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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.

Community service at the Visi Iy Nike production unit was carried out using a descriptive qualitative and participatory approach to understand real conditions and challenges in the field. The activities began with direct observation of the production process to map workflows, identify operational obstacles, and evaluate the efficiency of resources, including labor, machinery, and production time. In addition, in-depth interviews and group discussions were conducted to collect information regarding production constraints and strategies applied by the operators. The data were analyzed descriptively to identify gaps between production targets and actual outcomes. Based on these findings, several interventions were implemented, including operator skill training, assistance in production planning, and the application of simple lean manufacturing principles to reduce waste and improve efficiency. The results showed that the average production efficiency reached 77%, supported by skilled operators, adequate raw materials, and flexible management practices. Routine documentation and systematic recording of production targets also contributed to better monitoring, evaluation, and faster decision-making processes.

The Indonesian hospitality industry is currently facing a post-pandemic "profitability paradox," a phenomenon where increased occupancy rates do not guarantee a proportional increase in net profit margins due to persistent operational cost inflation. This study aims to evaluate operational cost efficiency strategies and their impact on profitability across three star-rated hotels with contrasting locational and market characteristics: @Hom Hotel Kudus (Central Java), Grand Verona Samarinda (East Kalimantan), and FUGO Hotel Banjarmasin (South Kalimantan). This research adopts a descriptive qualitative approach with a comparative multiple-case study design. Data were collected through in-depth interviews with top management, participant observation, and financial document analysis. The results reveal that geographical characteristics and market segments are the primary determinants in selecting efficiency strategies. (1) Hom Hotel Kudus, located in a secondary industrial area, implements Lean Operations strategies through workforce multi-skilling to address market price sensitivity. (2) Grand Verona Samarinda, in the East Kalimantan business hub, focuses on Supply Chain Engineering by localizing raw materials to mitigate high logistical costs. (3) FUGO Hotel Banjarmasin, in the lifestyle segment, adopts Technology-Driven Efficiency to suppress utility costs without degrading the guest experience. The study concludes that sustainable profitability is achieved not through aggressive cost-cutting, but through strategic cost management adaptive to local contexts. These findings provide a new managerial framework for the hospitality industry to shift from a revenue-centric orientation to value optimization.

This study aims to identify and minimize waste in the process of procuring Food & Beverage raw materials at Hotel PXY Jasa Bali using the Lean Inventory Management approach. Observations over one month showed that the total procurement cost reached 47% of the total revenue, exceeding the ideal limit of 35%. One of the main causes is the inefficient and lack of synchronization between divisions in the Rhapsody platform, which causes waste in the form of defects, delays, over-processing, and transportation. This study uses the Value Stream Mapping (VSM) method to map actual conditions and Process Activity Mapping (PAM) to identify the type of activity based on the waste category. In addition, root cause analysis is carried out using the Root Cause Analysis (RCA) approach. The mapping results showed that out of the total lead time of 598.44 minutes, only 278.49 minutes or 46.54% were value-added activities. This finding indicates that the procurement process is not yet efficient and needs optimization. Several recommendations were given to minimize waste, such as clearer division of tasks, improved communication with vendors, and the procurement of supporting facilities to reduce physical movement between divisions. The implementation of this lean service is expected to be able to increase the efficiency of the logistics process and reduce the company's overall operational costs.

Improving service quality is a primary priority in hospital management. Service quality can be improved by reducing the percentage of non-value added activities through the Lean Hospital approach. This study aims to identify activities and analyze the root causes of critical waste in the drug distribution and utilization processes at the Outpatient Pharmacy Installation of Karanganyar Regency Hospital. This study is a non-experimental research with a qualitative descriptive design. Critical waste was obtained through the distribution of a waste weighting questionnaire assessed by all personnel involved in the drug distribution and utilization processes. The results show that the Value Stream Mapping calculation for the drug distribution process obtained a lead time of 147.41 minutes and a VAR value of 36%, while in the drug utilization process, compounded prescription service obtained a lead time of 128.53 minutes and a VAR of 24%, and non-compounded prescription service obtained a lead time of 75.8 minutes and a VAR of 26%. The critical waste questionnaire calculation using the Borda method in the drug distribution process showed overproduction 60%, inventory 53.33%, and waiting 43.33%, while in the drug utilization process, waiting 43.75%, overproduction 42.85%, and defect 39.70%. The 5S method, a Lean method, was used to eliminate waste in the service process at the Outpatient Pharmacy Installation of Karanganyar Regency Hospital.

Ethical leadership is a crucial foundation for building an organizational culture of integrity, especially in this era of technological disruption and socio-economic complexity. This study examines how ethical leadership is implemented at Kopdit Bintang Timur, a credit union in Sikka Regency, to shape an organizational culture of integrity. Employing a descriptive narrative method with interview and observation techniques targeting managers and deputy managers, this research finds that ethical values such as honesty, fairness, and mutual cooperation are instilled through leader role modeling, transparent financial management, and active member participation. Key challenges include the difficulty of maintaining ethics amidst personal interests; however, routine oversight systems and fair complaint handling help to maintain integrity. The results indicate that ethical leadership contributes to member trust and organizational sustainability. Recommendations for development include formal ethics training programs and the utilization of technology to enhance transparency.

The purchase of secondhand goods, known as thrifting, involves acquiring and reselling pre-owned clothing at low cost. Originating from Western practices during the Great Depression in the United States, this activity is no longer solely about financial considerations it is also an effort to protect the ecosystem by reducing fashion waste and addressing the adverse impacts of fast fashion, such as pollution and unethical labor practices. In Indonesia, thrifting has expanded rapidly since the 2010s, supported by the creative industry, online access, and platforms like Shopee and Tokopedia. It contributes 10% to the nation’s creative economy (BPS 2022), with export value reaching Rp 100 trillion. This phenomenon has gained traction among young generations such as millennials and Gen Z, often aligning with local cultural traditions. In Maumere, a small city in East Nusa Tenggara with limited access to international fashion, thrifting has emerged as a primary option for students. Stores offer t-shirts, blouses, and dresses priced between Rp 20,000 and Rp 50,000, which suits their modest financial circumstances. Jeanette’s (Aunt Cindy’s) business focuses on top garments like crop t-shirts and crop blouses, leveraging online marketing through TikTok, Instagram, and Facebook to compensate for the store’s less-than-ideal location. This study employs a qualitative approach with direct interviews with Jeanette, using SWOT analysis for evaluation. Strengths: Affordable pricing and alignment with current fashion trends enhance customer loyalty. Weaknesses: Delayed inventory arrivals, "PHP" behavior (holding items without purchase), ineffective management, and limited product options. Opportunities: Adoption of digital technology and fashion trends. Challenges: Domestic competitors and low-priced imported goods. This study provides strategic guidance for small businesses in remote areas to adapt to the digital era.

Shortness of breath is one of the main problems experienced by patients with respiratory disorders such as chronic obstructive pulmonary disease (COPD), asthma, pulmonary tuberculosis, and lung cancer. This condition can reduce oxygen saturation, which leads to limitations in physical activity, decreased quality of life, and an increased risk of hypoxemia that may become fatal if not immediately addressed. The management of dyspnea is not only carried out through pharmacological therapy but also through non-pharmacological interventions that are simple, safe, and easy to apply by health care providers. One such intervention is the tripod position and pursed-lip breathing technique. The tripod position is a sitting posture in which the patient leans forward with both hands supporting the body on the knees or a table, thereby facilitating maximum chest expansion. Meanwhile, pursed-lip breathing is a breathing technique performed by inhaling through the nose and exhaling slowly through pursed lips, which prolongs the expiratory phase, reduces trapped air, and improves alveolar ventilation. This study aimed to determine the effectiveness of applying these two techniques in increasing oxygen saturation among patients with dyspnea in the Emergency Department of RSUD Limpung. The research design was a case study involving four patients diagnosed with COPD, asthma, pulmonary tuberculosis, and lung cancer. The intervention was carried out by assisting patients to sit in a tripod position and training them in pursed-lip breathing for approximately 10 minutes. Oxygen saturation was measured using a pulse oximeter before and after the intervention. The results showed an increase in oxygen saturation in all patients, from 92–97% to 95–99% after the intervention. In conclusion, tripod position and pursed-lip breathing proved to be effective non-pharmacological therapies that can be recommended in emergency nursing practice to reduce dyspnea and improve oxygenation.

This study aims to analyze and improve the quality control of packaging printing production at PT XYZ by applying the Lean Six Sigma methodology. Lean Six Sigma combines waste reduction principles with statistical quality control to achieve operational excellence. The research identifies major production challenges, including high defect rates, overproduction, and ineffective inventory management, all of which contribute to increased costs and reduced efficiency. The DMAIC framework—Define, Measure, Analyze, Improve, and Control—was employed to systematically address these issues. During the Define and Measure phases, types of waste were identified and defect rates were calculated using Defects Per Million Opportunities (DPMO). In the Analyze phase, root causes were examined using a Fishbone (Ishikawa) diagram, highlighting factors related to manpower, materials, machines, and methods. The analysis revealed a sigma level of 3.2, indicating a moderate level of process quality and substantial room for improvement. To address the identified issues, several improvement strategies were proposed. These include implementing a Just-In-Time (JIT) system to reduce inventory waste, adopting the First-In-First-Out (FIFO) inventory method for better material rotation, and conducting targeted technical training for operators to minimize human error. In the Control phase, the study suggests process standardization, routine inspections, and continuous monitoring as key practices to ensure that improvements are sustained over time. The findings and recommendations from this study are expected to contribute to better quality control, reduced operational waste, and enhanced productivity in the packaging printing process. Ultimately, this approach aims to strengthen PT XYZ’s competitiveness in the printing industry by fostering a culture of continuous improvement and quality excellence.

Increasing business competition requires companies to consistently improve quality and operational efficiency. This study aims to identify and reduce non-value added activities in the procurement process at Distributor X, a company engaged in the distribution of instant cooking spices. Common issues include expired goods (49.05%), damaged packaging (18.78%), and product mismatches (32.17%). The Lean Six Sigma approach with the DMAIC (Define, Measure, Analyze, Improve, Control) method is used to address these problems. Measurement results show an average DPMO value of 10,076.58 and a sigma level of 3.82, which are still far below the Six Sigma quality standard. Improvement proposals include the implementation of barcode/RFID systems, FIFO inventory management, higher-quality packaging materials, and the use of unique product codes. In the Control phase, monitoring is carried out through an ERP system and the establishment of structured SOPs to support distribution oversight. This approach demonstrates potential in reducing defect rates and improving the overall quality of the procurement process.

Waste management problems in Kudus City show high complexity, marked by an increase in the volume of daily waste generation that is not balanced by an adequate handling system. This study aims to optimize the waste management system in an integrated manner with an industrial engineering approach, especially through the application of the Lean Waste Management concept, redesigning facilities and logistics, and strengthening community participation based on Human-Centered Design (HCD). A qualitative method with a case study approach was used, with data triangulation techniques in the form of in-depth interviews, direct observation, and document analysis. The results of the study showed that 75% of households did not sort their waste, only 2 out of 6 TPSTs were active, and the TPA capacity had exceeded its limit since 2022. The efficiency of the transportation system is also low due to suboptimal routes and frequencies. This study offers solutions based on technology integration, facility redesign, logistics optimization, and community empowerment. With a systemic approach based on industrial engineering, an efficient and sustainable waste management model can be applied, not only in Kudus, but also in other areas with similar challenges.

Lean Management is a method that emphasizes reducing waste and increasing added value in healthcare service processes. Through a systematic literature review, this study identifies various aspects of Lean implementation in hospitals, such as reducing patient waiting times, optimizing resource utilization, and improving patient satisfaction. The findings reveal that Lean Management implementation not only supports operational efficiency but also enhances service quality and patient experience. The success of this method heavily depends on management support, active staff involvement, and adequate training. This study also highlights challenges such as resistance to change and budget constraints. These findings have significant implications for hospital managers and policymakers in formulating strategies to improve healthcare service effectiveness. Recommendations for future research include empirical studies examining Lean implementation in various hospital contexts, particularly in developing countries. This study aims to explore and analyze strategies for improving hospital operational efficiency through the Lean Management approach.

This study analyzes the differences and similarities of internal audit quality in the public sector and private sector using a literature analysis approach. The main objective was to explore factors that affect audit quality, such as auditor independence, competence, transparency, and accountability. The results show that the public sector often faces challenges in maintaining auditor independence due to the influence of bureaucracy and politicization. However, the sector has advantages in transparency and accountability, which support public trust in the management of public funds. In contrast, the private sector excels in operational efficiency and flexibility, supported by the use of modern audit technology and leaner organizational structures. Despite the differences, both sectors require high auditor competence and strong internal control systems to ensure audit effectiveness. This research suggests strengthening auditor training, implementing modern audit technology, and increasing collaboration between internal and external auditors to ensure audit objectivity and quality. In addition, further studies are recommended to explore the impact of applying new technologies, such as big data and artificial intelligence, and conduct cross-sectoral comparisons to understand audit implementation globally.

User satisfaction can be measured through a variety of methods, including user satisfaction surveys, direct feedback, and analysis of user behavior data. This research aims to analyze user satisfaction withLearning Management System (LMS) Course Lean Manufacturing using methodImportance Performance Analysis (IPA). Through surveys and data analysis of 100 respondents from LMS users, we identified critical attributes that influence user satisfaction. The IPA method is used to assess the level of importance and performance of each attribute, with a focus on determining attributes that have a high level of importance but low performance. The results show that a particular attribute, which we identified as attribute A, has high importance but low performance. Therefore, improvements to attribute A are considered crucial for increasing LMS user satisfactionCourse Lean Manufacturing. The implications of these findings provide guidance for system developers and course organizers to focus on certain aspects to increase the effectiveness and user acceptance of learning platformsLean Manufacturing. This research contributes to further understanding of the factors that influence LMS user satisfaction in learning contextsLean Manufacturing.  

This research was conducted among the people of Suka Makmur Village, Muaro Jambi Regency, among whom work as farmers and traders. In the lean season, they still have to fulfill their daily needs, such as clothing, food and shelter. Apart from that, they also have to save and invest to meet future needs. This research aims to: (1) find out strategies for managing family finances in an Islamic way in creating a sakinah family. (2) knowing the supporting and inhibiting factors faced by the people of Suka Makmur Village, Muaro Jambi Regency in managing family finances in an Islamic manner in creating a sakinah family. This research uses a qualitative approach with the type of field research. Determining the research subjects was purposive and used data collection techniques through observation, interviews and documentation. The results of this research show that the Islamic family financial management strategy in creating a sakinah family in the Suka Makmur Village community, Muaro Jambi Regency has carried out financial planning such as managing family finances, savings, investment and zakat. Meanwhile, the supporting and inhibiting factors faced by the people of Suka Makmur Village, Muaro Jambi Regency in managing family finances in an Islamic manner in creating a sakinah family. Supporting factors are faced such as instilling mutual respect, providing support to your partner or family, and having a good personality such as being frugal. Meanwhile, factors such as wasteful nature, lack of communication, and economic problems.    

Lean Inventory Management is a systematic approach that focuses on reducing waste in the inventory management process to improve operational efficiency and reduce costs. This study aims to analyze the impact of Lean Inventory Management implementation on reducing inventory costs in manufacturing companies. This research uses a case study method in a manufacturing company that has implemented Lean Inventory Management. Data were collected through in-depth interviews, direct observation, and analysis of company documents. The analysis techniques used include descriptive and comparative analysis to measure changes in inventory costs before and after implementation. The results showed that the implementation of Lean Inventory Management succeeded in significantly reducing inventory costs. Some of the strategies implemented include the implementation of Just-In-Time (JIT), reduction of buffer inventory levels, improved coordination with suppliers, and the use of information technology for real-time inventory monitoring. In addition, the company also noted improved operational efficiency and customer satisfaction as a positive impact of implementing Lean Inventory Management. This study concludes that Lean Inventory Management is an effective approach to reduce inventory costs in manufacturing companies. Proper implementation of lean strategies can result in significant cost savings

Body composition refers to the various components that make up a person's body weight, such as lean mass (muscle, water, bones, ligaments, and tendons) and fat mass. As we age, significant changes occur in body composition, including increased fat mass and decreased muscle and bone mass, which often leads to sarcopenic obesity. This condition, which is common in older adults, is associated with frailty, disability, metabolic syndrome, reduced survival rates in certain cancers, and osteopenia/osteoporosis. This activity uses the PDCA (Plan-Do-Check-Act) method to measure the body composition of elderly participants at Hana Nursing Home, South Tangerang. A total of 40 participants underwent body composition examinations. The examination results showed that the average total body fat, visceral fat, subcutaneous fat, and skeletal muscle mass were 36.7% each; 8%; 27.6%; and 20.7%. We need to carry out routine body composition checks for early detection to provide timely management, ultimately improving long-term public health. Keywords: Body Composition, Early Detection, Elderly, Obesity, Sarcopenia

This study analyzes and optimizes production systems in the Industry 4.0 context, examining the fundamental shift from centralized, push-based production models to decentralized, adaptive, pull-based approaches. The research employs a mixed-method approach combining comprehensive literature review and multiple case studies across manufacturing sectors. Findings reveal that integration of Internet of Things (IoT), cyber-physical systems, artificial intelligence, and big data analytics enables real-time communication between production components, product personalization, and faster decision-making. Despite significant benefits in efficiency, flexibility, and competitiveness, implementation challenges persist, including high initial investment, employee resistance, technical expertise limitations, and integration complexity. Optimization approaches such as mixed-integer linear programming, digitally-integrated Lean Six Sigma, and digital twin simulations effectively enhance performance indicators including flexibility, reliability, and energy efficiency. The study concludes that successful production system transformation requires an integrated strategy encompassing process engineering, digital competency development, change management, and continuous evaluation to ensure sustainable optimization in the digital era

The maritime industry, as one of the vital sectors in the global economy, plays an indispensable role in facilitating international trade and the transportation of goods worldwide. However, confronted with challenges of heightened global competition and fluctuations in fuel prices, the industry needs to seek solutions to enhance efficiency and overall performance. This study assesses the application of Lean Management Principles in the maritime industry, emphasizing strategies such as value stream mapping, waste identification, and employee training as crucial for success. Findings reveal potential for enhancing operational efficiency and reducing waste, along with additional benefits such as heightened customer satisfaction and contributions to environmental sustainability. Recommendations for further research encompass case studies on Lean Management implementation in the maritime industry, the development of tailored implementation models, and investigations into the environmental ramifications of Lean Management application. In conclusion, the implementation of Lean Management holds significant promise for improving the performance of the maritime industry and fostering its overall development.

The COVID-19 pandemic has presented unique challenges for startups, particularly in the areas of financial management. This research focuses on the financial obstacles faced by startups in the post-pandemic period, including cash flow management, access to funding, and risk mitigation. Through interviews with entrepreneurs and financial experts, the paper highlights effective strategies that startups have adopted to navigate these challenges, such as digital finance tools, crowdfunding, and lean financial management practices. The study concludes by offering a framework for startups to enhance their financial resilience and sustainability in a volatile economic environment.