DEVELOP LEAN HOSPITAL

PHARMACY:
Inventory/Logistic Management System
Pharmacy Workflow System

PE Wardani
 Latar Belakang
1. Aspek Inventory: “Inventory is usually a pharmacy’s largest
asset.”Too much inventory translates to too little cash. Also, to
less profitability. Too little inventory can mean lost sales.
(Raby,D,2013)
2. Aspek Workflow: Sistem penataan obat konvensional
mengandung waste motion &transportation. Pelayanan kurang
efisien, berdampak waktu tunggu lebih lama (waste waiting)
dan tekanan pada karyawan(waste human potential)
3. Aspek Inventory-Workflow: Mayoritas Farmasi RS tidak
memisahkan obat fast moving-slow moving
4. Permenkes 72 tahun 2016- Standar Pelayanan Kefarmasian
5. Snars Edisi 1, 2018
6. Gap antara Standar - Realita
 Tujuan
• Pemahaman tentang Inventory Management System
& Pharmacy Workflow System berbasis Lean
Healtcare
• Upaya meningkatkan mutu aspek Inventory
Management System & Pharmacy Workflow System
berbasis Lean Healtcare
• Upaya pemenuhan standar dan menekan waste
melalui implementasi prasarana yang tepat.
• Adopsi perkembangan teknologi untuk
meningkatkan mutu aspek Inventory Management
System & Pharmacy Workflow System berbasis Lean
Healtcare
Pelayanan Kefarmasian &
Penggunaan Obat (PKPO)
Lulus

Tidak Lulus
Menghadapi Akreditasi –
Memenuhi Standar
Di Rumah Sakit
“we have world-class doctors, world-
class treatment, and completely
broken processes.”
Graban, 2011
 Pengambilan Customer
Data Informasi Kaizen
keputusan satisfaction
LEAN HOSPITALS

• Lean is very different from

traditional “cost-cutting”
approaches that have been tried in
multiple industries, including
healthcare
 Lean thinking is LEAN:
• Provide a way to do more and more
• With less and less:
– Less human effort
– Less equipment
– Less time and
– Less space
• While coming closer and closer to providing
customer with what exactly they want (meet
customer value)
PKPO

Seleksi &
Pengorganisasian Penyimpanan
Pengadaan

Peresepan & Persiapan &

Pemberian Obat
Penyalinan Penyerahan

Pemantauan
Tujuan Pelayanan
Kefarmasian

Was The Processes broken?

Un-Lean Process (WASTE)

Inventory Motion

Transportation Deffect

Human
Waiting
Potential

Over Over
production processing
 WASTE Inventory
*Studi kasus RS X

Total daftar obat

1494

Fast moving Medium moving Slow moving

80% transaksi 15% transaksi 5% transaksi
136 209 1149

Aktif Non Aktif

1001 148
 Gambaran Persediaan
Nama Obat Sum of KELUAR Sum of STOCK Akhir KELUAR vs STOCK

Metformin 500mg 28,038 52,944 1.89

Miniaspi tab 1,443 40,092 27.78
Starfolat Tab 2,369 38,453 16.23
Vit B Complex 18,728 30,159 1.61
Paracetamol Tab 24,303 30,156 1.24
Medicine Packet SI-20-S 30,000 30,000 1.00
Vit C Tab 1,006 25,131 24.99
Aspilet Chewable 14,517 25,033 1.72
ISDN 5mg Harga jual Piroxicam KF 8,427 Stok Obat Slow Moving
23,038 2.73
Domperidon 10mg Tab
Amitriptyllin 25mg Tab
10mg Rp 153 13,450
3,315
1149 item
22,837
21,562
1.70
6.50
Calsium Laktat Total Nilai:Rp. 2.346.561
21,913 Berapa WASTE Inventory?
21,413 0.98
Profolat 400mcg 5,940 21,097 3.55
Methilprednisolone 4 mg Tab 6,086 19,460 3.20
Salbutamol 4mg tab 721 18,962 26.30
Omeprazole 20mg cap 21,513 17,371 0.81
NACL PUYER 2,600 15,400 5.92
Irbesartan 150 Mg tab 4,190 15,341 3.66
Piroxicam 10mg tab 44 15,337 348.57
Asam Traneksamat 500mg tab 3,263 14,671 4.50
 WASTE Pelayanan resep
Over Defect Defect
Waiting
Defect procesi Waiting
ng
Over Over
procesi
procesi
ng
ng Print
label

Prescription
Electronic/manual Validasi resep
Waiting
Waiting Defect transpo
Defect Defect Waiting rtation
motion
Over Over
procesi procesi invento
ng ng ry
Over Human
procesi Potenti
ng al

Penyerahan obat disertai Kontrol obat yang TTK menyatukan resep,

informasi disiapkan vs resep label, picking obat,
labeling dalam 1
keranjang
WASTE: motion & transportasi Ke arah
 waiting, human potential counter
penerimaan

Rak Obat (RO) Ke arah

counter
Penyerahan

RO
RO
Meja Kerja

RO
Pergerakan petugas dan baki obat kosong :
Dari arah counter  meja kerja  seluruh
ruangan  counter penyerahan :

Meja
labeling
…dan Apabila penataan
seperti ini…
WASTE: Defect
Tantangan Efisiensi Pelayanan
di Era Smart Hospital

Berbasis
Teknologi
LEAN Tools
 Lean Capabilities

We need to structure
Work is design as a
work in a ways that
series of ongoing
problems are readily
experiment that
apparent so that
immediate reveal
they can be fixed as
problems
quickly as possible

Graban, 2011
 Traditional vs Lean
organization
• Traditional organizations often focus more on cost and
the efficiency of individuals or departments.
• One way in which Lean is different from traditional
thinking is the focus on flow.
• Instead of asking people to work faster, Lean
organizations focus on reducing delays and systemic
barriers to flow.
• By focusing on flow, we can often increase capacity
(which often leads to revenue increases) and reduce
costs as an end result of these improvements
 Focusing on Flow

Value Streams Should Flow Like a

River
• Smooth & Steady flow

Flow of medication/prescription
• Physical flow from pharmacy to patient
How to streamline the flow

SDM Prasarana

Alur Penataan
 Kondisi Umum Rak
Penyimpanan

Rak kayu/besi lama

Sistem 2 dimensi  jumlah obat rata-rata 100-

2000, butuh banyak rak  ruangan terasa
sempit

Ruang penuh dengan rak  workflow

terhambat  fase bottleneck, idle
Prasarana: Rak 3 Dimensi

Volume: Panjang-Lebar-
Tinggi dimanfaatkan
Keuntungan: Ringkas-
Rapi-Menyediakan area
kosong dalam ruangan
untuk perbaikkan flow
Kanban Card
Prasarana: Komputer & HIS

Labeling

• Flow
Billing like a
Electronik river
prescribing
(review
resep)
Teknologi Robotik
 i-ROOM

i-ROOM RFID Antenne

Menerapkan Pull
System

High volume
i-ROOM
low cost

make things talk to each other

Sistem Penataan Berbasis Pareto
Konsep:
• Memisahkan obat fast
moving (FM-20% jumlah
item-80% jumlah
transaksi)
FM • Membatasi pergerakan
80% resep di area fast
moving: menghemat
langkah  menghemat
waktu
FM
• Hanya 20% resep yang
memerlukan pergerakan
Slow moving ke area slow moving
• Hemat langkah  hemat
energi karyawan
 Penataan
• Pembatasan area
pergerakan karyawan
• Pergerakan lebih
FM
singkat – efisien
Area pergerakan
utama karyawan
• Visualisasi: tumpukan
antrian keranjang
FM
resep seimbang di
SM semua fase
Pengendalian persediaan
• Konsep penataan obat berbasis pareto,
memisahkan obat Fast moving – Slow moving
Visualisasi
– Kelompok obat fast moving termonitor  tidak
boleh kosong
• Contoh: bila kosong (obat BPJS) harus diganti obat lain
yang lebih mahal
– Kelompok obat slow moving termonitor  tidak
boleh berlebihan
• Contoh: bila jumlah obat 1000  obat slow moving 800
item. Bila stok obat berlebihan, secara total akan
membebani nilai persediaan
Alur
• Alur resep masuk
 keluar
– Obat fast moving
80% transaksi
– Obat slow moving
20% transaksi
• Pastikan tidak ada
bottle neck & idle
proccess
 SDM

Rofiatun, 2017

Pengaturan jumlah & Penjadwalan yang tepat

menentukan alur pelayanan mengalir
 SDM
• Cycle time: waktu yang diperlukan petugas untuk menyelesaikan
1 siklus pekerjaan (termasuk waste yang ada)
• Takt Time: waktu real yang dibutuhkan sesuai jumlah
permintaan dan waktu (dan jumlah SDM) yang tersedia untuk
pelayanan setiap hari

Rofiatun, 2017
 Alur: resep & karyawan mengalir

Print
label

Prescription
Electronic/manual Validasi resep

Penyerahan obat disertai Kontrol obat yang TTK menyatukan resep,

informasi disiapkan vs resep label, picking obat,
labeling dalam 1
keranjang
Sistem konvensional vs
Automation

Biaya Safe service

CHANGE
investasi Speed
OR NOTHR Problems
Patient complain
Director’s KPI
Toyota House

(University of Kentucky, 2014)

TERIMA KASIH