Production
https://prod.org.br/article/doi/10.1590/0103-6513.20230063
Production
Research Article

Lean Healthcare systematically applied to improve mobility accessibility in the medical clinic of a medium-sized hospital

Samuel Martins Drei; Paulo Sérgio de Arruda Ignácio

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Abstract

Paper aims: The purpose of this paper is to applied systematically Lean Healthcare to improve mobility accessibility in the medical clinic ward of a medium-sized hospital.

Originality: The study focuses on the wheelchair’s availability, as well as their provisions in the hospital, since this approach was not identified in the literature. In addition, this study is part of a branch of a project, based on the non-identification of applications in the medical clinic ward of hospitals, in order to formalize a systematic application of Lean Healthcare in the wing worked.

Research method: The study's methodology was divided into two phases, Survey and Lean Proposal, following a systematic approach established in prior papers, with a focus on addressing various hospital waste scenarios that affect patient mobility. The Survey phase aimed to identify the root cause of waste related to wheelchair use within the hospital, while the Lean Proposal phase sought to mitigate this waste using Lean tools, ultimately improving patient mobility in the medical clinic by reducing non-added value.

Main findings: The implementation of systematically Lean Healthcare led to a 72.2% reduction in the total activity time, dropping from 20 to 7 minutes, primarily by cutting non-value-added time from 18 to 5 minutes. This change increased the value-added time by 19%. Additionally, the unnecessary movement to retrieve wheelchairs decreased by 83%, with occurrences reducing by 100%. Furthermore, Lean Healthcare improved mobility and demonstrates how this effective approach not only enhanced the quality of medical services but also created a more favorable work environment and inspired a culture of continuous improvement within the hospital.

Implications for theory and practice: For the theory, this research highlights a hospital wing previously unexamined within the context of Lean Healthcare, thereby reinforcing a culture of systematic application and continuous improvement within the hospital. Furthermore, it delves into the hospital's accessibility, specifically focusing on mobility accessibility, addressing a gap in the literature. In practice, the research has significant implications, as it effectively reduces non-added value elements within an actual process in a medium-sized hospital, ultimately enhancing the quality of clinical healthcare delivery in the Brazilian public healthcare system.

Keywords

Lean Healthcare, Public health, Medical clinic wing, Mobility accessibility

References

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

Borges, G. A., Tortorella, G. L., Martínez, F., & Thurer, M. (2020). Simulation-based analysis of lean practices implementation on the supply chain of a public hospital. Production, 30, e20190131. http://doi.org/10.1590/0103-6513.20190131.

Burgess, N., & Radnor, Z. (2013). Evaluating Lean in healthcare. International Journal of Health Care Quality Assurance, 26(3), 220-235. http://doi.org/10.1108/09526861311311418. PMid:23729126.

Calero, L., Maccasi, A., & Raymundo, C. (2020). Lean model of services for the improvement in the times of attention of the emergency areas of the health sector. In Human Interaction and Emerging Technologies: Proceedings of the 1st International Conference on Human Interaction and Emerging Technologies. Cham: Springer. http://doi.org/10.1007/978-3-030-25629-6_144.

Castrén, L. (2016). Lean healthcare may endanger sustainable performance improvement, if service dominant logic approach is excluded. In European Association for Research on Services Conference (pp. 577-589), Naples, Italy. Naples: University of Naples Federico II.

Clemente, K. A. P., Silva, S. V., Vieira, G. I., Bortoli, M. C., Toma, T. S., Ramos, V. D., & Brito, C. M. M. (2022). Barriers to the access of people with disabilities to health services: a scoping review. Revista de Saúde Pública, 56, 64. http://doi.org/10.11606/s1518-8787.2022056003893. PMid:35792776.

Cóllden, C., Gremyr, I., Hellström, A., & Sporraeus, D. (2017). A value-based taxonomy of improvement approaches in healthcare. Journal of Health Organization and Management, 31(4), 445-458. http://doi.org/10.1108/JHOM-08-2016-0162. PMid:28877618.

Drei, S. M., & Ignácio, P. S. A. (2019). Avaliação de um procedimento sistemático para o Lean Healthcare. In Anais do XXXIX Encontro Nacional de Engenharia de Produção. São José dos Campos: ABEPRO. http://doi.org/10.14488/ENEGEP2019_TN_STO_293_1656_37759.

Drei, S. M., & Ignácio, P. S. A. (2022). Lean healthcare applied systematically in a medium-sized medical clinic hospitalization. Journal of Health Organization and Management, 36(5), 666-689. http://doi.org/10.1108/JHOM-05-2021-0194.

Drei, S. M., Ignácio, P. S. A., Pacagnella Júnior, A. C., Min, L. L., & Silva, T. A. O. (2021). Lean Healthcare applied systematically in the basic image examination process in a medium-sized medical clinic. In IFIP International Conference on Advances in Production Management Systems (pp. 403-412). Cham: Springer International Publishing. http://doi.org/10.1007/978-3-030-85902-2_43.

Gonçalves, B. S., Vieira, E., Lima, R. M., & Dinis-Carvalho, J. (2022). A systematized approach for reduction of medical appointment waiting list. Production, 32, e20210137. http://doi.org/10.1590/0103-6513.20210137.

Groenewegen, P. P., Kroneman, M., & Spreeuwenberg, P. (2021). Physical accessibility of primary care facilities for people with disabilities: a cross-sectional survey in 31 countries. BMC Health Services Research, 21(1), 107. http://doi.org/10.1186/s12913-021-06120-0. PMid:33522925.

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. http://doi.org/10.1108/IJHCQA-08-2016-0116. PMid:29790443.

Kanamori, S., Sow, S., Castro, M. C., Matsuno, R., Tsuru, A., & Jimba, M. (2015). Implementation of 5S management method for lean healthcare at a health center in Senegal: a qualitative study of staff perception. Global Health Action, 8(1), 27256. http://doi.org/10.3402/gha.v8.27256. PMid:25854781.

Krijnen, A. (2007). The Toyota way: 14 management principles from the world’s greatest manufacturer. Action Learning Research and Practice, 4(1), 109-111. http://doi.org/10.1080/14767330701234002.

Lean Institute Brasil. (2023). Lean na saúde. Retrieved in 2023, August 28, from https://www.lean.org.br/workshop/110/lean-na-saude.aspx

Liker, J. K. (2021). O modelo Toyota: 14 princípios de gestão do maior fabricante do mundo. Porto Alegre: Bookman Editora.

Matthias, O., & Brown, S. (2016). Implementing operations strategy through Lean processes within health care: The example of NHS in the UK. International Journal of Operations & Production Management, 36(11), 1435-1457. http://doi.org/10.1108/IJOPM-04-2015-0194.

Montella, E., Di Cicco, M. V., Ferraro, A., Centobelli, P., Raiola, E., Triassi, M., & Improta, G. (2017). 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. http://doi.org/10.1111/jep.12662. PMid:27860065.

Ohno, T. (2019). Toyota production system: beyond large-scale production. Cambridge: Productivity Press. http://doi.org/10.4324/9780429273018.

Oliveira, K. B., Santos, E. F., & Garcia Júnior, L. V. (2017). Lean healthcare as a tool for improvement: a case study in a clinical laboratory. In V. Duffy & N. Lightner (Eds.), Advances in human factors and ergonomics in healthcare. Cham: Springer. http://doi.org/10.1007/978-3-319-41652-6_13.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., Stewart, L. A., Thomas, J., Tricco, A. C., Welch, V. A., Whiting, P., & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International Journal of Surgery, 88, 105906. http://doi.org/10.1016/j.ijsu.2021.105906. PMid:33789826.

Ramos, J. R. S., Calado, R. D., Fausto, I. R. S., Pinto, S. C. C. S., Teixeira, A. M., & Braz, R. M. M. (2022). Optimizing care of visually impaired people in the Emergency Care Units (UPA): a technical briefing applying Lean concept. IFAC-PapersOnLine, 55(10), 544-548. http://doi.org/10.1016/j.ifacol.2022.09.450.

Tiso, A., & Verbano, C. (2021). Lean and safety management in primary care: guidelines to improve the continuity of care for chronic pathways. In European Conference on Management, Leadership & Governance (pp. 516). Reading: Academic Conferences International.

Tortorella, G., Augusto, B. P., França, S. L. B., & Sawhney, R. (2019). Assessment methodology for Lean Practices in healthcare organizations: case study in a Brazilian public hospital. Production, 29, e20180080. http://doi.org/10.1590/0103-6513.20180080.

Toussaint, J., Billi, J. E., & Graban, M. (2017). Lean for doctors. Appleton, WI: Catalysis.

Vashi, A. A., Lerner, B., Urech, T. H., Asch, S. M., & Charns, M. P. (2019). Lean Enterprise transformation in VA: a national evaluation framework and study protocol. BMC Health Services Research, 19(1), 98. http://doi.org/10.1186/s12913-019-3919-2. PMid:30717729.

Womack, J. P., Jones, D. T., & Roos, D. (2007). The machine that changed the world: the story of lean production. Toyota’s secret weapon in the global car wars that is now revolutionizing world industry. New York: Simon & Schuster.
 


Submitted date:
09/11/2023

Accepted date:
06/29/2024

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