Manajemen Lean Pada Layanan Kemoterapi Anak Rawat Inap Di Rumah Sakit Cipto Mangunkusumo

Abstract

Background: Cancer in children has high morbidity and mortality.
 Retinoblastoma is the most common solid tumor in children at the
 Cipta Mangunkusumo Hospital (RSCM). Chemotherapy is one of
 the therapeutic modalities, interdisciplinary and many procedures.
 Lean management continuously reduces waste and improves work flow.
 Objective: This study used lean management to determine the
 efficiency of health care in teaching hospital.
 Methods: Action research was conducted at RSCM. Sampling by purposive sampling that represents the role in the flow of the service process. The observation guide uses cycle time observation
 sheets, value-added analysis sheets, waiting time and lead time.
 The waste found is listed in the DOWNTIME matrix. Observations
 were made on inpatient chemotherapy services for children and
 then a diagnosis was made using Value Stream Mapping. The
 Kaizen team consisted of pharmacists, nurses, doctors doing a plan-do-study-action, prepared an intervention plan, and conducted
 post-intervention observations. The 5S method is used to improve
 service flow.
 Results: In this study, patients with retinoblastoma in class III in
 patient ward included were 7 patients in the pre-intervention group and 16 patients in the postintervention group. Major decreases in lead time happened in the subprocesses of ordering chemotherapy (75%), decision-making of chemotherapy administration (55%) and
 filling of the resume (41%). Lead time process in chemotherapy administration for retinoblastoma changed from 48 hours, 36 minutes
 (more than 2 days) to 38 hours, 38 minutes (1.6 days or less than
 2 days). The efficiency of the process was measured using value
 added ratio which showed changes from 33% to 37%.
 Conclusion: 
 Lean management applied in the process of chemotherapy administration in the inpatient wards increased the
 efficiency of the process.