lean management - mmr.umy.ac.idmmr.umy.ac.id/wp-content/uploads/2017/10/1_firman... ·...
TRANSCRIPT
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Lean Managementfor Healthcare
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Firman, SE, MPH
Praktisi RS, Kandidat Doktor “Lean Six Sigma” FK UGM
ASNPembina IV/A
Facilitator/Konsultan/PenelitiTentang Mutu khususnya Lean
Mahasiswa/Dosen
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1 2 3 4
Pengantar Filosofi Lean Implementasi PenutupWhy Lean Management Lean Foundation How Lean Implementation Key Success Factors
TABLE CONTENT
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–Taiichi Ohno
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Empower EmployeeDatabase Decicion
Profitability Efficiency & Effectiveness
Customer Requirements
Competitive AdvantageWhy
We Do NeedLean Management
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LOREM IPSUM Manfaat
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10-90%Penurunan/pengurangan:
Lead Time, Inventory, Keb.Tempat, Defect dan Biaya Overhead
20-80%Peningkatan Productifitas
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Menurunkan Meningkatkan
37 mntRata2 waktu tunggu
90 %Infeksi
13%Total biaya diagnostik
1853Pasien tanpa IV (dari 8054 ke 9907)
48 %Aliran pasien
27 %Pasien baru
VS
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76,9%
67,7%
32,4%
54,5%Waktu transit keluar RS.
Waktu tunggukeluar RS.
Waktu antrian
Waktu pendaftaran
Menurunkan
(Ker, et al., 2014)Firman, SE, MPH> Lean Management
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£ 3,1 jt/thnRoyal Bolton Hospital
£ 0,5 jt/thnBiaya ICU RS Pittsburgh$ 426.244 /thn
RS Anak
Menghemat
Firman, SE, MPH> Lean Management
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Creating More Value for Customers
Identifying, Eliminating or Reducing Waste
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Lean adlh metodologi perbaikan proses yang digunakanuntuk memberikan produk dan layanan yang lebih baik, lebih cepat dan dengan biaya yang lebih rendah (Antony & Laureani, 2011)
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Pola pikir & metode melibatkan dokter & staf
mengatur praktik mereka agar berjalan lebih lancar
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Lean adalah
A Methodology
Firman, SE, MPH> Lean Management
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Firman, SE, MPH> Lean Management
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Filosofi Toyota Way
Respect for People Continuous Improvement
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Lean is never ending Philosophy
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Doing
Laksanakan prinsip-prinsip Lean
Deploying
Bentuk Tim, Sosialisasi/pelatihan
Dua Tahap dasar Implementasi LeanImplementasi Lean Management di RS (Lean Hospital) pada dasarnya
adlh proses mengimplementasikan prinsip2 Lean
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Identifikasi Value (nilai)
menurut perspektif
pelanggan (pasien)
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Pelanggan bersedia
membayar kegiatan tsb
Mengubah produk/jasa
mjd lebih berarti
Benar sejak
pertama kali
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FGDPujian
Menjadi Pasien
Survey & Interview
Patient Value?
Kotak Aduan
Pendapat Pakar
Firman, SE, MPH> Lean Management
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Proses pemetaan dan
pengidentifikasian
value stream pada pada
suatu proes
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Value Stream Mapping (VSM)
Menunjukkan semualangkah dlm proses
Alat paling berguna utkmengevaluasi keadaan dari
setiap proses
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Current State MappingPeta kondisi saat ini
Future State MappingPeta kondisi Ideal
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Bagaimana
Membuat Value
Stream Mapping?
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1) Pasien,
2) Staf
3) Obat,
4) BHP, trmsk bahan makanan/kantin,
5) Peralatan medis dan non medis,
6) Informasi,
7) Proses, termasuk proses klaim
asuransi kesehatan, dll.
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Dokumentasikan semua langkah (Identifikasi
langkah2 utama & langkah2 kecil di dalamnya
dlm satu proses/proses yg sejenis
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Firman, SE, MPH> Lean Management
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Menghilangkan
Mengurutkan
Menyederhanakan
Mengkombinasikan
4 Cara: Future State Mapping
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Firman, SE, MPH> Lean Management
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Membuat proses terus
berjalan/mengalir
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How Make Flow?
Hilangkan Waste Patuh Takt Time
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1 Defect
Kegiatan yg dilakukan dgn tdk tepat sejak saat pertama kali
2 Over ProductionMelakukan lebih dari apa yang dibutuhkan pasien
3 WaitingMenunggu prosedur atau aktifitas berikutnya.
Waktu selama tidak terjadi kegiatan apapun.
4 Non Utilized Talent
5 TransportationTransportasi bahan,
alat yg tidak perlu
6 Inventory
7 Motion
Gerakan orang
8 Extra Processing
Tidak bernilai atau tidak sesuai
kebutuhan pasien
W a s t e
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Defects Semua kegiatan yg dilakukan dgntdk tepat sejak saat pertama kali:
Contoh:
Medication error
Salah prosedur
Salah pasien
Salah informasi
Trmsk waktu yg dihabiskan utkmengulang pekerjaan itu.
Tools: 5S, Visual management, Standard work, Error-proofing
Firman, SE, MPH> Lean Management
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OverproductionMelakukan lebih dari apa yang dibutuhkan pasien
saat ini (terlalu banyak atau terlalu cepat).
Cth : • Pem diagnostic yg tdk perlu,
• Cetak/print out padahal cukup informasi lisan,• Formulir/blangko yang berulang/mirip,
• DllTools: Workload balancing, Standard work,
Checklists, Pull systems
Firman, SE, MPH> Lean Management
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• Menunggu prosedur atau aktifitasberikutnya. Waktu selama tidak terjadikegiatan apapun. Waktu menunggu.
Contoh:
• Menunggu: tt kosong, pulang, hasilpemeriksaan
• Dokter menunggu alat/BMHP utktindakan bedah, perawat menunggupergantian obat dari depo farmasi, dll.
Tools: VSM, Swimlane map, 5S, Workload balancing, Cross-train staff
Waiting
Firman, SE, MPH> Lean Management
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Nonutilized skill / intellect / Underutilized employees
• Tidak memanfaatkan potensi/kreatifitas karyawan
• Penempatan karyawan tdk sesuai keahliannya
• Tidak mendukung staf mengembangkan karirnya.
• Mengabaikan keterampilan dan bakat staf
Tools: Swimlane map, Workload balancing, Standard work
Firman, SE, MPH> Lean Management
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Transportation
• Transportasi bahan, alat yg tidak perlu
• Menempatkan stretcher di aula dansenantiasa memindahkannya
• Memindahkan formulir dari bangunanyang satu ke bangunan yang lain atausecara elektronik ke beberapa tempat
Tools: 5S, Physical layout, Visual management, standard work
Firman, SE, MPH> Lean Management
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InventoryPersediaan material, supply danperalatan yg berlebihan. Alat BHP / kebutuhan medis pelayanan lainnya.
• Linen, stok obat, BHP lain, specimen nunggu pemeriksaan, alkes yang tidak dibutuhkan
• Inventory yang berlebihanmerupakan waste
Tools: 5S, Visual management, Standard work, Pull systems
Firman, SE, MPH> Lean Management
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MotionGerakan orang, staf atau pasien yang tidak perlu
Mencari : Pasien, berkas, dll : menyimpandua komponen yg saling berhubungan di t4 yg berjauhan
Mencari Obat, BHP, dll
Tidak memiliki peralatan dasar di setiapruang pemeriksaan.
Tools: 5S, Physical layout, Visual management, Standard work
Firman, SE, MPH> Lean Management
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ExtraProcessing
Melakukan pekerjaan yang tidak bernilaiatau tidak sesuai kebutuhan pasien
Pemeriksaan ulang
Informasi ulang
Banyak kertas, banyak betadine, banyakkasa padahal tdk perlu
Tools: VSM, Visual management, Workload balancing, Standard work
Firman, SE, MPH> Lean Management
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Unit Product Aktivitas Value Aktifitas Waste
Ruang IGD Pasien
Diperiksa oleh dokter
Dilakukan tindakan
medis oleh perawat
Menunggu diperiksa
Menunggu tindakan medis
LaboratoriumSpesimen
pasien
Spesimen disentrifugasi
Spesimen diuji
Spesimen dikumpulkan dulu untuk
diproses sekaligus
Farmasi Resep Obat disiapkan Melakukan pengecekan obat berulang kali
Pelayanan
perioperatif
Instrumen
Steril
Waktu utk sterilisasi
instrumen
Instrumen disterilkan brsama dgn
instrumen lainnya dlm instrumen kit,
tetapi sbenarnya instrumen itu tdk pernah
digunakan.
Pelayanan
Gizi
Nampan
makanan
pasien
Waktu utk memasak
makanan atau menata
nampan
Menata ulang karena nampan tidak
disusun dengan benarFirman, SE, MPH> Lean Management
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Firman, SE, MPH> Lean Management
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Firman, SE, MPH> Lean Management
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Firman, SE, MPH> Lean Management
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Firman, SE, MPH> Lean Management
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• “ditarik” oleh
pelanggan
• Di RS, pull system utk
mengontrol
persediaan dgn
sistem Kanban
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• To the best
• Pertahankan Flow,
layanan trsedia saat
dibutuhkan, tingkat
mutu & keamanan
tinggi, bebas cacat /
kesalahan, value for
money, serta memiliki
semangat dan
kebanggaan yg tinggi
trhdp pekerjaannya.
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5S Tools lainValue Stream
Mapping
KaizenVisual
Management,
Kanban
Tools
Metode utk mengaturpengurangan waste waktudan pergerakan staf, serta
membuat masalah di tempat kerja mjd lebih
mudah terlihat
Metode utk membuatmasalah bisa dilihat, memudahkan respon(cepat) dan pemecahanmasalah. Kanban=Istilahjepang yang berarti sinyal, penanda. Utk mengelolainventory
Gambaran/peta aliran daripenyedia (RS) kpdpelanggan (pasien)
Istilah Jepang utk“continuous improvement,” berfokus pd improvement oleh staf di area kerjamasing2
Error proofing, Takt Time, Risk Assessment, Heijunka,
Six Sigma, dll
Firman, SE, MPH> Lean Management
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5S
Hrs mjd falsafah dlm kehidupan kerja sehari-hari &
bukan kegiatan musiman atau
sekadar trend bulan ini
Firman, SE, MPH> Lean Management
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Evaluasi 5S
1. Penilaian mandiri (dilakukan sendiri)
2. Penilaian oleh konsultan ahli
3. Penilaian oleh atasan
4. Kombinasi dr 3 cara diatas
5. Penilaian brdasarkan kompetisi kelompok
Firman, SE, MPH> Lean Management
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Visual Management Membuat proses kerja menjadi terlihat
Firman, SE, MPH> Lean Management
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Firman, SE, MPH> Lean Management
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Kanban• =Kartu, Tiket, penanda
atau Sinyal.
• Sistem yang memberitanda kapan suatu
barang/alat/komponenharus diganti/harus
ditambah = sistemKanban.
Firman, SE, MPH> Lean Management
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Firman, SE, MPH> Lean Management
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Firman, SE, MPH> Lean Management
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Kanban (2)
• Kanban sbgpapanpetunjuk suaturangkaianaktifitas.
Firman, SE, MPH> Lean Management
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Error Proofing/Mistakes Proofing/PokaYoke
• Alat anti salah. Tools utk Jidoka(otomasi mesin)
• Dpt mencegah kesalhan yg dptmengancam jiwa
• Setiap kegagalan perangkat inidpt mnyebabkan misdiagnosis, cedera serius atau bahkankematian px.
Firman, SE, MPH> Lean Management
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Heijunka Meratakan produksi/pelayanan
Firman, SE, MPH> Lean Management
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Heijunka jam praktek dokter?
(Ilustrasi grafik kunjungan jam praktek dokter)
0
10
20
30
40
50
60
70
80
Jam 8-10 jam 10-12 Jam 12-14 Jam 14-16 Jam 16-18 Jam 18-20
Dokter 1 Dokter 2 Dokter 3 Dokter 4
Firman, SE, MPH> Lean Management
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• Pagi lebih maju mjd jam 7, Sore juga maju
• Membuka praktek hr minggu
• Menambah dokter pd jam sibuk
• Jam kunjungan “kering” Promosi happy hours
• Mengarahkan pasien ttt (misalnya px baru) pd jam 7 pagi atau stlh jam 2 siang
• Sistem call center. Minimalkan kunjungan pasien lgsgtanpa janji (call center)
• Klinik IGD utk px fals emergency
Solusi?
Firman, SE, MPH> Lean Management
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• “good change” atau“improvement".
• Dasar penggunaan kaizen adlhanalisis & solusi cepat dlm skalakecil suatu masalah yg mudahditangani & dpt diukursecepatnya.
Kaizen Event
Firman, SE, MPH> Lean Management
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Kaizen (2)
Jarang menyebutnya sbg Kaizen
Firman, SE, MPH> Lean Management
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Firman, SE, MPH> Lean Management
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LangsungActionPastikan semua timdilatih, Pilih Pilot Project, Ikuti dgnperubhan budayatortor.
Lakukan KaizenPilih proyek. Ingat
3H1P. Oprtunistik utk
dampak keuangan yg
besar. Manfaatkan
data, expert
KembangkansystemSistem komunikasidan umpan balik, Leadership, fondasi/cara sendiritortor.
Evaluasi & NextEvaluasi dan buat hasilnya
terlihat. Rayakan. Jangan lekas
puas diri, kembangkan dan
cloning ke bagian/proyek lain
Tips Implementasi
Firman, SE, MPH> Lean Management
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Perlu transformasi budaya
Jgn hanya fokus tools & waste
(Process) nya saja.
Hhrs dipahami sbg suatu
sistem terintegrasi dlm budaya
organisasi dan juga
mengadobsi 3P yg lain :
Kunci Sukses
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Firman, SE, MPH> Lean Management
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Firman, SE, MPH> Lean Management
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3 POIN SUCCESS
LEADERSHIPEMPLOYEE
INVOLVEMENT
CULTURE CHANGE
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Leadership and management
Organizational culture
Ability of lean concept adaptation
Facilitate the implementation of lean
Attitude of continuous improvement
Respect for frontline workers
Commitment
Team training
Skills and expertise
Firman, SE, MPH> Lean Management
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Berikan waktu bagisumber daya and frontline staff
“No Time”
Tantangan
Temukan “Lean”
special untuk
konteks RS/PKM
dan budaya kita
“Not Japanese”
Hubungkan lean dgn
prioritas dan masalah
besar khususnya dlm
safety and quality
“Not relevant”
Buat itu sbgtanggung jawabdasar bagi manajerfrontline
“Not our job”
Siapkan diri krnhasilnya jkpanjang– tetapfokus, ulet danoptimis
“Flavour of the month”
Firman, SE, MPH> Lean Management
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Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek
“- Barack Obama
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Terima kasih