Lean healthcare implementation: Experiences and lessons learned from Brazilian hospitals

Main Article Content

Tatyana Karla Oliveira Régis
Cláudia Fabiana Gohr
Luciano Costa Santos

Abstract

This study aimed to analyze the process of implementing lean healthcare in three Brazilian hospitals that have played a pioneering role in the implementation of this system. We adopted the case study approach and collected data through interviews, document analysis, and observation. The results showed that the processes of implementation of lean healthcare in the hospitals shared many similarities in terms of the flow of patients, materials, or information. Finally, it was possible to obtain some guidelines for the application of lean principles and techniques in order to facilitate the implementation of lean healthcare in hospital operations.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Article Details

How to Cite
RÉGIS, T. K. O.; GOHR, C. F.; SANTOS, L. C. Lean healthcare implementation: Experiences and lessons learned from Brazilian hospitals. RAE - Revista de Administracao de Empresas , [S. l.], v. 58, n. 1, p. 30–43, 2018. DOI: 10.1590/S0034-759020180103. Disponível em: https://periodicos.fgv.br/rae/article/view/73879. Acesso em: 12 jun. 2024.
Section
Articles

References

Aronsson, H., Abrahamsson, M., & Spens, K. (2011). Developing lean and agile health care supply chains. Supply Chain Management, 16(3), 176-183. doi:10.1108/13598541111127164

Ben-Tovim, D. I., Bassham, J. E., Bennett, D. M., Dougherty, M. L., Martin, M. A., Neill, S. J., ... & Szwarcbord, M. G. (2008). Redesigning care at the Flinders Medical Centre: Clinical process redesign using “lean thinking”. Medical Journal of Australia, 188(6), 27-31.

Bertani, T. M. (2012). Lean healthcare: Recomendações para implantações dos conceitos de produção enxuta em ambientes hospitalares (Dissertação de mestrado). Recuperado de http://www. teses.usp.br/teses/disponiveis/18/18156/tde-29102012-235205/es.php

Burgess, N., & Radnor, Z. (2013). Evaluating lean in healthcare. International Journal of Health Care, 26(3), 220-235. doi:10.1108/09526861311311418

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 lowresource health systems. Academic Emergency Medicine, 19(3), 338- 347. doi:10.1111/j.1553-2712.2012.01311.x

Costa, L. B. M., Filho, M. G., 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), 99-120. doi:10.1002/hpm.2331.

Cunha, J. A. C., & Corrêa, H. L. (2013). Avaliação de desempenho organizacional: Um estudo aplicado em hospitais filantrópicos. RAE-Revista de Administração de Empresas, 53(5), 485-499. doi:10.1590/ S0034-75902013000500006

Dickson, E. W., Anguelov, Z., Vetterick, D., Eller, A., & Singh, S. (2009). Use of lean in the emergency department: A case series of 4 hospitals. Annals of Emergency Medicine, 54(4), 504-510. doi:10.1016/j. annemergmed.2009.03.024

Godinho, M. (2004). Paradigmas estratégicos de gestão da manufatura: Configuração, relações com o planejamento e controle da produção e estudo exploratório na indústria de calçados (Tese de doutorado, Universidade Federal de São Carlos). Recuperado de https:// repositorio.ufscar.br/handle/ufscar/3293

Graban, M. (2013). Hospitais lean: Melhorando a qualidade, a segurança dos pacientes e o envolvimento dos funcionários. Porto Alegre, RS: Editora Bookman.

Haddad, P., Gregory, M., & Wickramasinghe, N. (2014). Business value of IT in nealthcare. In N. Wickramasinghe, L. Al-Hakim, C. Gonzalez, & J. Tan, (Eds.) Lean thinking for healthcare (pp. 55-78). New York, USA: Sringer.

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:10.1016/j. ijpe.2015.05.029

Holden, R. J. (2011). Lean thinking in emergency departments: A critical review. Annals of Emergency Medicine, 57(3), 265-278. doi:10.1016/j.annemergmed.2010.08.001

Instituto Brasileiro de Geografia e Estatística. (2013). Síntese dos indicadores sociais: Uma análise das condições de vida da população brasileira. Recuperado de http://biblioteca.ibge.gov.br/visualizacao/livros/liv66777.pdf

Jimmerson, C. (2010). Value stream mapping for healthcare made easy. New York, USA: Editora Productivity Press.

Kollberg, B., Dahlgaard, J. J., & Brehmer, P. O. (2007). Measuring lean initiatives in health care services: Issues and findings. International Journal of Productivity and Performance Management, 56(1), 7-24. doi:10.1108/17410400710717064

Kruska, J. B., Reedy, A., Pascal, L., Rosen, M. P., & Boiselle, P. M. (2012). Quality initiatives lean approach to improving performance and efficiency in a radiology department. RadioGraphics, 32(2), 573-587. doi:10.1148/rg.322115128

LaGanga, L. R. (2011). Lean service operations: Reflections and new directions for capacity expansion in outpatient clinics. Journal of Operations Management, 29(5), 422-433. doi:10.1016/j. jom.2010.12.005

Liker, J. K. (2008). O modelo Toyota: 14 princípios de gestão do maior fabricante do mundo. Porto Alegre, RS: Editora Bookman.

Malagón-Lodoño, G., Morera, R. G., & Laverde, G. P. (2000). Administração hospitalar. São Paulo, SP: Editora Guanabara Koogan.

Meredith, J. O., Amy, L. G., Paul, W., Fraser, Y., & Mairi, B. M. (2011). Are we operating effectively? A lean analysis of operating theatre changeovers. Operations Management Research, 4(1), 89-98. doi:10.1007/s12063-011-0054-6

Mizuno, Y., Ito, T., Yoshikawa, T., Yomogida, S., Morio, K., & Sakai, K. (2012). Development of the workflow kine systems for support on kaizen. Work – A Journal of Prevention Assessment & Rehabilitation, 41(Suppl. 1), 5491-5492. doi:10.3233/WOR-2012-0862-5491

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. Canadian Journal of Emergency Medicine, 12(1), 50-57. doi:10.1017/S1481803500012021

Ohno, T. (1997). O sistema Toyota de produção: Além da produção em larga escala. Porto Alegre, RS: Editora Bookman.

Organização Nacional de Acreditação. (2017). Certificações concedidas. Recuperado de https://www.ona.org.br

Papadopoulos, T., Radnor, Z., & Merali, Y. (2011). The role of actor associations in understanding the implementation of lean thinking in healthcare. International Journal of Operations & Production Management, 31(2), 167-191. doi:10.1108/01443571111104755

Papworth, M. A., Milne, D., & Boak, G. (2009). An exploratory content analysis of situational leadership. Journal of Management Development, 28(7), 593-606. doi:10.1108/02621710910972706

Radnor, Z. J., Holweg, M., & Waring, J. (2012). Lean in healthcare: The unfilled promise? Social Science & Medicine, 74(3), 364-371. doi:10.1016/j.socscimed.2011.02.011

Rother, M., & Shook, J. (2003). Aprendendo a enxergar: Mapeando o fluxo de valor para agregar valor e eliminar o desperdício. São Paulo, SP: Lean Institute Brasil.

Shingo, S. (1996). O sistema Toyota de produção: Do ponto de vista da engenharia de produção. Porto Alegre, RS: Editora Bookman.

Suárez-Barraza, M. F., Smith, T., & Dahlgaard-Park, S. M. (2012). Lean service: A literature analysis and classification. Total Quality Management & Business Excellence, 23(3-4), 359-380. doi:10.1080 /14783363.2011.637777

Sullivan, P., Soefje, S., Reinhart, D., McGeary, C., & Cabie, E. D. (2014). Using lean methodology to improve productivity in a hospital oncology pharmacy. American Journal of Health-System Pharmacy, 71(17), 1491-1498. doi:10.2146/ajhp130436

Teichgräber, U. K., & Bucourt, M. (2012). Applying value stream mapping techniques to eliminate non-value-added waste for the procurement of endovascular stents. European Journal of Radiology, 81(1), 47-52. doi:10.1016/j.ejrad.2010.12.045

Tejedor-Panchon, F., Montero-Perez, F. J., Tejedor-Fernandez, M., JimenezMurillo, L., Barca-Gazquez, J. M. C, De La, & Quero-Espinosa, F. B. (2014). Improvement in hospital emergency department processes with application of lean methods. Emergencias, 26(2), 84-93.

Toussaint, J. (2009). Writing the new playbook for U.S. health care: Lessons from Wisconsin. Health Affairs, 28(5), 1343-1350. doi:10.1377/hlthaff.28.5.1343

Womack, J. P., Byrne, J. P, Fiume, A. P., Kaplan, G. S, & Toussain, J. T. (2005). Going lean in health care. Institute for Healthcare Improvement. Recuperado de http://www.ihi.org

Yin, R. (2005). Estudo de caso: Planejamento e método (4a ed.). Porto Alegre, RS: Editora Bookman.

Zidel, T. G. (2006). A lean guide to transforming healthcare: How to implement lean principles in hospitals, medical offices, clinics, and other healthcare organizations. Milwaukee, USA: Quality Press.