Business Process Improvement Analysis of Outpatient BPJS Pharmacy Service using Lean Healthcare Approach: A Case Study at RS Jantung Matraman Jakarta

Abstract

Prolonged prescription waiting times remain an operational challenge in outpatient pharmacies, particularly in hospitals serving patients covered by Indonesia’s National Health Insurance program. This study aimed to identify process inefficiencies and formulate improvement recommendations for outpatient BPJS pharmacy services at JHC Matraman Hospital using a Lean Healthcare approach. A mixed-methods approach combining observation, interviews, and document review was employed. Current-state Value Stream Mapping (VSM) was used to measure processing and waiting times, while activity classification, Pareto analysis, the DOWNTIME framework, fishbone diagrams, and the 5 Whys technique were applied to identify waste and investigate its root causes. The results showed that total lead times reached 40.4 minutes for noncompounded prescriptions and 82.8 minutes for compounded prescriptions, exceeding the respective benchmarks of 30 and 60 minutes. Waiting time accounted for 77.8% and 83.7% of the total lead time, whereas value-added activities accounted for only 10.8% and 9.8%, respectively. Prescription queues within the hospital information system and delays between workstations emerged as priority areas for improvement. These findings indicate that inefficient prescription flow and coordination contributed substantially to prolonged service times. Lean Healthcare provided a structured framework for developing targeted workflow redesign and performance-monitoring recommendations. However, implementation and prospective evaluation are required to determine whether the proposed improvements can sustainably reduce waiting times while maintaining medication safety.