Aplicação do mapeamento de fluxo de valor e Lean Healthcare na emergência de um hospital de referência regional
DOI:
https://doi.org/10.5585/exactaep.2021.20642Palavras-chave:
Lean Healthcare, Mapeamento de Fluxo de Valor, Emergência.Resumo
A crescente busca de sistemas de saúde por melhoria da eficiência e eficácia, e para atender ao aumento da demanda, pressupõe a redução dos desperdícios e agregação de valor. O setor de emergência, porta de entrada de grande parte dos pacientes, têm sido considerado um dos maiores desafios para sistemas de saúdes. Nesse contexto, o Lean Healthcare emergiu como uma alternativa para a promoção de sistemas de saúde mais eficientes. A partir disso, este artigo objetiva propor melhorias no fluxo de emergência de um hospital de referência no meio-oeste de Santa Catarina, utilizando a ferramenta Mapeamento de Fluxo de Valor. Como resultado, identificou-se os principais problemas no fluxo do paciente, a condição alvo a ser atingida, além das frentes de melhorias propostas, com vistas na redução do lead time. O estudo contribui na expansão do conhecimento referente à gestão e a práticas enxutas no departamento de emergência de hospitais de referência regional.
Downloads
Referências
Alnajem, M., Garza-Reyes, J. A., & Antony, J. (2019). Lean readiness within emergency departments: a conceptual framework. Benchmarking: An International Journal, 26(6), 1874–1904. https://doi.org/10.1108/BIJ-10-2018-0337
Antony, J., Sunder M., V., Sreedharan, R., Chakraborty, A., & Gunasekaran, A. (2019). A systematic review of Lean in healthcare: a global prospective. International Journal of Quality & Reliability Management, 36(8), 1370–1391. https://doi.org/10.1108/IJQRM-12-2018-0346
Bal, A., Ceylan, C., & Taçoğlu, C. (2017). Using value stream mapping and discrete event simulation to improve efficiency of emergency departments. International Journal of Healthcare Management, 10(3), 196–206. https://doi.org/10.1080/20479700.2017.1304323
Brito, L. A. L., Malik, A. M., Brito, E., Bulgacov, S., & Andreassi, T. (2017). Práticas de gestão em hospitais privados de médio porte em São Paulo, Brasil. Cadernos de Saúde Pública, 33(3). https://doi.org/10.1590/0102-311x00030715
Bruni, R. A., Laupacis, A., Levinson, W., & Martin, D. K. (2010). Public views on a wait time management initiative: a matter of communication. BMC Health Services Research, 10(1), 228. https://doi.org/10.1186/1472-6963-10-228
Burström, L., Starrin, B., Engström, M.-L., & Thulesius, H. (2013). Waiting management at the emergency department – a grounded theory study. BMC Health Services Research, 13(1), 95. https://doi.org/10.1186/1472-6963-13-95
Carter, P. M., Desmond, J. S., Akanbobnaab, C., Oteng, R. A., Rominski, S. D., Barsan, W. G., & Cunningham, R. M. (2012). Optimizing Clinical Operations as Part of a Global Emergency Medicine Initiative in Kumasi, Ghana: Application of Lean Manufacturing Principals to Low-resource Health Systems. Academic Emergency Medicine, 19(3), 338–347. https://doi.org/10.1111/j.1553-2712.2012.01311.x
Castanheira-Pinto, A., Gonçalves, B. S., Lima, R. M., & Dinis-Carvalho, J. (2021). Modeling, Assessment and Design of an Emergency Department of a Public Hospital through Discrete-Event Simulation. Applied Sciences, 11(2), 805. https://doi.org/10.3390/app11020805
Cucinotta, D., & Vanelli, M. (2020). WHO Declares COVID-19 a Pandemic. Acta Bio-Medica : Atenei Parmensis, 91(1), 157–160. https://doi.org/10.23750/abm.v91i1.9397
Dahlgaard, J. J., Pettersen, J., & Dahlgaard-Park, S. M. (2011). Quality and lean health care: A system for assessing and improving the health of healthcare organisations. Total Quality Management & Business Excellence, 22(6), 673–689. https://doi.org/10.1080/14783363.2011.580651
Doğan, N. Ö., & Unutulmaz, O. (2016). Lean production in healthcare: a simulation-based value stream mapping in the physical therapy and rehabilitation department of a public hospital. Total Quality Management & Business Excellence, 27(1–2), 64–80. https://doi.org/10.1080/14783363.2014.945312
Gill, P. S. (2012). Application of value stream mapping to eliminate waste in an emergency room. Global Journal of Medical Research, 12(6), 51–56.
Graban, M. (2016). Lean hospitals: improving quality, patient safety, and employee engagement. CRC press.
Gupta, S., Kapil, S., & Sharma, M. (2018). Improvement of laboratory turnaround time using lean methodology. International Journal of Health Care Quality Assurance, 31(4), 295–308. https://doi.org/10.1108/IJHCQA-08-2016-0116
Henrique, D. B., Rentes, A. F., Godinho Filho, M., & Esposto, K. F. (2016). A new value stream mapping approach for healthcare environments. Production Planning & Control, 27(1), 24–48. https://doi.org/10.1080/09537287.2015.1051159
Lima, R. M., Dinis-Carvalho, J., Souza, T. A., Vieira, E., & Gonçalves, B. (2021). Implementation of lean in health care environments: an update of systematic reviews. International Journal of Lean Six Sigma, 12(2), 399–431. https://doi.org/10.1108/IJLSS-07-2019-0074
Lummus, R. R., Vokurka, R. J., & Rodeghiero, B. (2006). Improving Quality through Value Stream Mapping: A Case Study of a Physician’s Clinic. Total Quality Management & Business Excellence, 17(8), 1063–1075. https://doi.org/10.1080/14783360600748091
Mello, C. H. P., Turrioni, J. B., Xavier, A. F., & Campos, D. F. (2012). Pesquisa-ação na engenharia de produção: proposta de estruturação para sua condução. Production, 22(1), 1–13. https://doi.org/10.1590/S0103-65132011005000056
Miguel, P. A. C., Fleury, A., Mello, C. H., Nakano, D. N., De Lima, E. P., Turrioni, J. B., Lee Ho, L., Morabito, R., Da Costa, S. E. G., Martins, R. A., Sousa, R., Pureza, V., & Elsevier. (2018). Metodologia de pesquisa em engenharia de produção e gestão de operações (3rd ed.). Elsevier Editora Ltda.
Morell-Santandreu, O., Santandreu-Mascarell, C., & Garcia-Sabater, J. J. (2021). A Model for the Implementation of Lean Improvements in Healthcare Environments as Applied in a Primary Care Center. International Journal of Environmental Research and Public Health, 18(6), 2876. https://doi.org/10.3390/ijerph18062876
Morrison, I. (2000). Health care in the new millennium: Vision, values, and leadership.
Ng, D., Vail, G., Thomas, S., & Schmidt, N. (2010). Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department. CJEM, 12(01), 50–57. https://doi.org/10.1017/S1481803500012021
Parkhi, S. S. (2019). Lean management practices in healthcare sector: a literature review. Benchmarking: An International Journal, 26(4), 1275–1289. https://doi.org/10.1108/BIJ-06-2018-0166
Prado-Prado, J. C., García-Arca, J., Fernández-González, A. J., & Mosteiro-Añón, M. (2020). Increasing Competitiveness through the Implementation of Lean Management in Healthcare. International Journal of Environmental Research and Public Health, 17(14), 4981. https://doi.org/10.3390/ijerph17144981
Preston, N. J. (2000). The Health of the Nation Outcome Scales: Validating Factorial Structure and Invariance Across Two Health Services. Australian & New Zealand Journal of Psychiatry, 34(3), 512–519. https://doi.org/10.1080/j.1440-1614.2000.00726.x
Radnor, Z. J., Holweg, M., & Waring, J. (2012). Lean in healthcare: The unfilled promise? Social Science & Medicine, 74(3), 364–371. https://doi.org/10.1016/j.socscimed.2011.02.011
Rocha, Í. J. A., & Vasconcelos, C. R. de. (2021). Lean healthcare implications in an occupational medicine clinic. International Journal of Lean Six Sigma, ahead-of-p(ahead-of-print). https://doi.org/10.1108/IJLSS-05-2020-0056
Rother, M., & Shook, J. (2007). Aprendendo a enxergar: mapeando o fluxo de valor para agregar valor e eliminar o desperdício: manual de trabalho de uma ferramenta enxuta. Lean Institute Brasil.
Sales, M., & De Castro, R. (2021). Value-based lean implementation in a surgical unit: the impact of the methodology. The TQM Journal, ahead-of-p(ahead-of-print). https://doi.org/10.1108/TQM-10-2020-0249
Sánchez, M., SUÁREZ, M., ASENJO, M., & BRAGULAT, E. (2018). Improvement of emergency department patient flow using lean thinking. International Journal for Quality in Health Care, 30(4), 250–256. https://doi.org/10.1093/intqhc/mzy017
Sarmento, M. C., Sanches, C. B., & Santos, L. C. (2018). Value stream mapping in healthcare: analysis and simulation in a cancer hospital. Journal of Lean Systems, 3(4), 64–89.
Sim, K. L., & Rogers, J. W. (2008). Implementing lean production systems: barriers to change. Management Research News, 32(1), 37–49. https://doi.org/10.1108/01409170910922014
Singh, P. (2019). Lean in healthcare organization: an opportunity for environmental sustainability. Benchmarking: An International Journal, 26(1), 205–220. https://doi.org/10.1108/BIJ-04-2018-0104
Stone, K. B. (2012). Lean Transformation: Organizational Performance Factors that Influence Firms’ Leanness. Journal of Enterprise Transformation, 2(4), 229–249. https://doi.org/10.1080/19488289.2012.664611
Swancutt, D., Joel-Edgar, S., Allen, M., Thomas, D., Brant, H., Benger, J., Byng, R., & Pinkney, J. (2017). Not all waits are equal: an exploratory investigation of emergency care patient pathways. BMC Health Services Research, 17(1), 436. https://doi.org/10.1186/s12913-017-2349-2
Taylor, A., Taylor, M., & McSweeney, A. (2013). Towards greater understanding of success and survival of lean systems. International Journal of Production Research, 51(22), 6607–6630. https://doi.org/10.1080/00207543.2013.825382
Thiollent, M., & Silva, G. D. O. (2007). Metodologia de Pesquisa-ação na Área de Gestão de Problemas Ambientais. Reciis, 1(1), 93–100. https://doi.org/10.3395/reciis.v1i1.37pt
Tortorella, G. L., Fogliatto, F. S., Anzanello, M., Marodin, G. A., Garcia, M., & Reis Esteves, R. (2017). Making the value flow: application of value stream mapping in a Brazilian public healthcare organisation. Total Quality Management & Business Excellence, 28(13–14), 1544–1558. https://doi.org/10.1080/14783363.2016.1150778
Towill, D. R., & Christopher, M. (2005). An evolutionary approach to the architecture of effective healthcare delivery systems. Journal of Health Organization and Management, 19(2), 130–147. https://doi.org/10.1108/14777260510600059
Wang, T.-K., Yang, T., Yang, C.-Y., & Chan, F. T. S. (2015). Lean principles and simulation optimization for emergency department layout design. Industrial Management & Data Systems, 115(4), 678–699. https://doi.org/10.1108/IMDS-10-2014-0296
Womack, J. P., Byrne, A. P., Fiume, O. J., Kaplan, G. S., & Toussaint, J. (2005). Going lean in health care. Cambridge, MA: Institute for Healthcare Improvement.
Worth, J., Shuker, T., Keyte, B., Ohaus, K., Luckman, J., Verble, D., Paluska, K., & Nickel, T. (2013). Aperfeiçoando a Jornada do Paciente: melhorando a segurança do paciente, a qualidade e a satisfação enquanto desenvolvemos a habilidade para resolver problemas. São Paulo: Lean Institute Brasil.
Zepeda-Lugo, C., Tlapa, D., Baez-Lopez, Y., Limon-Romero, J., Ontiveros, S., Perez-Sanchez, A., & Tortorella, G. (2020). Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review. International Journal of Environmental Research and Public Health, 17(15), 5609. https://doi.org/10.3390/ijerph17155609
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2021 Autores
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
