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19/07/2017
2
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
1
Pelayanan Parkir:PARKIR CEPAT
PENUH
2
Pelayanan registrasi:KONSENTRASI KEDATANGAN
PASIEN DI PAGI HARI
3
Pelayanan Pemeriksaan & Tindakan:
LAMBANNYA SISTEM PELAYANAN
4
Pelayanan obat:LAMBANNYA
PENYIAPAN OBAT
5
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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