Research Article

Analysis of hospital flow management: the 3 R’s approach

Bruna Dones Gayer; Érico Marcon; Wagner Pietrobelli Bueno; Priscila Wachs; Tarcisio Abreu Saurin; Paulo Ghinato

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Abstract: Paper aims: This article aims to study the logistics problems in Brazilian hospitals through Lean methods, approaching different aspects of logistics and the procedures adopted in health institutions such as receiving, storage and transporting.

Originality: The rising of hospitals’ costs is importantly impacted by hospital logistics. They are caused by aspects such as unstandardized processes and inadequate layout and equipment in critical stages of logistic operations. However, these problems are rarely addressed in literature.

Research method: We developed, through Design Science Research and lean tools, a model based on route, rhythm and routine (3 R’s) that enables the identification of logistics problems.

Main findings: Hospitals present complex logistic operations. The application of the model developed identified improvement opportunities due to unnecessary activities, lack of space and infrastructure, and lack of standardized procedures. These findings enable improvements in operations and a better comprehension of the factors that impact the processes of internal logistics.

Implications for theory and practice: The model provides a comprehensive view of the logistical process, its stages and aspects of improvement. Therefore, hospital managers can better identify and address logistical problems directly at non-value adding activities. Adaptations may be required due to the healthcare environment specificities.


Route, Rhythm, Routine, Hospital logistic flow, Lean healthcare


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