The performance of a company will determine the quality of the services produced. Services are considered to have quality when the products meet the consumer’s desires. It is important for the companies to know what consumers want and need to improve the service quality. One of them is the quality of health services which is one of the important things for patients. The service process at Darmayu Hospital received criticism from the patients. The study was conducted in an outpatient internal medicine clinic since there were many complaints from the patients. The aim of this study was the duration of each service process on an outpatient basis. The purposes of this study were to identify waste from patient service systems on out-patient care with a lean approach using value stream mapping to reduce waste that occurs, to identify the root causes of waste problems with a fishbone diagram, to identify the10 waste and to design the improvement proposals with participatory ergonomics. The results of the study obtained concluded that the value-added activity was 26,28% or less than 30% which meant that there was still waste on service activities. From the results of the spread questionnaires of 10 waste, there was 1 critical waste that was waste of waiting or waiting time for the doctor's examination. The root cause of waste problems was analyzed using the fishbone diagrams so that the root cause of the problem in terms of humans, methods, environment, and materials /information could be obtained. From the analysis of fishbone diagram results then the proposed improvements were given with the concept of kaizen.