Strategi Implementasi Lean Six Sigma Dalam Optimalisasi Proses Discharge Pasien di RSU San Medical Center Karawang

Betharlitha Maharlika, Rian Andriani, Maxsi Ary

Abstract


Proses discharge pasien merupakan tahapan kritis dalam pelayanan rumah sakit karena menentukan efisiensi alur pasien, kesiapan perawatan lanjutan, dan pengalaman pasien. Evaluasi di RSU San Medical Center Karawang menunjukkan rata-rata waktu discharge 143 menit, melebihi standar pelayanan minimal rumah sakit yaitu maksimal 120 menit sejak pasien dinyatakan boleh pulang sampai menerima tagihan akhir. Penelitian ini bertujuan merumuskan strategi implementasi Lean Six Sigma untuk optimalisasi proses discharge pasien. Penelitian menggunakan pendekatan kualitatif dengan desain studi kasus di RSU San Medical Center Karawang pada September-November 2025. Informan dipilih secara purposive sebanyak 10 orang, terdiri atas 2 dokter penanggung jawab pelayanan (DPJP), 2 perawat rawat inap, 2 petugas farmasi, 2 petugas administrasi/kasir, 1 manajer pelayanan keperawatan, dan 1 manajer pelayanan medis. Data diperoleh melalui wawancara semi-terstruktur, observasi proses dan telaah dokumen, kemudian dianalisis secara tematik menggunakan kerangka Define, Measure, Analyze, Improve, dan Control (DMAIC) serta pemetaan akar penyebab 5M. Temuan utama yang paling dominan adalah waiting waste akibat keterlambatan resume medis, alur serial, komunikasi manual, bottleneck farmasi, rework administrasi, dan verifikasi penjamin yang panjang. Strategi perbaikan meliputi standardisasi SOP lintas profesi, penjadwalan visit discharge, penyederhanaan resume medis, integrasi SIMRS, penerapan proses paralel, pembentukan koordinator discharge, serta pengendalian melalui indikator kinerja utama (key performance indicator/KPI) dan audit berkala. Lean Six Sigma dapat digunakan sebagai strategi manajerial lintas unit untuk meningkatkan efisiensi, konsistensi, dan mutu proses discharge pasien.


Keywords


Lean Six Sigma; Discharge Pasien; DMAIC; Mutu Rumah Sakit

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References


World Health Organization. Quality Health Services: A Planning Guide. Geneva: World Health Organization; 2020.

Bradley DC, Lannin NA, Clemson L, Cameron ID, Shepperd S. Discharge Planning from Hospital. Cochrane Database Syst Rev. 2022;2022(2):CD000313.

Patel P, Bechmann S. Discharge Planning. Treasure Island (FL): StatPearls Publishing; 2023.

Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 129 Tahun 2008 tentang Standar Pelayanan Minimal Rumah Sakit. Jakarta: Kementerian Kesehatan RI; 2008.

Zimmermann S, Bohomol E. Lean Six Sigma Methodology to Improve the Discharge Process in A Brazilian Intensive Care Unit. Rev Bras Enferm. 2023;76(3):e20220538.

Abdelhalim A, Zargoush M, Archer N, Roham M. Decoding the Persistence of Delayed Hospital Discharge: An in-Depth Scoping Review and Insights from Two Decades. Heal Expect. 2024;27(2):e14050.

Aly M, Hasaballah M, Mohamed G, Mostafa A, Akel D. Lean Management: As an Approach to Reduce Cycle Time of Patient Discharge Process. IOSR J Nurs Heal Sci. 2021;10(1):44–51.

Supriadi, Putri P. Waktu Tunggu Pemulangan Pasien Rawat Inap Rumah Sakit Swasta X di Tangerang Selatan. J Adm Bisnis Ter. 2020;2(2).

Yofa AS, Vionalita G. Analisis Penyebab Waktu Tunggu dari Proses Administrasi Pemulangan Pasien Rawat Inap dengan Jaminan Pribadi di Rumah Sakit Hermina Daan Mogot tahun 2019. J Kesehat Masy. 2020;1(2):52–61.

Afriana W, Zulyani F, Kurniawan T. Application of Lean Six Sigma Method in Hospital Management Process: Performance Optimization and Waste Reduction. ENDLESS. 2023;6(3):172–84.

Rathi R, Vakharia A, Shadab M. Lean Six Sigma in the Healthcare Sector: A Systematic Literature Review. Mater Today Proc. 2021;50(5):773–81.

Womack JP, Jones DT. Lean thinking: Banish Waste and Create Wealth in Your Corporation. London: Simon & Schuster; 2003.

McDermott O, Antony J, Bhat S, Jayaraman R, Rosa A, Marolla G, et al. Lean Six Sigma in Healthcare: A Systematic Literature Review on Challenges, Organisational Readiness and Critical Success Factors. Processes. 2022;10(10):1945.

Setyastuti K, Yuniati D, Chalidyanto D. Improving the Time of Discharge Based on Lean Six Sigma: An Analysis and Recommendation. Int J Nurs Midwifery Sci. 2024;8(2):276–86.

Rahma A, Wahyudi B, Veranita M. Waste Analysis Using Lean Management on Inpatient Discharge Waiting Time at RSI Siti Hajar Mataram. J Ilm STIKES Yars Mataram. 2025;15(2):103–15.

Fazaeli S, Yousefi M, Dokht MS, Heidarian H. Implementation of Six Sigma Method to Improve Hospital Discharge Process: A Before-and-After Study With the Control Group in a Large Hospital. Durham: Research Square; 2021.

Mohan P, Lekshmi L, Harikrishnan R, Abhijath V. Optimizing Discharge Management Through Lean Process Capability Improvement Using DMAIC. In: Emerging Technologies for Intelligent Systems (ETIS). 2025. p. 1–6.

Zakariah MA, Afriani V, Zakariah KM. Metodologi Penelitian Kualitatif, Kuantitatif, Action Research, Research and Development (R n D). Kolaka: Yayasan Pondok Pesantren Al Mawaddah Warrahmah; 2020.

Pahlevani M, Rajabi E, Taghavi M, VanBerkel P. Developing A Decision Support Tool to Predict Delayed Discharge from Hospitals Using Machine Learning. BMC Heal Serv Res. 2025;25(1).

Valentina J, Ayuningtyas D. Analysis of the Implementation of Early Discharge Planning at X General Hospital. Eduvest J Univers Stud. 2025;5(3):3428–37.

Putri N, Semiarty R, Syah NA. Health Insurance (BPJS-Kesehatan) Late Payment for Hospital Inpatient Claims: A Case Study in West Sumatra. Ber Kedokt Masy. 2020;36(12):351–7.

Tarigan IN, Lestari FD, Darmawan ES. Penundaan Pembayaran Klaim Jaminan Kesehatan Nasional oleh BPJS Kesehatan di Indonesia: Sebuah Scoping Review. J Ekon Kesehat Indones. 2022;7(2):108.

Sharma J, Bisht YS, Saini RS. Reducing Discharge Delays: Using DMAIC Approach in A Tertiary Care Hospital. Int J Community Med Public Heal. 2025;12(9):4028–38.

Waiman E, Achadi A, Agustina R. Reducing Hospital Outpatient Waiting Time Using Lean Six Sigma: A Systematic Review. J Adm Kesehat Indones. 2023;11(1):154–66.

Rollinson TJ, Furnival J, Goldberg S, Choudhury A. Learning from Lean: A Quality Improvement Project Using a Lean-Based Improvement Approach to Improve Discharge for Patients With Frailty in An Acute Care Hospital. BMJ Open Qual. 2021;10(4):e001393.

Syaharuddin Y. FMEA Approach of Lean Six Sigma Implementation: Estimating the Value of COPQ. [Skripsi]. Universitas Mulawarman]; 2020.

Salido MF, Borras TA, Casanova G, Ferrer JG. Value-Based Healthcare Delivery: A Scoping Review. Int J Env Res Public Heal. 2024;21(2):134.

Omonaiye O, Ward-Stockham K, Darzins P, Kitt C, Newnham E, Taylor NF, et al. Hospital Discharge Processes: Insights from Patients, Caregivers and Staff in an Australian Healthcare Setting. PLoS One. 2024;19(9):e0308042.




DOI: https://doi.org/10.33085/jkg.v9i2.7030

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