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LEAN MANAGEMENT DALAM KENDALI MUTU DAN KENDALI BIAYA

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Why We Need Lean ?

Bundle payment terjadi diseluruh negara yang mengadopsi universal health coverage

Everything goes to global

Universal Health Coverage adalah globalisasi dalam healthcare di mana menuntutindustri rumah sakit memberikan high quality namun dengan low cost operational.

BEFORE JKN AFTER JKN

FEE FOR SERVICETarif = Cost + Profit

PROSPECTIVE PAYMENT SYSTEMProfit = Sale - Cost

dari FEE for SERVICE menuju PROSPECTIVE PAYMENT SYSTEM

DISRUPTIVE CHANGES

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Customer demands more faster, more better, more affodable

Worlds has always been change in V.U.C.A mannerHospital must adapted with disruptive changes

Why We Need Lean ?

Focus manajemen industri rumah sakit hanya di unfairnesstapi bukan melakukan reduce cost

Biaya kesehatanmakin tinggi

Value yang dianggap baik oleh pasien semakin lama bergeser, dan demandnya semakin tinggi

sementara itu ...ketika dunia terus bergerak

4. value base care

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Lean Do with Fix inside the corporate Through people

Efisiensi tidak diajarkan dalampendidikan kedokteran dan keperawatan

Klinisi tidak dibekali pengetahuan mengenai Cost

Why We Need Lean ?

WASTEin Hospital

PerspektifKEUANGAN

PerspektifPELANGGAN

PerspektifINTERNAL PROSES

PerspektifPERTUMBUHAN

PendapatanBIAYA40% dibuat oleh : HIDDENT COST

60% PROSES BISNISTeridentifikasi

SEBAGAI WASTE

Pertumbuhanusaha

KompetensiSDM

Culture organisasi

teknologi

Pelangganloyal

PelangganBaru

Eliminasi titik Waste, makaKualitas layanan rujukanakan meningkat dengansendirinya

Focus for efficiency

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Kendali Mutu Kendali Biaya ?

Variable Cost

Fixed Cost

Governance expectation: Kemenkes, BPJS

What we facing today?

Yang dihadapi Rumah Sakit di Era JKN

PROSPECTIVE PAYMENT

FORMULARIUM NASIONAL

INA-CBG’SVALUE BASED

CARE

LOW COST OPERATIONAL

Profitability

Patient Safety

Patient Satisfaction

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COST Leadership

OPERATIONAL Excellence

PILIHAN STRATEGI RUMAH SAKIT di era JKN dengan segmen MIDDLE - LOW

Strategic Option:

By: Michael Porter, Competitve advantage

WASTE Elimination

strategy

strategy

strategy

What Lean is ?“Lean” is a term used to describe philosophy and way of thinking

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Genchi Genbutsugo and see the problem

“masalahadalah gunung emas”BOTTOM UP

SOLUTION

at the place, at the time

5 value agenda

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RSPELNI

Kerja sama antar RS di daerah tertentu untuk membentuk Hub & Spokes dengan tujuan :1. Economic Sharing 3. Increase Quality Of Service’2. Continuity of Care 4. Increase of Revenue

How To Deal With Fixed Cost

RUJUKAN PARSIALRUJUKAN HORIZONTALRUJUKAN VERTIKAL

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A firm’s NC is reflected through several dimensions:(1) the firm’s coordination activities with collaborating firms;

(2) the firm’s relational skills to facilitate interpersonal exchange;

(3) its partner knowledge, i.e., possessing organized and structured informationabout collaborating firms; and

(4) the firm’s internal communication to assist in the transfer of organizationalknowledge between collaborators.

What is network capability?What is network capability?

How To Deal With Fixed Cost

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We cannot solve our problem with the same thinking we used when we

created them~ Albert Einstein ~

standardizing physicianclinical pathway

How To Deal With Variable Cost

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Medicine standardization based on active substance contained on it

Implementing National Formulary on hospital

2013Formulary 2014

Formulary 2015Formulary

STANDARDIZED

How To Deal With Variable Cost

FARMASI• Zero inventory• Auto Re-Order• E-procurement• Biaya resep < Rp 9000

J U S T I N T I M EJ U S T I N T I M E

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RE-DESAIN PROSES PELAYANAN untuk PERBAIKAN; KUALITAS, WAKTU, BIAYA, SAFETY, PRODUK LAYANAN, LINGKUNGAN, dan MORAL

1. Task focused2. Situation focused 3. Penyempurnaan proses yang ada4. Mata rantai yang lemah5. Merancang ulang proses lama berbasis pengetahuan6. Menyumbangkan mata rantai yang hilang

dalam rangka peningkatan PRODUKTIVITAS (CORPORATE PERFORMANCE)

Pasien datang:LONJAKAN KUNJUNGAN

PASIEN

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Pelayanan Parkir:PARKIR CEPAT

PENUH

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Pelayanan registrasi:KONSENTRASI KEDATANGAN

PASIEN DI PAGI HARI

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Pelayanan Pemeriksaan & Tindakan:

LAMBANNYA SISTEM PELAYANAN

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Pelayanan obat:LAMBANNYA

PENYIAPAN OBAT

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Pelayanan Pasien pulang:PASIEN TIDAK DI EDUKASI UTK

PELAYANAN PENCEGAHAN SAKIT

6

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gemba

kanbanLean

KaizenJIT

Valuing PeopleValuing People

Melakukan Acceleration Culture Transformation, dimana hal ini melalui Pelatihan bagi lebih dari 1800 pegawai untuk mengedukasi perihal budayaperusahaan, yakni : Visi & Misi, 4 nilai, 11 perilaku dan 3 budaya RS. PELNI.

TRANSFORM THE MINDSET

SOSIALISASI

OBYEKTIFIKASI

INTERNALISASI

CORPORARECULTURE

Acceleration workshop

Gemba Divisi Budaya

Perilaku sehari-hari

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CULTURE TRANSFORMATION

Melakukan perubahan secara revolusioner pada organisasi, dimulai daricara berpikir, cara berperilaku, cara bekerja, dan cara berinteraksi.

TRANSFORM = ALTERING ABOUT ‘HOW’ (CARA)

Developing Hospital = Developing People

“Don't take employees for granted. If you don't value your team, they won't value

your customers”Sir Richard Bronson, Founder, Virgin Group

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Upaya perbaikan yang sangat fokus pada proses yang spesifik, untuk menghasilkan perubahan dengan cepatdan berdampak positif

Upaya perbaikan yang sangat fokus pada proses yang spesifik, untuk menghasilkan perubahan dengan cepatdan berdampak positif

Key KAIZEN mindsets ( Masaaki Imai )

Continually improve, with no idea being to smallA major source of quality defects is problems in the processFocus change on commonsense, low-cost, and low-risk impact not major innovations.All ideas are addressed and responded in the some wayCollect, verify, and analyze data to enact changeEmpower the worker to enact change

KAIZENKAIZEN

Managing

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BI Tool

HRIS

Internal & ExternalWebsiteAccounting

Medical Tools

Management Tool

EHR Slot SystemBed

Management

Prescription Online

LIS RIS

Purchasing Tool

Customer Tool Asset Tool

E-OfficeE-Filing

APM

Absence Record

Managing Innovation System

E- Procurement

Salary Record

Transparansi ketersediaan tempat tidur rawat inap kepada publik melaluifasilitas monitoring Bed Management yang tersedia di Admission Center, dan di Instalasi Gawat Darurat.

Transparansi proses cuci darah melalui monitor bagi keluarga pasienHemodialisa

Transparansi jadwal dokter harian pada anjunganpendaftaran mandiri , poster-poster, maupun melaluipetugas customer service

Bagian dari visi kami untukmenjadi“Teman Terpercaya”

BED MANAGEMENT More Accountable, More Effective, More Trust

VISUAL MANAGEMENT JIDOKA

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ANJUNGAN PENDAFTARAN MANDIRI

Loket otomatis untuk pendaftaran pasien BPJS, dalam rangka mengurai antrian dan memberikannilai lebih . Sehingga pasien JKN mendapatpelayanan dengan dengan cara mutakhir.

• menggunakan RFID pada kartu pasien• bisa langsung pilih klinik dokter tertentu• bisa langsung print SEP, • terkoneksi dengan server pelayanan BPJS• otomatis membuat urutan antrian• bagi pasien yang tidak memiliki digital literacy tetap disediakan loket pendaftaran manual

• Minim Antrian• Pendaftaran Cepat• Kekinian• Lead time efficiency

Much Efficient, More Faster, More Value HEIJUNKA

JIDOKA HEIJUNKA

PULL SYSTEM AND DEFECT PREVENTION

VISUAL MANAGEMENT STANDARDIZEDJUST IN TIME

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conclusionPlease noted carefully…

key aspects for best practiceskey aspects for best practices

DEVELOPING PEOPLEDEVELOPING PEOPLE BUILT IN QUALITYBUILT IN QUALITY

VALUE CREATIONCOST LEADERSHIPOPERATIONAL EXCELLENCE

CULTURE TRANSFORMATIONGENCHI GENBUTSU (GENBA)

REDESIGN PROCESSREDESIGN PROCESS

HEIJUNKAJIDOKASTANDARDIZEVISUAL MANAGEMENT

PeoplePeople ProductsProducts ProcessProcess

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“The best way to predict your future is to create it”Abraham Lincoln

“It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change”

Charles Darwin

TERIMA KASIH