Pelayanan rawat jalan merupakan garda utama layanan rumah sakit, apabila kesehatan pasien secara maksimal ditangani di pelayanan poliklinik maka tidak diperlukan lagi pelayanan lanjutan seperti rawat inap. Akan tetapi, waktu tunggu yang lama di pelayanan rawat jalan dapat menghambat kelancaran pelayanan dan menjadikan pasien tidak memberikan kepuasan yang tinggi. Metode Lean Hospital yang telah berhasil diterapkan di beberapa rumah sakit nasional maupun internasional diharapkan dapat menghilangkan hambatan dan menambah aktivitas yang bernilai pada proses pelayanan pasien. Tujuan penelitian ini adalah untuk mengidentifikasi alur pelayanan, letak hambatan dan akar penyebab masalahnya. Penelitian dilakukan pada Instalasi Rawat Jalan Poliklinik Spesialis Penyakit Dalam bulan Mei 2019. Jenis penelitian ini adalah penelitian deskriptif kualitatif menggunakan data observasi, wawancara dan telaah dokumen. Sampel diambil secara purposif hingga tercapai keadaan jenuh sejumlah 30 pasien. Analisa data menggunakan flowchart dalam mengidentifikasi alur pelayanan, kemudian Value Stream Mapping untuk mengidentifikasi kegiatan bernilai, menemukan waste serta mengidentifikasi hambatan dan The Five Whys untuk menganalisa akar penyebab hambatan. Penelitian ini menerapkan metode Lean Thinking sampai membuat alur dan Model BAS yaitu Baseline, Assess, dan Suggest Solution dari Model BASICS. Hasil penelitian menunjukkan alur pelayanan pasien rawat jalan secara langsung melibatkan 5 unit; 85.91% waktu pelayanan merupakan kegiatan non value added dan hanya 14.08% kegiatan value added. Total Waiting Time 2 jam 4 menit; Total Cycle Time 20 menit; Total Lead Time 2 jam 24 menit 30 detik. Waste yang terjadi adalah waste of waiting (35%), overproduction (29%), defects (22.5%), transportation (7%), overprocessing (6.2%). Hambatan utama terletak pada bagian Farmasi Rawat Jalan. Dari hasil observasi didapatkan hambatan waktu terbesar ada pada bagian farmasi. Dari analisa The Five Whys didapatkan akar penyebab masalah terbanyak ada pada jumlah sumber daya manusia dan penerapan e-prescription yang belum optimal. Usulan perbaikan dengan lean tools pada proses pelayanan rawat jalan diharapkan dapat menurunkan kegiatan non value added menjadi 60.25% dan meningkatkan kegiatan value added menjadi 39.74%.

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Outpatient services are the main guard of hospital services, if the patient’s health is maximally handled in these services then further services such as hospitalization are no longer needed. However, long waiting time in outpatient services can hamper the smooth running of services and make patients did not give their high satisfaction. The Lean Hospital method that has been successfully implemented in hospitals worldwide is expected to eliminate barriers and add valuable activities to the patient service process. The purpose of this study is to identify the service flow, location of the obstacles and the root causes of the problems. The study was conducted at the Outpatient Services Internal Medicine Specialist in May 2019. This research is a qualitative descriptive study using observational data, interviews and document review. Samples were taken by purposively by using patient sample until reached data saturation to 30 respondents. Flowcharts were used to identifying process flow, then using Value Stream Mapping to identify value-added activities, find waste and identify obstacles and The Five Whys to analyze the root causes of obstacles. This research applied the Lean Thinking Method until creating flow and applied BAS from BASICS Model, Baseline, Assess, and Suggest Solution. Results from this study showed that Outpatient Services Internal Medicine Specialist process including 5 units directly; 85.91% process time is non-value added activities and only 14.08% value-added activities. Total Waiting Time 2 hours 4 minutes; Total Cycle Time 20 minutes; Total Lead Time 2 hours 24 minutes 30 seconds. Waste observed as a list: waste of waiting (35%), overproduction (29%), defects (22.5%), transportation (7%), and overprocessing (6.2%). The main obstacle lies in the Outpatient Pharmacy section. From the results of observations, the biggest time constraints are in the pharmaceutical department. From the analysis of The Five Whys, the root causes of the most problems were found in the number of human resources and the application of e-prescription that was not optimal. The proposed improvements using lean tools at the outpatient services expected to decrease non-value added activity to 60.25% and increase value-added activities to 39.74%.