Implementation of lean kaizen to reduce waiting time for the Indonesian health social security agency prescription services in hospital pharmacy installation

BACKGROUND: The second largest Health Social Security Agency (BPJS Health) outpatients’ visits in Hospital Pharmacy Installation, Indonesia, have reached 450–600 visits/day between 2017 and 2018. This has an impact on the number of prescriptions to be served. Simultaneous doctor practice schedule and less human resources are the reasons for not achieving the service standard time requirement by the Ministry of Health (≤60 min for concoctions and ≤30 min for non-concoctions). Reducing waiting time has implications for the patients’ satisfaction and quality of care. AIM: The purpose of this study was to determine the waiting time for BPJS prescription services in the present state and future state after the implementation of lean kaizen through Plan-Do-Check-Act (PDCA) approach at Grha Permata Ibu Hospital. METHODS: The research method is operational research with qualitative and quantitative approaches through direct observation using the time and motion study technique and in-depth interviews. The number of samples was 30 BPJS Health outpatient prescriptions consisting of concoction and non-concoction prescriptions and seven informants for in-depth interviews. The data were classified based on the type of waste and confirmed by in-depth interviews. After the implementation of lean kaizen through PDCA, the researcher carried out future state value stream mapping and recalculated value-added activities and non-value-added activities. Finally, the present state and future state conditions are compared. RESULTS: The implementation of lean kaizen decreased the lead time (LT) from 135.31 min to 9.11 min in scenario-1 and 7.49 min in scenario-2 and a decrease in LT from 185.17 min to 31.09 min in scenario-1 and 29, 15 min in scenario-2 for the concoctions. PDCA in lean kaizen is for use in conditions where waste is most closely related to human behavior, but there is still a waste of motion that has not been intervened. CONCLUSION: This study suggests an updating information to reduce LT in pharmacy services by changing in pharmacy layout, conducting continuous monitoring and evaluation, and developing IT-based pharmaceutical services.