Pendekatan Lean Hospital untuk Mengidentifikasi Waste Kritis dalam Penanganan Kegawatdaruratan di Instalasi Rawat Jalan RSU An Ni’mah

Rizqiana Arum Sari, Aliefety Putu Garnida, Samingan Samingan

Abstract


Latar Belakang: Pelayanan rawat jalan merupakan titik akses utama bagi pasien rumah sakit dan berpotensi mengalami kejadian kegawatdaruratan yang membutuhkan respons cepat dan terkoordinasi. Namun, penanganan kegawatdaruratan di rawat jalan sering kali belum didukung oleh alur pelayanan yang spesifik dan terstandarisasi. Penelitian ini bertujuan untuk mengidentifikasi dan menganalisis pemborosan (waste) kritis dalam proses penanganan kegawatdaruratan di Instalasi Rawat Jalan RSU An Ni’mah menggunakan pendekatan Lean Hospital. Metode: Penelitian ini merupakan studi kualitatif dengan desain studi kasus yang dilaksanakan pada November–Desember 2025. Informan dipilih secara purposive dan terdiri atas unsur manajemen, penanggung jawab unit, serta tenaga pelaksana langsung. Pengumpulan data dilakukan melalui observasi non-partisipan terhadap alur pelayanan, wawancara mendalam, serta telaah dokumen terkait. Analisis data dilakukan menggunakan Value Stream Mapping (VSM) untuk memetakan alur proses dan mengukur waktu pelayanan, perhitungan Value Added Ratio (VAR), metode Borda untuk menentukan waste kritis, serta analisis fishbone untuk mengidentifikasi akar penyebab pemborosan. Hasil penelitian menunjukkan total lead time penanganan kegawatdaruratan sebesar 127,1 menit dengan VAR sebesar 19%, yang mengindikasikan dominasi aktivitas non value added. Pemborosan kritis didominasi oleh waste waiting (24,2%), diikuti defect (21,9%) dan motion (16,1%). Pemborosan terutama terjadi pada fase antrean awal pelayanan, penentuan kegawatdaruratan, proses administrasi alih rawat, serta koordinasi dan transfer pasien ke Instalasi Gawat Darurat. Analisis akar penyebab menunjukkan bahwa waste waiting dipengaruhi oleh faktor sumber daya manusia, metode pelayanan, ketersediaan peralatan, dan mekanisme monitoring. Kesimpulan: Inefisiensi penanganan kegawatdaruratan di rawat jalan terutama bersumber dari desain sistem dan alur pelayanan. Pendekatan Lean Hospital memberikan dasar yang sistematis untuk perbaikan berkelanjutan melalui penguatan SOP kegawatdaruratan rawat jalan, penerapan alur fast track, standardisasi alih rawat, dan penguatan monitoring berbasis response time.

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DOI: https://doi.org/10.52643/marsi.v10i2.8321

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