
kembali berakar pada
tradisi instalasi bedah
sentral yang
mengutamakan
keselamatan
!  Studi menunjukkan
kalau perawat di
instalasi bedah selalu
memberikan nilai lebih
tinggi tentang
keselamatan pasien
daripada perawat di
instalasi lainnya

Standarisasi prosedur
(El-Jardali F, et al, 2011)

•  Di instalasi bedah, intervensi

keselamatan pasien lebih
mudah diberikan dan lebih
dapat dilihat

•  Karena adanya prosedur

yang lebih terstandarisasi

27%
 HERI%

Checklist
Keselamatan
(Tweedy, J.T. 2005)

•  Checklist keselamatan untuk

instalasi bedah sentral
mencapai 78 item

•  Lebih banyak dari

departemen manapun di
rumah sakit

HERI

28%
 HERI%

Pendidikan perawat
(Aiken, et al. 2003)

!  Tingkat pendidikan perawat di

instalasi bedah cenderung lebih
tinggi

!  Sehingga memiliki banyak

pengetahuan mengenai
keselamatan pasien

Aspek Psikologi
(Scheier, et al, 1999)
•  Karakteristik lain dari instalasi
bedah sentral terdapat pada
psikologi pasien

•  Pembedahan merupakan
sebuah pengalaman khusus
bagi pasien dan walaupun
menjanjikan kesembuhan,
seringkali justru memunculkan
ketakutan

29%
 HERI%

Kejadian meninggal
(Johnson, J.E. 2006)

•  Penelitian menunjukkan :
pasien yang berada di ruang
inap untuk pembedahan
selama beberapa jam setelah
operasi lebih kecil peluang
meninggal dunia

•  Ketimbang pasien yang

diinapkan selama 7 hingga 10
hari

Studi Serrano dan

Slunecka tahun 2006

•  Menggunakan metodologi
VSM pada instalasi bedah
sentral

•  Kepuasan pasien,
penghematan biaya, dan
waktu menyiapkan
ruangan dengan hasil yang
positif

30%
 HERI%

!  Studi McCullock et al tahun 2010

di John Radcliffe Hospital,
Oxford, menemukan kalau
kualitas meningkat 28% menjadi
149% dan angka rujukan turun
dari 27% menjadi 20%.

!  Studi Brooker di sebuah instalasi

bedah anak tahun 1997 berhasil
mengubah kebiasaan perawat
dengan mendidik perawat
memberikan keputusan terbaik
dalam memberikan balutan
yang pas untuk tipe luka anak
sehingga mengurangi
kesalahan yang dapat
menghasilkan infeksi serius

Studi Nies et al, 2010

•  Menemukan kalau alat Clinical
Decision Support (CDS)
mampu mengurangi
pemborosan dalam
pemeriksaan darah di sebuah
unit bedah kardiovaskuler

31%
 HERI%

Appleton Medical
Care Surgical Unit

•  Tujuan: menghilangkan
kesalahan
•  Kasus: infeksi lutut
•  Lean tool: standarisasi kerja
(A3)

Appleton Medical Care

(AMC) dan Theda Clark
Medical Center (TCMC)

•  Tujuan: mencapai dan

meningkatkan perbaikan
harian
•  Kasus: Business
Performance System
•  Lean tool: perbaikan
berkelanjutan

32%
 HERI%

Ronald Reagan
UCLA Medical
Center
!  Tujuan: meningkatkan kepuasan
pasien
!  Contoh Kasus: Utilisasi
Sumberdaya
!  Lokasi kasus: Department of
Neurosurgery
!  Lean tool: kerja standar

Langkah
implementasi LEAN
di instalasi bedah
central

!  Memeriksa sistem manajerial

!  Menyusun peta aliran nilai
!  Implementasi kerja standar
dan 5S
!  Implementasi Poka Yoke
!  Implementasi penggantian
cepat atau SMED (Single
Minute Exchange or Die)

33%
 HERI%

HERI

FUNGSI UNIT FARMASI

!  Menyediakan semua
obat yang diresepkan
dan

!  Memberikan konsultasi
pada pasien mengenai
penggunaan obat
tersebut

HERI

Utarini, A., Nugraheni, A.I.P., Agastya, 2009.

Improving Clinical Performance: Clinical
Management System

!  Bagi
rumah sakit secara ekonomi 40-50%
pendapatan rumah sakit bersumber dari farmasi

34%
 HERI%

HERI

!  Instalasiini juga berperan

kunci dalam mencegah
kesalahan obat
!  Sehingga setiap pekerjanya
harus memahami tentang
pentingnya keselamatan
kerja, bahaya-bahaya yang
dapat ditemukan dalam
proses dan pekerjaan,
peran pada saat terjadinya
masalah darurat, dan
kebijakan maupun prosedur
keselamatan secara umum.

HERI

MASALAH !  Dalam segi pemborosan waktu, instalasi

farmasi bermasalah dengan isu waktu
tunggu.
!  Berbagai upaya telah dilakukan untuk
menghilangkan atau menurunkan
pemborosan waktu yang terjadi di unit
farmasi.
!  Salah satu upaya awal adalah
penggunaan sistem antri yang berfokus
pada prioritas, sedemikian hingga
datangnya pesanan dari pasien dinilai
berdasarkan tingkat kedaruratan dan
pesanan yang paling darurat akan
diutamakan terlebih dahulu

35%
 HERI%

HERI

SOLUSI
Lean case studies
!  Pemborosan waktu Lean thinking in Hereford
dapat dikurangi dengan The service transformation team have been working at Hereford Hospitals NHS trust
helping the pathology and pharmacy departments to improve turnaround times and

proses streamline yang

eliminate waste, using 'lean' principles.

Typically, staff are briefed on Lean - this takes usually 1/1.5 hours. At the end of this

dikembangkan lewat
Lean thinking presentation staff are given two to three days to complete waste
identification forms. After this improvements are collated, prioritised and the team
agrees which improvements will be done. An implementation plan is then produced,

pemetaan proses
detailing who is doing what and when. Improvements are done quickly, in days. This is
just one approach we use when staff can’t commit to participating in four day rapid
improvement events.

HERI

KETERSEDIAAN

!  Dalam segi obat, ada

dua masalah yang
muncul yaitu adanya
obat yang tidak tersedia
dan adanya obat yang
kadaluarsa

36%
 HERI%

HERI

VSM

HERI
Pharmacy Management System
(PMS)
!  Kesalahan obat dapat
dikurangi menggunakan
pemesanan
menggunakan sistem
elektronik seperti e-mail.

37%
 HERI%

HERI

Hasil Lean di RS Exempla

!  Farmasi hanya menghemat
biaya persediaan hingga
$7.887,33.
!  Jumlah obat yang dikirim ke
ICU dalam tiga hari
menurun hingga 28%
!  Jumlah obat yang tidak
digunakan menurun 62%
dari 362 obat menjadi 136
obat saja.

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HERI%

38%
 HERI%

3A. PEMBOROSAN

LEAN%
3. PEMBOROSAN
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HERI%

Komponen Aktivitas Organisasi

•  Aktivitas ber-Nilai Tambah

–  Pekerjaan yg pelanggan mau membayarnya

•  Aktivitas Tidak ber-Nilai Tambah namun

diperlukan/ Pemborosan terselubung
–  Melakukan pekerjaan yg tdk diinginkan
pelanggan namun perlu buat organisasi

•  Aktivitas Tidak ber-Nilai Tambah

–  Pekerjaan yg tidak perlu dan pelanggan tidak
mau membayarnya

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HERI%

39%
 HERI%

Pemborosan
Terselubung
•  Inspeksi
•  Perbaikan
•  Pencatatan
•  Persetujuan
•  Pengantaran

Kurangi aktivitas diatas

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HERI%

Pemborosan
1.  Defects
2.  Overproduction
3.  Waiting
4.  Not-utilized People
5.  Transportation
6.  Inventory
7.  Motion
8.  Extra processing

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HERI%

40%
 HERI%

Defects
•  Tidak sesuai harapan
•  Cacat
•  Rusak
•  Pengecekan ulang
•  Salah
•  Terlambat
•  Lembur untuk memperbaiki kesalahan

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HERI%

Overproduction

•  Memproduksi melebihi kebutuhan

•  Meminta barang dlm jumlah banyak
•  Menyediakan barang sebelum dibutuhkan

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HERI%

41%
 HERI%

Waiting

Menunggu barang, Menunggu alat sdg pemeliharaan,

Menunggu pemeriksaan, Menunggu hasil pemeriksaan,
Menunggu pembayaran

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HERI%

Not-utilized People
•  Definisi Job desk tidak jelas
•  KPI tidak ada
•  Sedikit/ tidak ada cross-training

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HERI%

42%
 HERI%

Transportation
•  Memindahkan barang yg tidak
perlu
•  Mengantar berkas
•  Menyimpan barang jauh dari
ruang kerja
•  Tempat printer jauh dari
pegawai
•  Jarak antar pelayanan jauh

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HERI%

Inventory

Just in Time – Sesuai kebutuhan

Terlalu banyak barang, Terlalu banyak bahan baku,
Terlalu banyak rak, Terlalu banyak peralatan
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HERI%

43%
 HERI%

Motion

Operator Movement
Menjemput pasien, Mengambil obat/ alkes, Mengantar
berkas, Alkes/ Almed jauh Jalan
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HERI%

Extra Processing

Processing
Sering inspeksi, Foto copy berlebih, Pemeriksaan diagnostik berulang,
Permintaan informasi tetapi tidak diperlukan, Berulang-ulang memberi
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HERI%
informasi

44%
 HERI%

FORMULIR()(AUDIT(WASTE(

Nama$Observer$/$tim$ :………….................................$ $ Tanggal$:…………………………………$

Unit$observasi$ $ :…………………………………………$ $
$ $ $ $ $ $
Kategori(Waste( Jenis(pertanyaan(untuk( Contoh( Solusi(
mendeteksi(waste(

apakah$ada$peralatan$yang$ $ $
Defect$ rusak/tidak$terpelihara?$

Apakah$ada$pekerjaan$yang$ $ $
$ dilakukan$untuk$kedua$kali?$

Apakah$ada$dokumen$yang$ $ $
dikirim$2$kali$krn$berbagai$
$ alasan?$

Apakah$ada$pengisian$formulir$ $
Over$production$ berulang?$ $

Apakah$ada$perlengkapan$yang$ $
$ telah$disiapkan$tidak$digunakan$ $

Apakah$terlalu$banyak$minta$ $
Waiting$ persetujuan?$ $

Apakah$ada$keterlambatan$ $
dalam$menyampaikan$data$
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
$ HERI%
hasil$peneriksaan$ $

Apakah$ada$keterlambatan$ $ $
dalam$pengiriman$obat$dan$
$ alkes?$

Non$Utilized$ Apakah$tidak$ada$crossF $ $
people$ training?$

Apakah$tidak$ada$upaya$ $ $
$ FORMULIR()(AUDIT(WASTE(
menggali$usulan$perbaikan?$

Nama$Observer$/$tim$ :………….................................$ $ $
Apakah$tidak$ada$proses$ Tanggal$:…………………………………$
$
$Unit$observasi$ $ :…………………………………………$
pengayaan$pekerjaan?$ $
$ $ $ $ $ $
Kategori(Waste( Apakah$lokasi$antar$unit$
Jenis(pertanyaan(untuk( $
Contoh( $
Solusi(
Transpot$ pelayanan$jauh?$
mendeteksi(waste(
Apakah$jarak$fotocopy,$fax,$
apakah$ada$peralatan$yang$ $$ $
Apakah'terlalu'banyak'minta' '$
tempat$sampah$jauh$dari$posisi$
Defect$
Waiting' rusak/tidak$terpelihara?$
persetujuan?' '
$ duduk?$
Apakah$ada$pekerjaan$yang$ $ $
$ Apakah'ada'keterlambatan' $ '$
$ dilakukan$untuk$kedua$kali?$
Apakah$pendistributioan$
dalam'menyampaikan'data'
' hasil'peneriksaan'
Apakah$ada$dokumen$yang$ '$ $
dikirim$2$kali$krn$berbagai$
$ Apakah'ada'keterlambatan'
alasan?$ ' '
dalam'pengiriman'obat'dan'
Apakah$ada$pengisian$formulir$ $
' alkes?'
Over$production$ berulang?$ $
Non'Utilized' Apakah'tidak'ada'cross< ' '
Apakah$ada$perlengkapan$yang$ $
people'
$ training?'
telah$disiapkan$tidak$digunakan$ $

Apakah'tidak'ada'upaya'
Apakah$terlalu$banyak$minta$ ' '$
'Waiting$ menggali'usulan'perbaikan?'
persetujuan?$ $
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
HERI%
Apakah$ada$keterlambatan$
Apakah'tidak'ada'proses' ' '$
' dalam$menyampaikan$data$
pengayaan'pekerjaan?'
$ hasil$peneriksaan$ $
Apakah'lokasi'antar'unit' ' '
Apakah$ada$keterlambatan$ $ $
Transpot' pelayanan'jauh?'
dalam$pengiriman$obat$dan$
$ alkes?$
Apakah'jarak'fotocopy,'fax,' ' '
tempat'sampah'jauh'dari'posisi'
Non$Utilized$ Apakah$tidak$ada$crossF $ $ 45%
'people$ duduk?'
training?$

Apakah$tidak$ada$upaya$
Apakah'pendistributioan' '$ '$
'$ menggali$usulan$perbaikan?$
dokumen'msh'manual?'
 HERI%
Apakah'terlalu'banyak'minta' '
Waiting' persetujuan?' '

Apakah'ada'keterlambatan' '
dalam'menyampaikan'data'
' hasil'peneriksaan' '

FORMULIR()(AUDIT(WASTE(
Apakah'ada'keterlambatan' ' '
dalam'pengiriman'obat'dan'
Nama$Observer$/$tim$ :………….................................$ $ Tanggal$:…………………………………$
'Unit$observasi$ $ alkes?'
:…………………………………………$ $
$ $ $ $ $ $
Non'Utilized'
Kategori(Waste( Apakah'tidak'ada'cross<
Jenis(pertanyaan(untuk( 'Contoh( 'Solusi(
people' mendeteksi(waste(
training?'
apakah$ada$peralatan$yang$ $ $
Apakah'tidak'ada'upaya' ' '
Defect$ rusak/tidak$terpelihara?$
' menggali'usulan'perbaikan?'
Apakah$ada$pekerjaan$yang$ $ $
$ Apakah'tidak'ada'proses'
dilakukan$untuk$kedua$kali?$ ' '
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Apakah'terlalu'banyak'minta'
Apakah$ada$dokumen$yang$ $ '$
Waiting' dikirim$2$kali$krn$berbagai$
persetujuan?'
Apakah'lokasi'antar'unit' '' '
$ alasan?$
Transpot' pelayanan'jauh?'
Apakah'ada'keterlambatan' '
Apakah$ada$pengisian$formulir$ $
dalam'menyampaikan'data'
Apakah'jarak'fotocopy,'fax,' '$ '
Over$production$ berulang?$
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tempat'sampah'jauh'dari'posisi' '
Apakah$ada$perlengkapan$yang$ $
' duduk?'
$ Apakah'ada'keterlambatan'
telah$disiapkan$tidak$digunakan$ '$ '
dalam'pengiriman'obat'dan'
Apakah'pendistributioan' ' '$
Apakah$terlalu$banyak$minta$
''Waiting$ alkes?'
dokumen'msh'manual?'
persetujuan?$ $

Non'Utilized'
Inventory' Apakah'tidak'ada'cross<
Apakah'ada'barang'rusak?'
Apakah$ada$keterlambatan$ '' ''$
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
HERI%
people' training?'
dalam$menyampaikan$data$
'$ Apakah'ada'barang'berlebih?'
hasil$peneriksaan$ '$ '
Apakah'tidak'ada'upaya' ' '
Apakah$ada$keterlambatan$
Apakah'ada'barang'kadaluarsa?' '$ '$
' menggali'usulan'perbaikan?'
dalam$pengiriman$obat$dan$
$ alkes?$
Apakah'tata'ruang'di'desain'
Apakah'tidak'ada'proses' ' '
Motion'
'Non$Utilized$ sesuai'aliran'pelayanan?'
pengayaan'pekerjaan?'
Apakah$tidak$ada$crossF $ $
people$ training?$
Apakah'ada'upaya'mengatur'
Apakah'lokasi'antar'unit'
FORMULIR()(AUDIT(WASTE( ' '
Transpot' Apakah$tidak$ada$upaya$
posisi'peralatan,'alur'orang,'&'
pelayanan'jauh?' $ $
'Nama$Observer$/$tim$
$ :………….................................$
menggali$usulan$perbaikan?$
alur'barang?' $ Tanggal$:…………………………………$
Unit$observasi$ $ :…………………………………………$
Apakah'jarak'fotocopy,'fax,' ' $ '
$ $ $ Apakah$tidak$ada$proses$
$ $ $ $ $
Apakah'data'dikumpulkan'
tempat'sampah'jauh'dari'posisi' ' 'Solusi(
$Kategori(Waste( Jenis(pertanyaan(untuk(
pengayaan$pekerjaan?$ Contoh(
'Excess'processing' duduk?'
berulang<ulang?'
mendeteksi(waste(
Apakah$lokasi$antar$unit$ $ $
Transpot$ Apakah'ada'pengulangan'untuk'
apakah$ada$peralatan$yang$
Apakah'pendistributioan'
pelayanan$jauh?$ '$ '$
'Defect$
' rusak/tidak$terpelihara?$
email/telpon?'
dokumen'msh'manual?'
Apakah$jarak$fotocopy,$fax,$ $ $
Apakah$ada$pekerjaan$yang$
tempat$sampah$jauh$dari$posisi$ $ $
Inventory' Apakah'informasi'disampaikan'
Apakah'ada'barang'rusak?' ' '
$ dilakukan$untuk$kedua$kali?$
duduk?$
' tidak'sesuai'kebutuhan?'
'$ Apakah'ada'barang'berlebih?'
Apakah$ada$dokumen$yang$ '$ '$
' Apakah$pendistributioan$
dikirim$2$kali$krn$berbagai$
'$ Apakah'ada'barang'kadaluarsa?'
alasan?$ ' '

Apakah'tata'ruang'di'desain'
Apakah$ada$pengisian$formulir$ ' '$
Over$production$
Motion' berulang?$
sesuai'aliran'pelayanan?' $

Apakah$ada$perlengkapan$yang$ $
Apakah'ada'upaya'mengatur' ' '
$ telah$disiapkan$tidak$digunakan$ $
posisi'peralatan,'alur'orang,'&'
' Apakah$terlalu$banyak$minta$
alur'barang?' $
Waiting$ persetujuan?$ $
Apakah'data'dikumpulkan' ' '
Apakah$ada$keterlambatan$ $
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Excess'processing'
HERI% berulang<ulang?'
dalam$menyampaikan$data$
$ hasil$peneriksaan$ $
Apakah'ada'pengulangan'untuk' ' '
' email/telpon?'
Apakah$ada$keterlambatan$ $ $
dalam$pengiriman$obat$dan$
$ Apakah'informasi'disampaikan'
alkes?$ ' '
' tidak'sesuai'kebutuhan?'
Non$Utilized$ Apakah$tidak$ada$crossF $ $
'people$ training?$
46%
Apakah$tidak$ada$upaya$ $ $
$ menggali$usulan$perbaikan?$

Apakah$tidak$ada$proses$ $ $
 Apakah'jarak'fotocopy,'fax,' ' '
tempat'sampah'jauh'dari'posisi'
' duduk?'

Apakah'pendistributioan' ' '

' dokumen'msh'manual?' HERI%
Inventory' Apakah'ada'barang'rusak?' ' '

' Apakah'ada'barang'berlebih?' ' '

' Apakah'ada'barang'kadaluarsa?' ' '

Apakah'tata'ruang'di'desain' '
FORMULIR()(AUDIT(WASTE( '
Motion' sesuai'aliran'pelayanan?'
Nama$Observer$/$tim$ :………….................................$ $ Tanggal$:…………………………………$
Unit$observasi$ $ :…………………………………………$ $
$ $ $ Apakah'ada'upaya'mengatur'
$ $ $ ' '
Kategori(Waste( posisi'peralatan,'alur'orang,'&'
Jenis(pertanyaan(untuk( Contoh( Solusi(
' mendeteksi(waste(
alur'barang?'
apakah$ada$peralatan$yang$
Apakah'data'dikumpulkan' '$ '$
Defect$ rusak/tidak$terpelihara?$
Excess'processing' berulang<ulang?'
Apakah$ada$pekerjaan$yang$ $ $
$ Apakah'ada'pengulangan'untuk'
dilakukan$untuk$kedua$kali?$ ' '
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dikirim$2$kali$krn$berbagai$
Apakah'informasi'disampaikan' ' '
'$ alasan?$
tidak'sesuai'kebutuhan?'
Apakah$ada$pengisian$formulir$ $
'Over$production$ berulang?$ $

Apakah$ada$perlengkapan$yang$ $
$ telah$disiapkan$tidak$digunakan$ $

Apakah$terlalu$banyak$minta$ $
Waiting$ persetujuan?$ $

Apakah$ada$keterlambatan$ $
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
HERI%
dalam$menyampaikan$data$
$ hasil$peneriksaan$ $

Apakah$ada$keterlambatan$ $ $
dalam$pengiriman$obat$dan$
$ alkes?$

Non$Utilized$ Apakah$tidak$ada$crossF $ $
people$ training?$

Apakah$tidak$ada$upaya$ $ $
$ menggali$usulan$perbaikan?$

Apakah$tidak$ada$proses$ $ $
$ pengayaan$pekerjaan?$

Apakah$lokasi$antar$unit$ $ $
Transpot$ pelayanan$jauh?$

Apakah$jarak$fotocopy,$fax,$ $ $
tempat$sampah$jauh$dari$posisi$
$ duduk?$

$ $ $
Apakah$pendistributioan$

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
HERI%

47%
 HERI%

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
HERI%

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
HERI%

48%
 HERI%

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
HERI%

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
HERI%

49%