Analysis of time variability in Lean Healthcare: a case study in a Brazilian emergency room

Authors

  • Ricardo de Carvalho Turati Universidade Federal de Mato Grosso do Sul (UFMS) Campus de Três Lagoas
  • Marcel Andreotti Musetti Universidade de São Paulo Escola de Engenharia de São Carlos Departamento de Engenharia de Produção

Keywords:

Lean Healthcare, Hospital Processes, Process Variability

Abstract

Lean Healthcare has often been used as a strategy for operational improvement activities in hospitals. In this sense, this article aims to present a statistical approach applied in existing situations in hospital processes, more specifically, a first aid hospital in Brazil. The TSA (Time Statistical Approach) consists of the construction of confidence intervals for the mean, through the use of the Student t distribution. The results of this application were presented in a case study carried out at a first aid center. The results of the TSA application have shown that variability in activity and wait times can directly affect the improvement efforts involved. The case study also shows that obtaining the standardization of work in hospital environments may require much more effort than in manufacturing environments.

References

Bertani, T. M. (2012). Lean Healthcare: Recomendações para implantações dos conceitos de produção enxuta em ambientes hospitalares (Doctoral dissertation, Universidade de São Paulo).

Bowen, D. E., & Youngdahl, W. E. (1998). “Lean” service: in defense of a production-line approach. International journal of service industry management, 9(3), 207-225.

Baker, M., & Taylor, I. (2009) Make Hospitals Work, Lean Entreprise Institute, Lean Academy Institute.

Brandao de Souza, L. (2009). Trends and approaches in lean healthcare. Leadership in health services, 22(2), 121-139.

Miguel, P. A. C. (2012). Metodologia de pesquisa em engenharia de produção e gestão de operações. Elsevier.

Collar, R. M., Shuman, A., Feiner, S., McGonegal, A., Heideil, N., Duck, M., McLean, S. A., Billi, J., Healy, D. W., & Bradford, C. (2012) Lean management in academy surgery, Journal of the American College of Surgeons, v. 214, Issue 6, June pp 928–936.

Deif, A. (2012). Assessing lean systems using variability mapping. Procedia CIRP, 3, 2-7.

Devore, J. L. (2010). PROBABILIDADE E ESTATÍSTICA PARA ENGENHARIA E CIÊNCIAS. Cengage Learning Edições Ltda.

Grove, A. L., Meredith, J. O., Macintyre, M., Angelis, J., & Neailey, K. (2010). UK health visiting: challenges faced during lean implementation. Leadership in Health Services, 23(3), 204-218.

Henrique, D. B. (2014). Modelo de mapeamento de fluxo de valor para implantações de lean em ambientes hospitalares: proposta e aplicação (Doctoral dissertation, Universidade de São Paulo).

Hopp, W. J., & Spearman, M. L. (2008) Factory Physics: Foundations of Manufacturing Management. Nova Iorque: McGraw-Hill Higher Education, 720p.

Jimmerson, C., Weber, D., & Sobek, D. K. (2005). Reducing waste and errors: piloting lean principles at Intermountain Healthcare. The Joint Commission Journal on Quality and Patient Safety, 31(5), 249-257.

Jimmerson, C. (2009). Value stream mapping for healthcare made easy. CRC Press.

Meredith, J. O., Grove, A. L., Walley, P., Young, F., & Macintyre, M. B. (2011). Are we operating effectively? A lean analysis of operating theatre changeovers. Operations Management Research, 4(3-4), 89.

Montgomery, D. C., & Runger, G. C. (2009) Estatística aplicada e probabilidade para Engenheiros 4° Ed.. LTC.

Pande, P. S., Neuman, R. P., & Cavanagh, R. R. (2002). Estratégia seis sigmas: coma a GE, a Motorola e outras grandes empresas estão aguçando seu desempenho.

Pyzdek, T. (2003). The Six Sigma Handbook: The Complete Guide for Greenbelts, Blackbelts, and Managers at All Levels, Revised and Expanded Edition.

Rotondaro, R. G. (2002). Seis Sigma: estratégia gerencial para a melhoria de processos, produtos e serviços. São Paulo: Atlas.

Rother, M., & Shook, J. (2003). 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.

Smith, C. D., Spackman, T., Brommer, K., Stewart, M. W., Vizzini, M., Frye, J., & Rupp, W. C. (2013). Re-engineering the operating room using variability methodology to improve health care value. Journal of the American College of Surgeons, 216(4), 559-568.

Sokovic, M., Pavletic, D., & Pipan, K. K. (2010). Quality improvement methodologies–PDCA cycle, RADAR matrix, DMAIC and DFSS. Journal of Achievements in Materials and Manufacturing Engineering, 43(1), 476-483.

Taninecz, G. (2007). Pulling Lean Through a Hospital-Hotel-Dieu Grace success story. Canadá: Lean Institute.

Tapping, D., & Shuker, T. (2003). Value Stream Management for the Lean Office: Eight Steps to Planning, Mapping, & Sustaining Lean Improvements in Administrative Areas. CRC Press.

Tapping, D., Kozlowski, S., Archbold, L., & Sperl, T. (2009). Value stream management for lean healthcare. Chelsea: Mcs Media.

Tejedor-Panchon, F., Montero-Pérez, F. J., Tejedor-Fernandez, M., Jimenez-Murillo, L., De La Barca, J. M. C., & Gázquez, F. B. Q. E. (2014). Improvement in hospital emergency department processes with application of lean methods. Emergencias, 26(2), 84-93.

Turati, R. D. C. (2015). Desenvolvimento de uma abordagem estatística dos tempos para o Lean Healthcare: uma proposta para análise dos tempos nos processos hospitalares (Doctoral dissertation, Universidade de São Paulo).

Turati, R.C, & Musetti, M. A. (2017) Uma proposta para a gestão da melhoria no Lean Healthcare, In: III Fórum discuta Lean Sul. Anais, Brusque, SC.

Vermeulen, M. J., Stukel, T. A., Guttmann, A., Rowe, B. H., Zwarenstein, M., Golden, B., ... & Team, E. I. (2014). Evaluation of an emergency department lean process improvement program to reduce length of stay. Annals of emergency medicine, 64(5), 427-438.

Zanchet, T, Saurin, T.A., & Missel, E.C. (2007) Aplicação do mapeamento do fluxo de valor em um centro de material e um complexo hospitalar VII SEPROSUL – Semana de Engenharia de Produção Sul Americana.

Yin, R. K. (2005) Estudo de caso: planejamento e métodos. 3 ed., Porto Alegre: Bookman.

Young, T. P., & McClean, S. I. (2008). A critical look at Lean Thinking in healthcare. Quality and Safety in Health Care, 17(5), 382-386.

Published

2018-02-26

Issue

Section

Artigos