Lean Management DLM Kendali Mutu Kendali Biaya PDF [PDF]

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19/07/2017



LEAN MANAGEMENT DALAM KENDALI MUTU DAN KENDALI BIAYA



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Why We Need Lean ? Everything goes to global Universal Health Coverage adalah globalisasi dalam healthcare di mana menuntut industri rumah sakit memberikan high quality namun dengan low cost operational.



Bundle payment terjadi di seluruh negara yang mengadopsi universal health coverage



DISRUPTIVE CHANGES dari FEE for SERVICE menuju PROSPECTIVE PAYMENT SYSTEM



BEFORE JKN



FEE FOR SERVICE Tarif = Cost + Profit



AFTER JKN



PROSPECTIVE PAYMENT SYSTEM Profit = Sale - Cost



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Why We Need Lean ? Value yang dianggap baik oleh pasien semakin lama bergeser, dan demandnya semakin tinggi



Customer demands more faster, more better, more affodable



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



sementara itu ... ketika dunia terus bergerak



Focus manajemen industri rumah sakit hanya di unfairness tapi bukan melakukan reduce cost



Biaya kesehatan makin tinggi



4. value base care



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Why We Need Lean ?



Klinisi tidak dibekali pengetahuan mengenai Cost



Efisiensi tidak diajarkan dalam pendidikan kedokteran dan keperawatan



Lean Do with Fix inside the corporate Through people



WASTE in Hospital Perspektif KEUANGAN



Perspektif PELANGGAN



Perspektif INTERNAL PROSES



Perspektif PERTUMBUHAN



Pertumbuhan usaha



Focus for efficiency BIAYA 40% dibuat oleh : HIDDENT COST



Pendapatan



Pelanggan loyal



Pelanggan Baru



Eliminasi titik Waste, maka Kualitas layanan rujukan akan meningkat dengan sendirinya



60% PROSES BISNIS Teridentifikasi SEBAGAI WASTE



Culture organisasi



Kompetensi SDM



teknologi



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Governance expectation: Kemenkes, BPJS



Kendali Mutu Kendali Biaya ? Fixed Cost Variable Cost



What we facing today?



Yang dihadapi Rumah Sakit di Era JKN PROSPECTIVE PAYMENT



FORMULARIUM NASIONAL



INA-CBG’S



VALUE BASED CARE



LOW COST OPERATIONAL Profitability



Patient Satisfaction



Patient Safety



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



Strategic Option:



strategy strategy strategy



COST Leadership OPERATIONAL Excellence WASTE Elimination



By: Michael Porter, Competitve advantage



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



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Genchi Genbutsu go and see the problem at the place, at the time



BOTTOM UP SOLUTION



masalah



“ adalah gunung emas”



5 value agenda



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How To Deal With Fixed Cost



RSPELNI



RUJUKAN PARSIAL RUJUKAN HORIZONTAL RUJUKAN VERTIKAL



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



What is network capability? 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 information about collaborating firms; and (4) the firm’s internal communication to assist in the transfer of organizational knowledge between collaborators.



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We cannot solve our problem with the same thinking we used when we created them ~ Albert Einstein ~



Howstandardizing To Deal With Variable Cost physician



clinical pathway



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How To Deal With Variable Cost



STANDARDIZED 2013 Formulary



2014 Formulary



2015 Formulary



Implementing National Formulary on hospital Medicine standardization based on active substance contained on it



JUST IN TIME



FARMASI • • • •



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



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



dalam rangka peningkatan PRODUKTIVITAS (CORPORATE PERFORMANCE) 1. 2. 3. 4. 5. 6.



Task focused Situation focused Penyempurnaan proses yang ada Mata rantai yang lemah Merancang ulang proses lama berbasis pengetahuan Menyumbangkan mata rantai yang hilang



Pelayanan Pasien pulang: PASIEN TIDAK DI EDUKASI UTK PELAYANAN PENCEGAHAN SAKIT



Pelayanan Pemeriksaan & Tindakan: LAMBANNYA SISTEM PELAYANAN



Pelayanan Parkir: PARKIR CEPAT PENUH



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Pasien datang: LONJAKAN KUNJUNGAN PASIEN



Pelayanan registrasi: KONSENTRASI KEDATANGAN PASIEN DI PAGI HARI



5 Pelayanan obat: LAMBANNYA PENYIAPAN OBAT



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Valuing People



JIT kanban



Kaizen



Lean



gemba



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



SOSIALISASI



Acceleration workshop



OBYEKTIFIKASI Gemba Divisi Budaya



CORPORARE CULTURE



INTERNALISASI



Perilaku sehari-hari



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Developing Hospital = Developing People



CULTURE TRANSFORMATION Melakukan perubahan secara revolusioner pada organisasi, dimulai dari cara berpikir, cara berperilaku, cara bekerja, dan cara berinteraksi.



TRANSFORM = ALTERING ABOUT ‘HOW’ (CARA)



“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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KAIZEN Upaya perbaikan yang sangat fokus pada proses yang spesifik, untuk menghasilkan perubahan dengan cepat dan berdampak positif Key KAIZEN mindsets ( Masaaki Imai )



Continually improve, with no idea being to small A major source of quality defects is problems in the process Focus change on commonsense, low-cost, and low-risk impact not major innovations. All ideas are addressed and responded in the some way Collect, verify, and analyze data to enact change Empower the worker to enact change



Managing



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Absence Record



Management Tool



Purchasing Tool



HRIS



E-Filing



E- Procurement Salary Record



Internal & External Website



Accounting Managing Innovation System BI Tool Customer Tool



Asset Tool



APM



EHR



E-Office



Medical Tools



Slot System



BED MANAGEMENT



Bed Management



Prescription Online



LIS



RIS



More Accountable, More Effective, More Trust



VISUAL MANAGEMENT JIDOKA Transparansi ketersediaan tempat tidur rawat inap kepada publik melalui fasilitas monitoring Bed Management yang tersedia di Admission Center, dan di Instalasi Gawat Darurat.



Bagian dari visi kami untuk menjadi “Teman Terpercaya”



Transparansi proses cuci darah melalui monitor bagi keluarga pasien Hemodialisa



Transparansi jadwal dokter harian pada anjungan pendaftaran mandiri , poster-poster, maupun melalui petugas customer service



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HEIJUNKA



ANJUNGAN PENDAFTARAN MANDIRI Much Efficient, More Faster, More Value



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



Loket otomatis untuk pendaftaran pasien BPJS, dalam rangka mengurai antrian dan memberikan nilai lebih . Sehingga pasien JKN mendapat pelayanan 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



JIDOKA HEIJUNKA VISUAL MANAGEMENT



JUST IN TIME STANDARDIZED



PULL SYSTEM AND DEFECT PREVENTION



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conclusion Please noted carefully…



key aspects for best practices DEVELOPING PEOPLE



BUILT IN QUALITY



REDESIGN PROCESS



People



Products



Process



CULTURE TRANSFORMATION GENCHI GENBUTSU (GENBA)



VALUE CREATION COST LEADERSHIP OPERATIONAL EXCELLENCE



HEIJUNKA JIDOKA STANDARDIZE VISUAL MANAGEMENT



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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



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