Lean healthcare: estratégia para a qualificação da gestão em saúde e enfermagem

Abstract

The dissertation presented here is entitled Lean Healthcare: strategy for qualifying management in healthcare and nursing, and it was aimed at implementing and evaluating the application of the lean methodology principles to improve both the managerial work process of nurses and healthcare quality. It all started from the idea that managers of healthcare organizations need to apply management tools which enable the assessment of their organizational processes, thus ensuring that the services rendered to the population have the best possible quality. In this sense, the lean healthcare system is presented as a philosophy, a management method with a set of tools which come from lean production and were introduced in healthcare scenarios as a possible alternative to change the way these organizations are managed. Given this context, nurses are presented as central professionals who seek to articulate management and assistance dimensions in healthcare, which makes maintaining the quality of services rendered dependent basically on remaining close to patients. Bringing the nursing management practice and lean methodology into focus as potential tools for process improvement led to the implementation of such methodology practices and tools in this investigation. This is an applied research, exploratory and the case study type. It is divided into three stages: 1) mapping of processes, 2) modeling of processes, and 3) practical application of lean tools and practices. In order to achieve the proposed objectives and confirm the hypothesis, the theoretical and methodological framework of Lean Healthcare was used in all stages of the research, as well as the supporting methods Business Process Modeler Notation and the Bizagi® software in the second stage and the management improvement tool Plan-Do-Check-Act in the third stage. Data analysis proceeded with a qualitative and quantitative approach. The results of the first two stages indicated that the work management process of nurses Management in Nursing Personnel Schedule should be studied in depth in the third stage. Lean principles guided the analysis of the situation encountered and the proposition of the future situation. Its practices and applied tools led to a reduction of 94% in the amount of time nurses spend on activities that were not worthwhile as well as to reducing waste inherent in their management work process. It was concluded that nurses can act effectively to promote best practices and contribute substantially to the change process in healthcare. The results are promising as they indicate a path to implement lean practices in healthcare, starting with small problems. However, the research suggests that the motivation to seek improvements must be systemic and therefore lean healthcare can be adopted as a management strategy focused on creating value for patients, improving healthcare management and assistance essentially.