Padronização de kits de material cirúrgico para tratamentos de coluna utilizando a abordagem Lean Healthcare approach

Luana Coelho de Morais; Stella Jacyszyn Bachega; Naiara Faiad Sebba Calife; Dalton Matsuo Tavares

doi:10.5585/exactaep.2021.18071

Authors

Luana Coelho de Morais Escola de Engenharia de São Carlos da Universidade de São Paulo (EESC - USP) https://orcid.org/0000-0003-2404-9362
Stella Jacyszyn Bachega Universidade Federal de Catalão (UFCAT) https://orcid.org/0000-0002-7533-5361
Naiara Faiad Sebba Calife Universidade Federal de Catalão (UFCAT) https://orcid.org/0000-0003-1817-3922
Dalton Matsuo Tavares Universidade Federal de Catalão (UFCAT) https://orcid.org/0000-0001-8531-5578

DOI:

https://doi.org/10.5585/exactaep.2021.18071

Keywords:

Lean Healthcare, Surgical Pack, Lean Production.

Abstract

Packs containing selected surgical material can reduce delays, costs, errors and provide safety for the medical team and for the patient. The research goal was to scale packs required for two types of spine treatment using tools from Lean Healthcare as support. PDCA cycle was used as a method of troubleshooting. In the ‘Plan’ stage, we evaluated the current situation and the need for change using Value Stream Mapping, regarding the current and future situations. In the “Do” stage, a plan was developed to improve the changes, with the assistance of the 5S approach. Kaizen, Standardized Work and Visual Management tools were used in the “Check” stage, to propose the implementation of the changes. In the “Act” stage, it was suggested to follow-up the actions. This eliminates the activities that do not add value in the patient’s vision, or the process client.

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Author Biographies

Luana Coelho de Morais, Escola de Engenharia de São Carlos da Universidade de São Paulo (EESC - USP)

She is Master’s degree student in Production Engineering at the University of São Paulo at São Carlos School of Engineering. She holds a degree in Production Engineering from the Federal University of Goiás. Acting mainly in the following subjects: Lean Healthcare, patient monitoring system, computer simulation, technology, operational research, and lean production.

Stella Jacyszyn Bachega, Universidade Federal de Catalão (UFCAT)

She holds a PhD and a Master's degree in Production Engineering from the Federal University of São Carlos, and a graduate degree in Administration from Federal University of Lavras. She is Full Professor in the Production Engineering Department and Academic Master's Program in Production Engineering (PPGEP) at the Federal University of Goiás – Catalão campus. Amongst her areas of activity in teaching, research and extension are: operational research, systems and information technology, operations management, sustainability and administration. Accomplishing research that provides transversal approaches involving two or more of the following areas: management, production engineering, computing, and environmental. She is also the leader of the Group of Studies in Modeling and Simulation (GEMS).

Naiara Faiad Sebba Calife, Universidade Federal de Catalão (UFCAT)

She holds a degree in Electrical Engineering from the Federal University of Uberlândia . A Master's Degree in Production Engineering from the Federal University of São Carlos. She is Assistant Professor in the Production Engineering Department at Federal University of Goiás – Catalão campus, working mainly in the following areas: Logistics, Warehousing, Supply Chain Management, and Hospital Logistics. She also has experience in hospital management and financial management.

Dalton Matsuo Tavares, Universidade Federal de Catalão (UFCAT)

Prof. Dr. Dalton Matsuo Tavares has a PhD in Mechanical Engineering from the School of Engineering of São Carlos, University of São Paulo. Research areas include the development of robotics research, industrial communication standards and open control platforms, aimed at the standardized integration of devices in production environments. He holds a Bachelor's Degree (IBILCE / Unesp 1999) and a Master's Degree (ICMC / USP 2002) in Computer Sciences. He is Full Professor in the Computer Science Department at the Federal University of Goiás – Catalão campus. His experience also encompasses the area of Computer Science, with emphasis on Operating Systems and Network Security.

References

Adebanjo, D., Laosirihongthong, T., & Samaranayake, P. (2016). Prioritizing lean supply chain management initiatives in healthcare service operations: a fuzzy AHP approach. Production Planning & Control, 27 (12), 953-966. doi: https://doi.org/10.1080/09537287.2016.1164909.

Alves, A. C., Gonçalves, A. M., Fernandes, J. M., Vaz, I., Teixeira, S., Sousa, I., Pereira, J. J., & Dória-Nóbrega, S. (2016). Combined tools for Surgical Case Packages contents and cost optimization: a preliminary study. Procedia Computer Science, 100, 393-398. doi: https://doi.org/10.1016/j.procs.2016.09.174

Amran, M. D. M., Januddi, F., Nuraina, S., Ikbar, A. W. M, & Khairanum, S. (2020). The barriers in lean healthcare implementation. Test Engineering and Management, 82 (1-2), 1972-1981.

Ballou, R. H. (2007). Business logistics/supply chain management. India: Pearson Education.

Boronat, F., Budia, A., Broseta, E., Ruiz-Cerdá, J. L., & Vivas-Consuelo, D. (2018). Application of Lean Healthcare methodology in a urology department of a tertiary hospital as a tool for improving efficiency. Actas Urológicas Españolas (English Edition), 42 (1), 42-48. doi: https://doi.org/10.1016/j.acuroe.2017.11.008.

Bryman, A. (1989). Research methods and organization studies. London: Uniwin Hyman.

Byrnes, J. N., Schmitt, J., Tommaso, C., & Occhino, J. A. (2017). Cost reduction techniques in the operating suite: Surgical tray optimization. American Journal of Obstetrics & Gynecology, 216(3), Supplement, S616, March 01. doi: https://doi.org/10.1016/j.ajog.2016.12.119.

Chen, M., & Lu, Z. (2014). Effects of PDCA Applied to Medical Record Quality Management. Chinese Medical Record English Edition, 2(8), 372-375. doi: https://doi.org/10.3109/23256176.2014.992175

Cichos, K. H., Hyde, Z. B., Mabry, S. E., Ghanem, E. S., Brabston, E. W., Hayes, L. W., McGwin Jr. G., & Ponce, B. A. (2019). Optimization of Orthopedic Surgical Instrument Trays: Lean Principles to Reduce Fixed Operating Room Expenses. The Journal of Arthroplasty, 34, 238-2840. doi: https://doi.org/10.1016/j.arth.2019.07.040.

Collar, R. M., Shuman, A. G., Feiner, S., Mcgonegal, A. K., Heidel, N., Duck, M., Mclean, S. A., Billi, J. E., Healy, D. W., & Bradford, C. R. (2012). Lean management in academic surgery. Journal of the American College of Surgeons, 214(6), 928-936. doi: https://doi.org/10.1016/j.jamcollsurg.2012.03.002.

Costa, L. B., & Godinho, M., Filho. (2016). Lean healthcare: review, classification and analysis of literature. Production Planning & Control 27 (10): 823-836. doi: https://doi.org/10.1080/09537287.2016.1143131.

Costa, L. B., Godinho, M., Filho, Rentes, A. F., Bertani, T. M., & Mardegan, R. (2015). Lean healthcare in developing countries: evidence from Brazilian hospitals. The International Journal of Health Planning and Management, 32 (1), e99-e120. doi: https://doi.org/10.1002/hpm.2331.

Creswell, J. W. (2014). Research design: Qualitative, quantitative and mixed methods approaches. Newbury Park, CA: Sage Publications.

Crosby, L., Lortie, E., Rotenberg, B., & Sowerby, L. (2019). Surgical Instrument Optimization to Reduce Instrument Processing and Operating Room Setup Time. Otolaryngology-Head and Neck Surgery, 1-5. doi: https://doi.org/10.1177/0194599819885635.

Curatolo, N., Lamouri, S., Huet, J. C., & Rieutord, A. (2013). A Critical Analysis of Lean Approach in Hospital. Business Process Management Journal, 20(3), 433-454. doi: https://doi.org/10.1108/BPMJ-04-2013-0051.

D’Andreamatteo, A., Ianni, L., Lega, F., & Sargiacomo, M. (2015). Lean in healthcare: A comprehensive review. Health Policy, 119(9), 1197-1209. doi: https://doi.org/10.1016/j.healthpol.2015.02.002.

Dobrzykowski, D. D., Mcfadden, K. L., & Vonderembse, M. A. (2016). Examining pathways to safety and financial performance in hospitals: A study of lean in professional service operations. Journal of Operations Management, 42-43(1), 39-51. doi: https://doi.org/10.1016/j.jom.2016.03.001.

Drotz, E., & Poksinska, B. (2014). Lean in healthcare from employees’ perspectives. Journal of Health Organization and Management, 28(2), 177-195. doi: https://doi.org/10.1108/JHOM-03-2013-0066.

Farrelly, J. S., Clemons, C., Witkins, S., Hall, W., Christison-Lagay, E. R., Ozgediz, D. E., Cowles, R. A., Stitelman, D. H., & Caty, M. G. (2017). Surgical tray optimization as a simple means to decrease perioperative costs. Journal of Surgical Research, 220, 320-326. doi: https://doi.org/10.1016/j.jss.2017.06.029.

Farrokhi, F. R., Gunther, M., Williams, B., & Blackmore, C. C. (2015). Application of lean methodology for improved quality and efficiency in operating room instrument availability. Journal for Healthcare Quality. 37(5), 277-286. doi: https://doi.org/10.1111/jhq.12053.

Giraldo, A., Mothersell, W. M., & Motwani, J. (2015). The need for implementing lean in healthcare organizations. International Journal Productivity and Quality Management, 16(2), 211-230. doi: https://doi.org/10.1504/IJPQM.2015.071240.

Graban, M. (2011). Lean hospitals: improving quality, patient safety, and employee satisfaction. New York: CRC Press.

Grosz, B. J. (1996). Collaborative Systems (AAAI-94 Presidential Address). AI magazine, 17(2), 67-85. doi: https://doi.org/10.1609/aimag.v17i2.1223

Hendry, C. (2012). Human resource management: a strategic approach to employment. London: Routledge.

Henrique, D. B., Rentes, A. F., & Godinho, M., Fillho. (2016). A new value stream mapping approach for healthcare environments. Production Planning & Control, 27(1), 24-48. doi: https://doi.org/10.1080/09537287.2015.1051159.

Hicks, C., McGovern, T., Prior, G., & Smith, I. (2015). Applying lean principles to the design of healthcare facilities. International Journal of Production Economics, 170(Part B), 677-686. doi: https://doi.org/10.1016/j.ijpe.2015.05.029.

Holden, R. J., Eriksson, A., Andreasson, J., Williamsson, A., & Dellve, L. (2015). Healthcare workers' perceptions of lean: A context-sensitive, mixed methods study in three Swedish hospitals. Applied Ergonomics, 47(1), p. 181-192. doi: https://doi.org/10.1016/j.apergo.2014.09.008.

Improta, G., Cesarelli, M., Montuori, P., Santillo, L. C., & Triassi, M. (2017). Reducing the risk of healthcare‐associated infections through Lean Six Sigma: The case of the medicine areas at the Federico II University Hospital in Naples (Italy). Journal of Evaluation in Clinical Practice, 24(2), 338-346. doi: https://doi.org/10.1111/jep.12844.

Jackson, T. L. (Ed.). (2012). Kaizen workshops for lean healthcare. CRC Press.

Johnson, J. E., Smith, A. L., & Mastro, K. A. (2012). From Toyota to the bedside: nurses can lead the lean way in health care reform. Nursing administration quarterly, 36(3), 234-242. doi: https://doi.org/10.1097/ NAQ.0b013e318258c3d5.

Joosten, T., Bongers, I., & Janssen, R. (2009). Application of lean thinking to health care: issues and observations. International journal for quality in health care, 21(5), 341-347. doi: https://doi.org/10.1093/intqhc/mzp036.

Lindskog, P., Hemphälä, J., & Eriksson, A. (2017). Lean tools promoting individual innovation in healthcare. Creativity and Innovation Management, 26(2), 175-188. doi: https://doi.org/10.1111/caim.12201.

Liu, X., Zhu, Y., Peng, K., Zhou, C., Liu, M., Liu, S. C., & Tu, C. (2014). Application of PDCA Method in Quality Management of Running Medical Records at the Department of Orthopedics. Chinese Medical Record English Edition, 2(3), 112-115. doi: https://doi.org/10.3109/23256176.2014.910906.

Lunardini, D., Arington, R., Canacari, E. G., Gamboa, K., Wagner, K., & Mcguire, K. J. (2014). Lean principles to optimize instrument utilization for spine surgery in an academic medical center: an opportunity to standardize, cut costs, and build a culture of improvement. Spine, 39(20), 1714-1717. doi: https://doi.org/10.1097/BRS.0000000000000480.

Machado, V. C., & Leitner, U. (2010). Lean tools and lean transformation process in health care. International Journal of Management Science and Engineering Management, 5(5), 383-392. doi: https://doi.org/10.1080/17509653.2010.10671129.

Mannon, M. (2014). Lean healthcare and quality management: The experience of ThedaCare. Quality Management Journal, 21(1), 7-10. doi: https://doi.org/10.1080/10686967.2014.11918371

Marchand, K.B., Taylor, K.B., Salem, H.S., Mont, M.A., & Marchand, R.C. (2020). Surgical Tray Optimization and Efficiency: The Impact of a Novel Sealed Sterile Container and Instrument Tray Technology. Surg Technol Int, Nov 27;37: sti37/1375. Advance online publication. PMID: 33245139.

Martins, R. A. (2012). Abordagens Quantitativa e Qualitativa. In P. A. C. Miguel (Org.). Metodologia de pesquisa em engenharia de produção e gestão de operações (pp. 47-63). Rio de Janeiro: Elsevier.

Ministério da Saúde. (2015). Despacho n.º 1400-A/2015: Anexo - Plano Nacional para a Segurança dos Doentes 2015-2020. Diário da República, 2(28), 3882-(2)-3882-(10). Retrieved December 04, 2020, from https://dre.pt/application/file/66457154

Ministério da Saúde. (2016). Manual de boas práticas de gestão das Órteses, Próteses e Materiais Especiais (OPME). Retrieved November 05, 2020, from http://bvsms.saude.gov.br/bvs/publicacoes/manual_praticas_ gestao_proteses_materiais_especiais.pdf.

Montella, E., Di Cicco, M. V., Ferraro, A., Centobelli, P., Raiola, E., Triassi, M., & Improta, G. (2016). The application of Lean Six Sigma methodology to reduce the risk of healthcare–associated infections in surgery departments. Journal of Evaluation in Clinical Practice, 23(3), 530-539. doi: https://doi.org/10.1111/jep.12662.

Moraros, J., Lemstra, M., & Nwankwo, C. (2016). Lean interventions in healthcare: do they actually work? A systematic literature review. International Journal for Quality in Health Care, 28(2), 150–165. doi: https://doi.org/10.1093/intqhc/mzv123.

Poksinska, B. B., Fialkowska-Filipek, M., & Engström, J. (2016). Does Lean healthcare improve patient satisfaction? A mixed-method investigation into primary care. BMJ Quality & Safety, 26(2), 85-86. doi: https://doi.org/10.1136/bmjqs-2015-004290.

Rutledge, J., Xu, M., & Simpson, J. (2015). Application of the Toyota Production System Improves Core Laboratory operation. American Journal of Clinical Pathology, 133(1), 24-31. doi: https://doi.org/10.1309/AJCPD1MSTIVZI0PZ.

Schonberger, R. J. (2018). Reconstituting lean in healthcare: From waste elimination toward ‘queue-less’ patient-focused care. Business Horizons, 61(1), 13-22. doi: https://doi.org/10.1016/j.bushor.2017.09.001.

Sugianto, J. Z., Stewart, B., Ambruzs, J. M., Arista, A., Park, J. Y., Cope-Yokoyama, S., & Luu, H. S. (2015). Applying the Principles of Lean Production to Gastrointestinal Biopsy Handling: From the Factory Floor to the Anatomic Pathology Laboratory. Laboratory Medicine, 46(3), 259–264. doi: https://doi.org/10.1309/LMJCUFUN0LT8C6DB.

Tay, H. L. (2016). Lean Improvement Practices: Lessons from Healthcare Service Delivery Chains. IFAC-PapersOnLine, 49(12), 1158-1163. doi: https://doi.org/10.1016/j.ifacol.2016.07.660.

Tay, H. L., Singh, P. J., Bhakoo, V., & Al-Balushi, S. (2017). Contextual factors: assessing their influence on flow or resource efficiency orientations in healthcare lean projects. Operations Management Research, 10 (3-4), 118–136. doi: https://doi.org/10.1007/s12063-017-0126-3.

Tortorella, G., Dun, D. H., & Almeida, A. G. (2020). Leadership behaviors during lean healthcare implementation: a review and longitudinal study. Journal of Manufacturing Technology Management, 31(1), 193-215. doi: https://doi.org/10.1108/JMTM-02-2019-0070.

Van Rossum, L., Aij, K. H., Simons, F. E., Eng, N. van der, & Have, W. D. ten. (2016). Lean healthcare from a change management perspective: The role of leadership and workforce flexibility in an operating theatre. Journal of Health Organization and Management, 30(3), 475-493. doi: https://doi.org/10.1108/JHOM-06-2014-0090.

Waldhausen, J. H., Avansino, J. R., Libby, A., & Sawin, R. S. (2010). Application of lean methods improves surgical clinic experience. Journal of pediatric surgery, 45(7), 1420-1425. doi: https://doi.org/10.1016/j.jpedsurg.2009.10.049

Wang, X. (2014). Application of PDCA Method in Medical Record Archiving Management. Chinese Medical Record English Edition, 2(1), 22-26. doi: https://doi.org/10.3109/23256176.2014.897487.

Wannemuehler, T. J., Elghouche, A. N., Kokoska, M. S., Deig, C. R., & Matt, B. H. (2015). Impact of L ean on surgical instrument reduction: Less is more. The Laryngoscope, 125(12), 2810-2815. doi: https://doi.org/10.1002/lary.25407. Epub 2015 Jun 24.

Worth, J., Shuker, T., Keyte, B., Luckman, J., Ohaus, K., Verble, D., & Nickel, T. (2012). Perfecting patient journeys. Lean Enterprise Institute.

Yin, R. K. (2015). Case study research: Design and Methods, Applied social research methods series. London: Sage Publications.

Zadeh, R. S., Shepley, M. M., & Waggener, L. T. (2012). Rethinking efficiency in acute care nursing units: Analyzing nursing unit layouts for improved spatial flow. HERD: Health Environments Research & Design Journal, 6(1), 39-65. doi: https://doi.org/10.1177/193758671200600103.