Analisis Pengaruh Faktor Struktur Mutu Rumah Sakit terhadap Waktu Tunggu Pasien Pengguna Aplikasi Mobile Jaminan Kesehatan Nasional melalui Business Process Management di Unit Rawat Jalan RSUD Mohammad Noer

Latar belakang: Waktu tunggu pelayanan rawat jalan di RSUD Mohammad Noer Pamekasan masih melebihi standar ≤60 menit. Rata-rata waktu tunggu tahun 2022–2024 mencapai 106 menit, sementara kunjungan pasien JKN meningkat dari 42.864 pada 2022 menjadi 54.790 pada 2024. Pemanfaatan Mobile JKN belum sepenuhnya menghasilkan efisiensi karena masih terdapat permasalahan pada proses pelayanan. Tujuan: Menganalisis pengaruh faktor struktur mutu rumah sakit yang meliputi sumber daya materiil, regulasi/kebijakan rumah sakit, dan sumber daya manusia terhadap waktu tunggu pasien pengguna Mobile JKN, serta menerapkan Business Process Management (BPM) untuk menyusun dan mengimplementasikan perbaikan proses pelayanan rawat jalan. Metode: Penelitian menggunakan mixed-methods (Sequential Explanatory). Tahap kuantitatif menggunakan pendekatan cross-sectional pada 315 responden untuk menganalisis hubungan faktor struktur mutu rumah sakit dengan waktu tunggu menggunakan. Analisa data dilakukan secara univariat, bivariat menggunakan Chi-Square, dan multivariat menggunakan regresi logistik berganda. Tahap kualitatif dilakukan melalui Business Process Management yang meliputi process discovery, pemodelan proses, flow analysis, identifikasi non-value added, waste dan issue, Focus Group Discussion, root cause analysis, redesain, implementasi, dan monitoring. Pengukuran pascaimplementasi menggunakan jumlah sampel yang sama dan perbedaan waktu tunggu sebelum dan sesudah BPM dianalisis dengan uji Mann-Whitney. Hasil: Sebelum penerapan BPM, rata-rata total waktu tunggu adalah 113 menit 13 detik dan 60,6% pasien mengalami waktu tunggu >60 menit. Pada analisa bivariat, Sumber daya materiil tidak berhubungan signifikan dengan waktu tunggu (p=0,462), sedangkan regulasi/kebijakan rumah sakit (p=0,006) dan sumber daya manusia (p=0,042) berhubungan signifikan. Hasil regresi logistik berganda menunjukkan bahwa regulasi kebijakan rumah sakit (p=0,002) dan sumber daya manusia (p=0,028) berhubungan dengan waktu tunggu. Permasalahan utama berkaitan dengan prosedur layanan, responsivitas dan komunikasi petugas. Redesain difokuskan pada optimalisasi validasi dan penerbitan SEP serta pengelolaan kedatangan pasien. Setelah implementasi BPM, rata-rata waktu tunggu menurun menjadi 94 menit 08 detik dan proporsi pasien sesuai standar meningkat menjadi 52,4%. Perbedaan sebelum dan sesudah penerapan BPM signifikan secara statistik (p=0,001). Kesimpulan: BPM mampu meningkatkan efisiensi waktu tunggu pasien pengguna Mobile JKN secara signifikan, ditunjukkan oleh penurunan rata-rata waktu tunggu sebesar 19 menit 05 detik. Namun, waktu tunggu masih melebihi standar ≤60 menit sehingga perbaikan selanjutnya perlu diarahkan pada waktu tunggu pemeriksaan perawat dan dokter.

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Background: Outpatient service waiting time at RSUD Mohammad Noer Pamekasan remains above the ≤60-minute standard. The average waiting time from 2022 to 2024 reaches 106 minutes, while JKN patient visits increase from 42,864 in 2022 to 54,790 in 2024. The use of Mobile JKN has not fully improved service efficiency because problems remain within the service process. Objective: This study aims to analyze the effects of hospital quality structure factors, comprising material resources, hospital regulations/policies, and human resources, on the waiting time of Mobile JKN users, and to implement Business Process Management (BPM) to develop and implement improvements to the outpatient service process. Methods: This study employed a mixed-methods design using a sequential explanatory approach. The quantitative phase employed a cross-sectional design involving 315 respondents to examine the effects of hospital quality structure factors on the waiting time of Mobile JKN users using the binary logistic regression analysis. The qualitative phase was conducted through Business Process Management, comprising process discovery, process modeling, flow analysis, identification of non-value-added activities and waste, issue identification, Focus Group Discussion, root cause analysis, process redesign, implementation, and monitoring. Post-implementation measurements were conducted using the same sample size, and the difference in waiting time before and after BPM implementation was analyzed using the Mann-Whitney test. Results: Before BPM implementation, the mean total outpatient service waiting time was 113 minutes and 13 seconds, and 60.6% of patients experienced waiting times of more than 60 minutes. In the bivariate statistical analysis, material resources were not significantly associated with waiting time (p=0.462), whereas hospital regulations/policies (p=0.006) and human resources (p=0.042) were significantly associated with waiting time. Multiple logistic regression results showed that hospital regulations/policies (p = 0.002) and human resources (p = 0.028) were independently associated with waiting time. The main problems were related to service procedures, staff responsiveness, and communication. The redesign focused on optimizing SEP validation and issuance and patient arrival management. After BPM implementation, the mean total service process time decreased to 94 minutes and 8 seconds, and the proportion of patients meeting the waiting time standard increased to 52.4%. The difference in waiting time before and after BPM implementation was statistically significant (p=0.001). Conclusion: BPM significantly improved the efficiency of the outpatient service waiting time for Mobile JKN users, as indicated by a reduction in the mean total service process time of 19 minutes and 5 seconds. However, waiting time remains above the ≤60-minute standard; therefore, subsequent improvements should focus on reducing waiting time for nurse and doctor examinations.

Keywords: waiting time, Mobile JKN, Business Process Management, hospital quality