BUSINESS PROCESS IMPROVEMENT TO REDUCE LENGTH OF STAY IN HOSPITAL: A CASE OF XYZ HOSPITAL

• Main Author: Tresnasari Setiawan, Agita
• Format: Theses
• Language: Indonesia
• Subjects: Manajemen umum
• Online Access: https://digilib.itb.ac.id/gdl/view/64909
• Institution: Institut Teknologi Bandung

In healthcare, outpatient waiting times are commonly seen as indicators of service quality and reducing outpatient waiting times has been the subject of a vast number of research. An indicator used by the XYZ Hospital as a measure of patient’s satisfaction is the Length of Stay (LOS) of patient. In this case study, the LOS is defined to be the time it takes for a patient to receive the outpatient service offered by the hospital. Kepmenkes no. 129 (2008) on Minimum Service Standard (Standar Pelayanan Minimum or SPM) of Hospitals that states that the waiting duration for a patient in a hospital outpatient service should not be longer than 60 minutes and the hospital has their own standard of 90 minutes. Preliminary study revealed that the average LOS for BPJS patients is 152.27 minutes with 76% of the total sample exceeding the set standards and average LOS for Eksekutif patients is at 68.58 minutes with 16.8% of the total sample exceeding the set standards. The objective of this research is to analyze process capability to reduce LOS to achieve the standards. This study uses DMAIC methodology as an assisting tool combined with process mapping and the Seven Wastes, and Five Whys to assist the root cause analysis. Process capability analysis showed that process is incapable for both BPJS and Eksekutif patients at overall capability of Ppk = -0.27 and PpK = 0.28 respectively in reference to the industrial standard of 1.33. The outpatient process is comprised of five on site processes which are; registration at Front Office (FO), assessment at the Nurse Station (NS), doctor’s examination, payment at cashier, and service at the pharmacy. Further analysis showed that the probable bottleneck is recognized to be the Front Office and pharmacy for BPJS patients in which waiting times are significantly longer. By the use of process mapping by BPMN, wastes and inefficiencies were recognized. The root causes identified are; inefficiency of the existing appointment scheduling system, limited resources, and that a fully autonomous online registration is not yet supported. To analyze the different alternative solutions, discrete-event simulation was used to perform multiple scenarios. The scenario analysis when compared shows that the best scenario would involve efforts in optimizing scheduled intervals, adjustment of FO registration, and no delay in appointment session. When adding of resources is considered, having the addition of 2 pharmacists (a total of 7) to the scenario of scheduled arrivals is enough to bring the total LOS and LOS at every station to meet the hospital’s standards. The decisions involving optimized scheduled arrivals will have the most significant impact to the length of stay of patients in the outpatient process. The implementation suggested for this includes activities relating to making further analysis and assessment of appointment system, building targets and performance measures over scheduled appointments and LOS performance, and enforcing socialization and education on appointment booking before a trial period of the optimized appointment system. By increased efforts in implementing the suggested solutions, it is hoped that patient’s waiting time will see an improvement.