Identifikasi Pemborosan dengan Pendekatan Lean Management pada Waktu Tunggu Obat Racikan Pasien Rawat Jalan di Instalasi Farmasi RSUD Dr. H. Koesnadi Bondowoso

Abstract

Medication wait time indicates hospital pharmacy quality. RSUD Dr. H. Koesnadi Bondowoso experienced a decline in compounded-drug service performance against the Minimum Service Standard (maximum 60 minutes), from 88% (2023) to 74.86% (2024) and 62.20% (August 2025), indicating waste in the service process. This study measured waiting time, identified Value Added (VA) and Non-Value Added (NVA) activities, and determined the types, frequency, and causes of waste using a Lean Management approach. The descriptive study involved 67 compounded prescriptions and one pharmacy-staff informant. Data were collected through direct observation using a stopwatch and interviews, then analyzed using Value Stream Mapping (VSM) and a six-factor Fishbone Diagram. Results showed an average waiting time of 89.14 minutes, with 57% of prescriptions exceeding the standard. Non-Value Added activities dominated both prescription types, with a Value Added Ratio of 7.27% for stock-based and 17.20% for direct compounding; the main bottleneck occurred during prescription input and e-ticket printing. A total of 156 waste occurrences were identified, dominated by waiting (35.3%), motion (21.2%), and overprocessing (17.9%), influenced by man, method, machine, material, measurement, and environment factors. Compounded-drug services have not met the waiting-time standard, indicating the need for improved staff scheduling, information-system stability, and workflow redesign.