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"Asuhan Keperawatan (Aske merupakan suatu pendekatan yang dilakukan seorang perawat terhadap kliennya. Motu Asuhan keperawatan di RSUD Dr. H. Abdul Moeloek Lampung masih diternokan pendokumentasian asuhan keperawatan pada rekam medik pasien yang asih belum terisi; masih adanya masyarakat yang merasa belum puas terhadap pelayanan yang dibe ·kan oleh perugas diruangan (20,3%); kelohan tentang pelayanan sebanyak 21,9%; 70% dari 20 pasien mengatakan perawat yang kurang ramah dalam menangani pasien, 75% dari 20 pasien merasa tidak diperhatikan oleh perawat. Hal ini perlu sekali mendapat perhatian dari semua pihak terkait:; dan menempatkan Pemantauan Motu Askep (PMA) sebagai kegiatan yang penting dilaksanakan secara berkesinambungan. Dalam pelaksanaannya, PMA belum didukung dengan sistem informasi pengolahan data yang masih dilakukan secara manual, belum ada analisis tiap penelitian adalah Ruang Rawat Inap yang ada di Rumah Sakit Umum Daerah Dr. H. Abdul Moeloek Propinsi Lampung. Sebagai hasil dari penelitian ini adalah diperolehnya prototipe Sistem lnformasi Pemantauan Mutu Asuhan Keperawatan yang diharapkan dapat effektif dan effisien dalam penyediaan informasi yang dibutuhkan. lnformasi yang diperoleh akan dirancang agar benar-benar relevan. cepat, tepat dan akurat, serta dapat lebih bennanfaat. terutama untuk kepentingan perencanaan peningkatan mutu pada umumnya, dan pemantauan Askep pada khususnya, sehingga dapat tercapai optimalisasi pemantauan mutu Askep di rumah sakit tersebut Agar pelaksanaan sistem infonnasi ini dapat berjalan dengan baik dan berkelanjutan, dibutuhkan pengembangan prototipe yang berbasis jaringan.

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Asuhan Keperawatan (Askep) represent an approach to do a nurse to its clien. Quality of Askep in Dr. H. Abdul Moeloek :cam pung hospital still found documentation of asuhan keperawatan on IJ&.tient record which still not yet loaded; there is still of society which feel not et satisfied to service given in a hospital (03%); sigh about ice counted 2 J,goA,; 70% from 20 patient tell less friendly nurse in handling patient, 75% from 20 patient feel not be paid attend on by nurse. This matter very important to get attention from all related partieand place Monitoring Quality of Askep ( PMA) as activity which is important to be implementation chronically.

In its implementation, PMA not yet been supported with infonnation system. data-processing which still (done/cond ucted) manually. there is no analysis every treatment upbringing step and also monitoring instrument quality of standard not yet altogether used to assess quality o askep. For that require to develop of monitoring.

This research was result a prototype of Information System Monitoring Quality of Askep. This system is expected to supply any needed information effectively earn and effektif of efficient in is ready of required information. obtained infonnation will be designed to really relevant, quickly, precisely and is accurate, and also earn more useful, especially for planning of make-up of quality in general, and monitoring of Askep especially, so that can reach by monitoring quality of Askep. For implementation of this information system can walk better and have continuation, required by development of prototype being based on network."

"From the Back Cover: The Health Care Leader's Essential Guide to driving quality, value, and performance. Advanced Performance Improvement in Health Care: Principles and Methods provides healthcare educators, leaders, and clinicians with the specific knowledge and tools vital for creating and advocating for quality-centric, next-generation healthcare organizations. This unique compilation of management, analytical, and statistical methods and techniques serves as a comprehensive guide to harnessing today's technology and developing a culture of quality that delivers sustainable, quantifiable value in healthcare organizations. Amidst a deepening crisis in U.S. health care, Advanced Performance Improvement provides a results-oriented approach to rehabilitating an ailing healthcare system. With his innovative, instructive strategies, the author offers a welcome road map to guide meaningful change in the industry and to equip healthcare managers to meet 21st century challenges. Offers a comprehensive methodology for improving quality in healthcare organizations. Details a process analysis toolkit with dozens of proven techniques. Illustrated with easy-to-follow diagrams and flow charts. Provides best practices for measuring value and performance. Includes extensive discussion of medical informatics, Lean, Six-Sigma, and more."

"Pelayanan di Instalasi Gawat Darurat (IGD) memegang peran penting dalam menentukan kualitas pelayanan dan keselamatan pasien di rumah sakit. Indikator kinerja IGD, seperti Length of Stay (LOS), yang mengukur lama pasien d IGD dari kedatangan hingga pemulangan atau pemindahan, dapat memengaruhi tingkat kepadatan di IGD. Penelitian ini bertujuan untuk mengidentifikasi alur pelayanan, hambatan, dan akar penyebab masalah terkait LOS di IGD. Pengumpulan data dilakukan pada bulan April-Mei 2024 dengan pendekatan kualitatif studi kasus, berupa observasi pada 30 pasien, wawancara, dan telaah dokumen. Analisis data menggunakan flowchart untuk mengidentifikasi alur pelayanan, Value Stream Mapping untuk mengenali kegiatan bernilai dan menemukan waste, serta The Five Whys untuk menganalisis akar penyebab hambatan. Metode Lean Thinking digunakan untuk menghasilkan alur dan Model BAS (Baseline, Assess, Suggest Solution) dari Model BASICS. Hasil penelitian menunjukkan bahwa alur pelayanan pasien IGD melibatkan lima tahapan; dengan 65,5% waktu pelayanan adalah kegiatan non-value added, 23,4% kegiatan necessary but non-value added, dan 11,1% kegiatan value added, dengan total Lead Time 7 jam 55 menit 29 detik. Dari sisi pasien, waste yang terjadi meliputi waste of waiting (94,9%) dan transportation (5,1%). Bottleneck terjadi pada aktivitas menunggu terdaftar di rawat inap (25,2%), menunggu advis DPJP (22,9%), menunggu hasil pemeriksaan penunjang (22,3%), dan menunggu kesiapan rawat inap (18,2%), dengan total 88,6%. Perbaikan LOS di IGD dapat menggunakan lean tools seperti standardized work, visual management, heijunka, kaizen, dan just in time agar waste dapat dikurangi.

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Emergency Department (ED) services play a crucial role in determining the quality of care and patient safety in hospitals. Performance indicators in the ED, such as Length of Stay (LOS) which measures the duration from a patient's arrival to their discharge or transfer can significantly impact the congestion levels in the ED. This study aims to identify the service flow, obstacles, and root causes of issues related to LOS in the ED. Data collection was conducted from April to May 2024 using a qualitative case study approach, including observations of 30 patients, interviews, and document reviews. Data analysis involved using flowcharts to identify the service flow, Value Stream Mapping to recognize value-added activities and identify waste, and The Five Whys to analyze the root causes of obstacles. Lean Thinking methodology was applied to develop a service flow and the BAS (Baseline, Assess, Suggest Solution) model from the BASICS model. The study results show that the patient service flow in the ED involves five stages, with 65.5% of service time consisting of non-value-added activities, 23.4% of necessary but non-value-added activities, and 11.1% of value-added activities, resulting in a total lead time of 7 hours, 55 minutes, and 29 seconds. From the patient's perspective, the waste observed includes waiting (94.9%) and transportation (5.1%). Bottlenecks were identified in activities such as waiting to be registered for inpatient care (25.2%), waiting for specialist advice (22.9%), waiting for the results of supporting examinations (22.3%), and waiting for inpatient readiness (18.2%), totaling 88.6%. Improving LOS in the ED can utilize lean tools such as standardized work, visual management, heijunka, kaizen, and just-in-time to reduce waste."

"Latar Belakang : Waktu tunggu menjadi suatu permasalahan yang mendesak di rumah sakit karena semua rumah sakit saling berkompetisi untuk memberikan pelayanan yang tepat, cepat dan profesional. Di ruang rawat inap lantai 5 gedung baru RS Permata Cibubur kerap masih didapatkan keluhan pasien atau keluarga pasien terkait waktu tunggu pasien pulang dari rawat inap. Tujuan : Tercapainya perbaikan pelayanan pasien pulang dari rawat inap dengan menggunakan metode Lean Six Sigma. Metode : Penelitian ini menggunakan desain penelitian quasi experimental dengan memberikan perlakuan perbaikan menggunakan metode Lean Six Sigma dan menghitung waktu tunggu pada proses pelayanan pasien pulang pada 2 kelompok pasien dengan jaminan pribadi dan pasien jaminan asuransi swasta, sebelum dan sesudah perlakuan. Hasil : Setelah dilakukan observasi dan wawancara maka dilakukan identifikasi waste pada proses pelayanan pasien pulang dari rawat inap dan didapatkan 4 waste, yaitu waiting, defect, motion, dan overprocessing. Core problem dari proses pelayanan pasien pulang didapatkan bahwa DPJP tidak input sendiri resep pasien pulang, hal ini menyebabkan beberapa kegiatan yang tidak bernilai tambah dan membuat waktu tunggu proses pelayanan pasien pulang menjadi memanjang. Fokus perbaikan yaitu dengan menjadikan DPJP input sendiri resep pasien pulang dan didapatkan total waktu tunggu yang mengalami penurunan dan prosentase kegiatan bernilai tambah yang meningkat. Rata-rata waktu tunggu pasien pulang sebelum perlakuan dengan jaminan pribadi sebesar 61 menit dan dengan jaminan asuransi swasta sebesar 125,8 menit. Setelah dilakukan perlakuan upaya perbaikan dengan metode Lean Six Sigma didapatkan rata-rata waktu tunggu pasien pulang dengan jaminan pribadi sebesar 43,2 menit dan pasien dengan jaminan asuransi swasta sebesar 101,7 menit. Sedangkan prosentase kegiatan bernilai tambah sebelum perlakuan pada pasien dengan jaminan pribadi sebesar 57,4 % dan pasien dengan asuransi swasta sebesar 29,7%. Sesudah perlakuan upaya perbaikan didapatkan prosentase kegiatan bernilai tambah pada pasien pribadi sebesar 59,7 % dan pasien dengan asuransi swasta sebesar 30,4%. Kesimpulan : Metode Lean Six Sigma secara umum dapat dikatakan efektif untuk digunakan dalam melakukan evaluasi terhadap alur pelayanan di unit pelayanan kesehatan, karena terbukti khususnya pada penelitian ini terjadi pengurangan waktu tunggu pada proses pelayanan pasien pulang dari rawat inap.

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Background: Waiting time is an urgent problem in hospitals because all hospitals compete with each other to provide precise, fast and professional services. In the inpatient room on the 5th floor of the new building of Permata Cibubur Hospital, there are often still complaints from patients or patients' families related to the waiting time for patients to return home from hospitalization. Objective: To achieve the improvement of patient services discharged from hospitalization by using the Lean Six Sigma method. Method: This study uses a quasi-experimental research design by providing improvement treatment using the Lean Six Sigma method and calculating the waiting time in the process of returning patients to 2 groups of patients with personal insurance and private insurance patients, before and after the treatment. Results: After observation and interviews, waste identification was carried out in the service process of patients returning from hospitalization and 4 wastes were obtained, namely waiting, defect, motion, and overprocessing. The core problem of the service process for discharged patients is found that the DPJP does not input the prescriptions of discharged patients themselves, this causes several activities that are not value-added and makes the waiting time for the process of serving discharged patients prolonged. The focus of improvement is to make the DPJP input its own prescription for patients to go home and get a decrease in the total waiting time and an increase in the percentage of value-added activities. The average waiting time for patients to go home before treatment with personal insurance is 61 minutes and with private insurance guarantee is 125.8 minutes. After the treatment of improvement efforts with the Lean Six Sigma method, the average waiting time for patients to go home with personal insurance was 43.2 minutes, and for patients with private insurance, guarantees were 101.7 minutes. Meanwhile, the percentage of value-added activities before treatment for patients with personal insurance was 57.4% and for patients with private insurance was 29.7%. After the treatment of improvement efforts, the percentage of value-added activities in private patients was 59.7% and for patients with private insurance was 30.4%. Conclusion: The Lean Six Sigma method in general can be said to be effective to be used in evaluating the service flow in health service units because it is proven that especially in this study there is a reduction in waiting time in the service process of patients returning from hospitalization."