KENDALI MUTU & KENDALI BIAYA

MELALUI PENERAPAN KAIZEN

Memberikan Nilai Tambah Bagi Pasien Dan Efisiensi Di Era JKN

Dr.dr. Fathema Djan Rachmat, Sp.B, Sp.BTKV (K), MPH

 THE CHALLENGES
Critical Issues in Global Healthcare

Critical Issues in Global Healthcare

 THE CHALLENGES

9 perspective of Quality Assurance & Cost Control Team

(Mandatory from Permenkes 71 / 2013)

PATIENT
1. Quality EFFECIVITY TIMELINES
SAFETY
2. Delivery
3. Cost PATIENT CARE
CENTEREDNE COORDINATIO EFFICIENCY
4. Integrity SS N

DOCUMENTATI CLINICAL
ACCESS
ON PATHWAY
 KORIDOR PELAYANAN RUMAH
SAKIT

Healthcare Eco-System Penilik mutu

UU dan PP
Pelaksana
pemberi mandat
mandat

Program Kerja
Nasional
Pembayar

Provider
 dari FEE for SERVICE menuju
PROSPECTIVE PAYMENT SYSTEM
BEFORE BPJS AFTER BPJS

FEE FOR SERVICE PROSPECTIVE PAYMENT SYSTEM

Tarif = Cost + Profit Profit = Sale - Cost
Dari bagan di atas terlihat bahwa pendapatan
maksimum untuk sekelompok pelayanan medis dengan
indikasi medis yang sama, telah ditentukan pada nilai
tertentu.
 THE CHALLENGES

Pemenuhan kebutuhan pegawai

tidak dapat beradaptasi dengan
kecepatan peningkatan produksi

Keterbatasan pada logistik farmasi, akibat

peningkatan yang cukup signifikan dari
kebutuhan ( peningkatan jumlah pasien )

Biaya tinggi pada berbagai prosedur

diagnostik dan terapetik
DAMPAK PEMBIAYAAN BAGI RS SWASTA
ERA sebelum JKN ERA JKN

income Middle – up Income

Market Middle – Low
Market

Market
RS. SWASTA
Market
RS. SWASTA

Up Middle Low Up Middle Low

THE CHALLENGES
One day in RS PELNI
HIDDEN COST
TIPE PEMBOROSAN
STRATEGIC FORESIGHT
- A strategic anticipation. Prediction and
evaluation of future events over a long
or medium term -

Goals:
UNDERSTAND THE PATTERNS, DEVISE SCENARIOS FOR THE
FUTURE, AND THEN CAN CREATE STRATEGIES TO AVOID
DANGERS AND SEIZE OPPURTUITIES IN THE FUTURE

Often used as a source of diagnoses of major

social and economic problems over time and as a
tool for forecasting and decision- making by the
goverment, business and the public sphere
institutions
 The Future of Work.
NOW

Multiple Generation : Connected, the use of social

1 Different generations, values

working side by side 5 cloud knowledge sharing
and instant communication
tools

Faster : The world is Talent Warriors,

2 evolving faster than ever
before 6 organization, managers and
leaders with the best talent
wins
Innovative and Disruptive.
We must constantly seek to
3 disrupt and change using
innovation methods
7 Workspace,global,
distributed
virtual,

Digitally enabled, Digital and

4 technology disruptors the
world
 CHALLENGES IN JKN ERA

PMK No. 69 tahun

2013
Instable condition, determine
PMK No. 59 tahun management to do an appropriate
strategy. The strategy dan suits
2014 with agile condition LEAN
STRATEGY
PMK No. 52 tahun -harvard business
2016 review, lean strategy-
PMK No. 64 tahun
2016
“ Management has no more critical role than motivating and engaging large
numbers of people to work together toward a common goal”
- Convis, Lean Hospital -

not just about getting through an intial Lean

Leadership and project, but it’s a never ending journey
management (continuous improvement )
challenge

“ We put a lot of thought into these processes

Traditional and they must be perfect” otherwise it’s a failure
management mindset

Process can always be improved upon, even if it

Lean Thinkers seems to work fine today
 WHY LEAN

The Lean Strategy Process

ANALYSIS LEARNING
DELIBERATE
VISION The organization managers at all EMERGENT
STRATEGY
Founders examines its levels make daily STRATEGY
Senior
choose the strengths, decisions and Feedback
executives agree
business’s weakness, conduct and findings
upon the firm’s
reason for oppurtunities, experiments reshape the
objective, scope,
existance threats, resources, guided by the strategy
and advantage
and capibilities strategy

the process restarts

 LEAN MANAGEMENT

“ A systematic approach to
identifying and eliminating waste
( non value added activities ) “ A management approach
through continous improvement that focus on total
by flowing the product/ service at elimination of waste and
the pull of the customer( patient) respect to people.”- M.
in pursuit of perfection.” - C.
Graban, Lean Hospital-
Wolcott, Healthcare Kaizen Tour
2014

Pendekatan manajemen yang fokus untuk

menghilangkan pemborosan dan menghargai
pegawai
 TYPICAL LEAN RESULT

• 20 - 80 % Productivity improvement
• 50 - 90 % Reduction in inventory
• 50 - 99 % throughput time reduction
• 30 - 50 % reduction in space
requirement
• 10 - 30 % reduction in overheads
Art smalle: A brief History of setup reduction, 1988
 LEAN benefit for hospital : success story

Alegent Health, Nebraska

Menurunkan turn around time untuk tes lab 60 % tanpa menambah SDM
atau instrumen baru

Kingston General Hospital, Ontario

Menurunkan cycle time proses sterilisasi instrumen 70 %

Allegheny Hospital, Pennsylvania

Menurunkan kematian pasien terkait sepsis akibat CVP 95 %

ThedaCare, Wisconsin
Menurunkan waktu tunggu pasien akan operasi ortopedik dari 14 hari
menjadi 31 jam

Avera McKennan
Menurunkan Length Of Stay pasien 29 % dan menunda renovasi IGD
bernilai $1,25 juta dolar

Graban, Mark. Lean Hospital. 2011

 Effects of lean implementation in Franciscan

Baptist Health Care

(Florida)

- The Executive Guide to Healthcare Kaizen-

 contoh
Dimensi Mutu contoh farmasi
laboratorium

LEAN DAN menilai pencapaian

pencapaian terhadap
angka kejadian
terhadap angka
KENDALI Safety kejadian interaksi nearmiss atau KPC
yangberkaitan
obat
MUTU dengan budaya staf

penurunan kejadian menurunkan angka

Quality ketidaktersediaan obat kehilangan sampel
KENDALI MUTU
memperbaiki respon memperbaiki
Delivery time delivery obat ke turnaround time
rawat inap pemeriksaan

menurunkan nilai menurunkan biaya/

Cost stok cost unit

peningkatan angka peningkatan angka

morale kepuasan pegawai kepuasan pegawai
 START FROM SMALL STE
“ There are no big problem,
there are just a alot of little
problems” - HENRY FORD -
perubahan yang lebih
impresif, lebih cepat,
terimplementasi dengan
baik karena teruji
menyelesaikan masalah
dengan baik

“Kaizen means do everyday improvement, everybody

improve, everywhere improvement; from incremental
improvement to dramatic strategic improvement.”-
Masaaki Imai-
 TYPES OF KAIZEN
Kaizen Scope of
Duration Examples
methode problem

Using 5S principles to reorganize a

Point Hours of
Small nurse’s station; solving an
Kaizen days equipment downtime problem

One week ( Reducing operating, room

Kaizen often longer changeover time, pharmacy mistake
Medium including proofing; standardizing automated
events
planning ) inventory cabinets across units

Layout and process redesign of a

System department, such as clinical lab,
Large 9-18 weeks
kaizen pharmacy, or ED triage process
IMPLEMENTASI
LEAN DI RUMAH SAKIT PELNI
RS PELNI’S HEALTHCARE MODEL
RS PELNI’s Healthcare Perspective
 4.
We use Information
Technology aproach
for Healthcare
services.

We hold to our
principle To Made
Not to Buy

properti RS. Pelni, dilarang memperbanyak

atau publikasi ulang tanpa ijin. Fathema,
Mayang, 2015
 PETA IMPLEMENTASI IT DALAM PROSES
BISNIS RS PELNI
Aplikasi PERESEPAN
E-Health Record  Bed Management Aplikasi JADWAL ONLINE
Aplikasi RESEP IGD Operasi dokter, Bed Management
ONLINE Bed Management perawat dan E-Health Record
Antrian Pasien Ranap pasien/Slot System Billing System
E-Health Record  E-Health Record

MAIN PROCESS PELAYANAN POLIKLINIK PELAYANAN IGD PELAYANAN OK & ICU PELAYANAN RAWAT INAP
PELAYANAN PENUNJANG MEDIS
SUPPORT PROCESS
PELAYANAN PENUNJANG NON MEDIS

Aplikasi PACS SYSTEM pada

layanan radiologi Aplikasi Bridging &
Integrasi SIRS dan LAB Grouping Billing
INFORMATION SYSTEM System
Order Lab,Radiologi Online Aplikasi Visualisasi
BED MANAGEMENT di
Admision
Aplikasi E-office
Aplikasi E-filing
KINERJA 312 TEMPAT TIDUR MENJADI 509 TEMPAT TIDUR
PERTUMBUHAN ASET 21.83 %
PENJUALAN 44 %
2015 MARGIN LABA KOTOR 33.87 %
EFISIENSI OPERASIONAL 19 %
EFISIENSI INVENTORY COST 27.6 %
PROGNOSA KINERJA 201

• Pertumbuhan pendapatan
22,3 %
• Layanan baru prosedur
peripheral vaskular dan
operasi jantung
• Pertumbuhan aset 29,8 %
• Efisiensi inventory 27,6 %
 Conclusion:
Dalam menghadapi JKN rumah sakit memerlukan suatu strategi yang
fleksibel sehingga dapat adaptif dengan perubahan-perubahan yang
kerap kali terjadi.

Lean merupakan suatu strategi yang dapat dipergunakan untuk dapat

bertahan dan berkembang.

Kaizen adalah suatu tools yang merupakan pilar Lean Management yang
berarti Continous Improvement.

Kaizen dibangun melalui kerekatan ( empowering and engangement

employees ) yang menghasilkan perbaikan dalam QCDPSME
 TERIMA KASIH
DAN
SALAM PERBAIKAN
BERKELANJUTAN