Continuous Improvement Di Rumah

Sakit Dengan Menggunakan Kaizen

Lean hospital :
Membangun untuk kendali mutu kendali biaya

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

MPh
KILASAN CURRICULUM VITAE
leadership should taking part
of
• Good Corporate Governance Clinical
• Hospital by laws Governance
• Medical staff by laws/ Clinical Govern
• Boards Manual

• Pedoman Praktik Klinis

Corporate
Governance

Leadership is not just about influencing other people, it also

connecting between now and future. That’s a vision. Measuring the
achievement of strategic goals using Balance Score Card.
 SINERGI ANTARA “STANDAR RUMAH SAKIT”
DAN “MANAGEMENT TOOLS”

1. Leadership 4. Measurement & Crisis Management

2. Strategy 5. Workforce
3. Customer 6. Operations

Results :
Patients and another Business process in 7.1 Healthcare Production
customer requirements, healthcare services Process
needs, and expectations company 7.2 Patients Results
7.3 Leadership and
Governance Results
7.,4 Financial and Market
KARS and JCI
requirements from 15
standards

CORPORATE
CLINICAL GOVERNANCE
GOVERNANCE
 WASTE Business Focus for
growth
in Hospital efficiency
40% cost structure
revenue In hospital is
FINANCE HIDDENT COST
perspective

Loyal New
customer customer
CUSTOMER
perspective

60% business process

identified as WASTE
INTERNAL
PROCESS Waste Elimination,
perspective

GROWTH
perspective Organization Employee teknologi
culture competence
Regulator Expectation
(Ministry of Health -> BPJS)
Stakeholder Expectation
(RUPS -> Owner)

Quality Control Cost Control ?

Fixed Cost

Variable Cost
What Lean is ?
“Lean” is term used to describe philosophy
and way of thinking
FILOSOFI LEAN MANAGEMENT
CONTINUOUS
RESPECT FOR PEOPLE
IMPROVEMENT

• Ongoing improvement in a • Employees

structured and scientific way,
constructively
in alignment with a long-term
vision, by finding the root challenged to perform
cause of problems and to the best of their
building consensus amongst abilities and to
a team
improve over time
• Total elimination of waste in
process • No lay offs due to
kaizen

Graban & Scwartz. The executive guide to healthcare kaizen. 2014

 Tools of Lean management

TOTAL RESPECT TO
ELIMINATION PEOPLE
WASTE IN (EMPLOYEE
STANDARDIZE
PROCESS EMPOWERMENT)
SOCRATEC
METHOD

FLOW

JUST IN KAIZEN JIDOKA

POKA
KANBAN TIME YOKE

VISUAL 5S GEMBA
MANAGEMENT HEIJUNKA
 KAIZEN
PERUBAHAN UNTUK MENJADI
LEBIH BAIK – PERBAIKAN
BERKELANJUTAN
Penekanan pada KREATIVITAS,
lower cost dan lower resource
DATA + ALAT BANTU + STRUKTUR
“A HIGHLY FOCUSED, ACTION ORIENTED
method for making QUICK, HIGH IMPACT
improvements to a SPECIFIC PROCESS or
AREA.” –Christian Wolcott
Upaya perbaikan yang
sangat fokus pada
proses yang spesifik,
untuk menghasilkan
perubahan dengan
cepat dan berdampak
positif.
 DOWNTIM
Defect
E

Heijunka
Jidoka
Extra
Processin
g

Overproduction

Pull
5R
System
Defect
Non utilized
talent

Quality Improvement. The Health Foundation. Standardiz

Kaizen
2013 e
 Process mapping & Problem
identified:
Inpatient business process (2014)
1. Admission process 3. Inpatient process
1.1 Emergency 3.1 Accepting
patient ready to 1.2 Outpatient pro admission
transefer 5. Dischage planning process
CITO admission staff’s phone 3.2 preparing
call to book chosen room
1.3 . Phoning every
the room for new patient 5.1 Discharge
inpatient ward to book
1.4 redo phoning ER decision on the day 5.2 making
bed 3.3 accepting
&inpatient ward for room medical
patient ready resume
specification 3.4 handover 5.3 preparing
1.5 to transfer patient with ER
from ER medication for
Finishing inpatient 1.6 . Creating patient’s nurse 5.4 finishing
nurse discharge
administration mediical record discharge
5.5 patient administration
3.6 making note
1.7 3.5 Delivering education before
1.8.. Delivery of patient’s ID 5.6 scheduling ffor
Delivery patients’ patient to their
at the ward’s discharge
medical record files patients to inpatient room next outpatient visit
ward white board
to ER PATIENT
PATIENT
DISCHARGED
INDICATED FOR
4.6 handling AS INDICATED
INPATIENT 2.5 transfering 2.4 Phoning complaints 4.5 Surrgical &
ADMITTION patientt to inpatient dedicated room
ward intervention service
before transfering
patients 4.4 . Pharmacy service
2.3 accepting 4.3 Diagnosticservices
medical record files
4.2 Medical
from admission 2.2 accepting call
service 4.1 Nursing
from admission staff
service
2.1 Room booking entry about patient’s room
specification
4. Inpatient assesment and service
2.Emergency AS IS :
Department Process 5 MAIN PROCESS
30 SUB PROSES.
10 SUB PROCESS WITH
PROBLEM/ WASTE
@rspelni #ISQUA2017
https://theaseanpost.com/article/potential-digital-healthcare
 Lean Insights in the Digital Age
Developing
Lean thingking : adaptife &
capabilities at
agile , QCDSMPE
the front line ITERATION,
INNOVATION Your next process
& is your customer
ENGAGING DISRUPTION
USERS MIND SET

MANAGING
LEAN Mentoring &
STREAMS
LEARNING coaching
process,
experiments
Connectivity & 7
Flow in Healthcare
http://www.leanuk.org/article-pages/articles/2015/july/17/beyond-legacy-assets-
and-mind-sets-lean-insights-for-the-digital-age.aspx & http://planet-
lean.com/staying-relevant-lean-management-in-the-digital-age with modification
 MENGAPA LEAN HOSPITAL ?
Inovasi yang berkelanjutan

PLAN

ACT KAIZEN DO

CHECK

Sumber: nordstorm innovation lab concept of agility.

Kreativitas pegawai di asah dengan Kaizen

Semua menjadi ahli eksperimen
Mengukir kemampuan beradaptasi cepat
Landasan yang substansial untuk melakukan sustaining inovation
Membuat incumbent ‘stay current’
RS PELNI
2018
The Objectives

Our Hospital Growth

• JKN Implementation since 2014 , using prospective payment

• Started at the end of 2013 ( AvBOR 48,12 % with 312
beds,liquid ratio 67 %)
• Paradigm Shift about cost
• Strategy to survive and thrive
 Methods

Promoting IDEA to
promoting LEAN

• Redefine Vision
• Culture transformation program
• Empowering 1225 staffs with business process mapping and identify
waste
• Various practical managerial tools
• Structured idea suggestion system
• Daily Coaching and periodecally idea competitions
• Created Kaizen Culture by Kaizen and Culture Promotion Office ( KCPO )
RESULTS

• Kaizen teams were established since

Nov 2014 - Dec 2015 ( 52 teams )
• KCPO harvested 662 ideas and 349
ideas implemented and standardized
RESULTS

• Saved 250.000 minutes

working hours
• Reduced patients
complain
• Reduces waiting time
less than 5 %

• Operational efficiency in 2014

was 13,78 % and in 2015 was
19,97 %.
• Liquid Ratio in 2015 was 120 %
with AvBOR 85% 509 beds
• Complete facilities such as MRI,
MS CT, Cath lab, Add 1
endoscopy tower, New Patient
Building 116 beds
 Higher Staff engagement correlates highly with lower turnover, better quality and
lower cost

employee Patient
engagement Patient Volume Lower cost
Satisfaction

Quality and
Outcomes

- the executive quide to healthcare kaizen-

 • Corporate • Smart Hospital • Employee
Governance Digipreneurship
• Clinical • Corporate
Governance Digipreneurship

• Digital Culture
 BUDAYA AMAN
Fokus pada keselamatan pasien, staf
dan organisasi

BUDAYA RINGKAS BUDAYA MENYEMBUHKAN

Fokus pada menciptakan lingkungan yang
Fokus pada mengurangi memberikan pengalaman positif bagi pasien dan
pemborosan di seluruh aspek keluarganya untuk mempercepat proses
kegiatan penyembuhan
DIGIPRENEURSHIP
STAFF RS PELNI
CONCLUSION

Adapting to new national healthcare payment policy

need future thinking and shifting paradigm. PELNI
hospital took lean approach to pursue affordable
excellence by coming into our own strength of
resources; our employees. Our efficiency is not cost
cutting but cost saving by elimination of waste in
process
 key aspects for best practices

DEVELOPING PEOPLE BUILT IN QUALITY REDESIGN PROCESS

People Products Process

CULTURE VALUE CREATION HEIJUNKA
TRANSFORMATION COST LEADERSHIP JIDOKA
GENCHI GENBUTSU OPERATIONAL EXCELLENCE STANDARDIZE
(GENBA) VISUAL MANAGEMENT
TERIMA KASIH