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Prolonged outpatient waiting time remains a major challenge in public hospitals and reflects inefficiencies in service process management. Internal medicine clinics are characterised by high service complexity and patient volume, making them particularly vulnerable to process waste that contributes to extended waiting times. Objective: This study aimed to develop an outpatient service flow model based on the Lean Hospital approach to reduce waiting time in the internal medicine clinic of RSUD Balaraja. Methods: A qualitative case study design was employed. Data were collected through direct observation of outpatient service processes, document review, and Focus Group Discussions (FGD) with relevant stakeholders. Process analysis was conducted using Value Stream Mapping (VSM) to identify value-added and non–value-added activities, while Fishbone Diagram analysis was applied to explore the root causes of process inefficiencies. All findings were integrated to develop a future-state outpatient service flow model. Results: The findings indicate that prolonged outpatient waiting time is primarily influenced by inefficient service flow design, repetitive administrative processes, and weak coordination among service units. The proposed service flow model demonstrates a more streamlined, integrated, and patient-centred process, with potential reductions in waiting time through systematic waste elimination and process improvement. Conclusion: The Lean Hospital approach provides an effective framework for developing outpatient service flow models in public hospitals. The proposed model offers a practical basis for improving outpatient service efficiency in complex clinical settings such as internal medicine clinics.

Prescription waiting time is a key indicator of pharmacy service quality that directly influences patient satisfaction and hospital efficiency. Data from the Outpatient Pharmacy Installation of Pelabuhan Jakarta Hospital show average waiting times of 30.49 minutes for non-compounded medications and 35.93 minutes for compounded medications. Although these figures are still within national standards, they have not met the hospital’s internal targets, indicating inefficiencies that require systematic improvement.This study aimed to analyze prescription waiting times and identify waste in outpatient pharmacy services using Lean Hospital and Continuous Improvement approaches. A qualitative analytical method with a case study design was applied. Data collection involved participatory observation, in-depth interviews with key informants (head of pharmacy, pharmacists, and technicians), and document review. Analysis utilized Lean tools such as Value Stream Mapping (VSM), identification of Value Added (VA) and Non-Value Added (NVA) activities, bottleneck analysis, fishbone diagram, and Failure Mode and Effects Analysis (FMEA).The findings revealed that service processes were dominated by non-value-added activities, especially during prescription receipt, verification, packaging, and dispensing. Major wastes included waiting, motion, and overprocessing. Contributing factors were uneven staff distribution, suboptimal e-prescribing systems, incomplete prescriptions, and lack of standardized procedures. The proposed future state VSM demonstrated potential improvements in reducing waiting time and enhancing service efficiency.