IDENTIFYING OPPORTUNITIES FOR IMPROVEMENT IN HOSPITAL DISCHARGE PROCESS OF MATERNITY PATIENT THROUGH LEAN HEALTHCARE
Palabras clave:
Lean Thinking, Lean Healthcare, Maternidade, Processo de AltaResumen
O Lean Healthcare é uma metodologia de gestão focada no paciente e na cooperação entre os seus participantes que busca a melhoria contínua ao eliminar desperdícios agregando assim, mais valor aos processos hospitalares. Considerando as variadas oportunidades de aplicação dessa filosofia, levando em conta que o Lean Healthcare começou a ser aplicado recente, essa pesquisa buscou analisar o processo de alta hospitalar em uma maternidade de um hospital de grande porte com o objetivo de aumentar o disponibilidade do leito de internação, visto que esse setor repetidas vezes apresenta um quadro de superlotação.
Por meio de observações não participantes campo e diagnóstico da situação atual, foram analisados os principais desperdícios encontrados no processo de alta. Os desperdícios encontrados foram classificados de acordo com as sete perdas da produção enxuta e com o impacto que causam no valor do paciente. Em seguida, ações de contramedidas foram propostas pelos autores. Essas ações focam no nivelamento do fluxo de pacientes, visto que atualmente as altas médicas ocorrem em lotes e com isso ocorre um acúmulo de tarefas nas atividades seguintes o que aumenta o tempo de reocupação dos leitos liberados.
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AL-ARAIDAH, O., MOMANI, A., KHASAWNEH, M and MOMANI, M. Lead-Time Reduction Utilizing Lean Tools Applied to Healthcare: The Inpatient Pharmacy at a Local Hospital. Journal for Healthcare Quality [online]. 2010, 32(1), 59-66.s.i. DOI 10.1111/j.1945-1474.2009.00065.x. ISSN 1062-2551. Available: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:land ingpage&an=01445442-201001000-00010
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JADHAV, J.R., MANTHA, S.S and RANE, S.B. Exploring Barriers in Lean Implementation. International Journal of Lean Six Sigma [online], 2014, 5(2), 122–148. DOI 10.1108/ IJLSS-12-2012-0014. ISSN 2040-4166. Available: http://www.emeraldinsight.com/doi/ abs/10.1108/IJLSS-12-2012-0014
KENNEY, C and BERWICK, D.M. Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience. Boca Raton: CRC Press, 2010.
MAZZOCATO, P., SAVAGE, C., BROMMELS, M., ARONSSON, H and THOR, J. Lean Thinking in Healthcare: A Realist Review of the Literature. BMJ Quality & Safety [online]. 2010, 19(5), 376–382. DOI 10.1136/qshc.2009.037986. ISSN 2044-5423 Available: http:// qualitysafety.bmj.com/content/19/5/376
RADNOR, Z and WALLEY, P. Learning to Walk Before We Try to Run: Adapting Lean for the Public Sector. Public Money and Management [online]. 2008, 28(1), 3–20. DOI 10.1111/j.1467- 9302.2008.00613.x. ISSN 1467-9302. Available: http://www.tandfonline.com/doi/abs/10.1111/ j.1467-9302.2008.00613.x.
ROTHER, M and HARRIS, R. Creating Continuous Flow. Cambridge: Lean Enterprise Institute, 2001.
SCHEFFER, M. Demografia Médica no Brasil 2015. São Paulo: Conselho Regional de Medicina do Estado de São Paulo, 2015.
SHINGO, S. A Study of the Toyota Production System: From an Industrial Engineering Viewpoint. New York: Productivity Press, 1989.
SIMERS. Falta de Investimento Público Indica que Saúde não é Prioridade no Brasil. SIMERS [online]. 28 December 2016. [cit. 24-August-2017]. Available from: http://www.simers.org. br/2016/12/saude-nao-e-prioridade-no-brasil/
OHNO, T. Toyota Production System: Beyond Large-Scale Production. New York: Productivity Press, 1988.
TORTORELLA, F., UKANOWICZ, D., DOUGLAS-NTAGHA, P., RAY, R and TRILLER, M. Improving Bed Turnover Time With a Bed Management System. The Journal of Nursing Administration [online]. 2013, 43(1), 37–43. DOI 10.1097/NNA.0b013e3182785fe7. ISSN 1539-0721. Available: http://journals.lww.com/jonajournal/Abstract/2013/01000/Improving_ Bed_Turnover_Time_With_a_Bed_Management.8.aspx
WEBER, D.O. Toyota-style management drives Virginia Mason. Physician executive. 2006, 32(february), 12–17. ISSN 0898-2759. Available: https://www.researchgate.net/profile/ David_Weber2/publication/7269195_Toyota-Style_Management_Drives_Virginia_Mason/ links/02bfe50fefe60309bc000000/Toyota-Style-Management-Drives-Virginia-Mason.pdf
WOMACK, J.P and JONES, D.T. Lean Thinking: Banish Waste and Create Wealth in Your Corporation. New York: Productivity Press, 2003.
CHENG, S.Y., BAMFORD, D., PAPALEXI, M and DEHE, B. Improving Access to Health Services - Challenges in Lean Application. International Journal of Public Sector Management [online]. 2015, 28(2), 121–135. DOI 10.1108/IJPSM-05-2014-0066. ISSN 0951-3558. Available: http://www.scopus.com/inward/record.url?eid=2-s2.0-84929758468&partnerID=40 &md5=b3045aef84039c88bca1274cb456cbef
COSTA, L.B.M and GODINHO FILHO, M. Lean Healthcare: Review, Classification and Analysis of Literature. Production Planning & Control [online]. 2016, 7287(february), 1–14. DOI 10.1080/09537287.2016.1143131. ISSN 1366-5871. Available: http://www.tandfonline. com/doi/full/10.1080/09537287.2016.1143131
D’ANDREAMATTEO, A., IANNI, L., LEGA, F and SARGIACOMO, M. Lean in Healthcare: A Comprehensive Review. Health Policy [online]. 2015, 119(9), 1197–1209. DOI 10.1016/j. healthpol.2015.02.002. ISSN 0168-8510. Available: http://www.sciencedirect.com/science/ article/pii/S0168851015000366?via%3Dihub
DAMELIO, R. The basics of process mapping. New York: Productivity Press, 2011.
DE CARVALHO, J.C., RAMOS, M and PAIXÃO, C. A Lean Case Study In An Oncological Hospital: Implementation of a Telephone Triage System in the Emergency Service. Risk Management and Healthcare Policy [online]. 2013, 7, 1–10. DOI 10.2147/RMHP.S49535. ISSN 1179-1594. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864937/
DICKSON, E.W., SINGH, S., CHEUNG, D.S., WYATT, C.C and NUGENT, A.S. Application of Lean Manufacturing Techniques in the Emergency Department. Journal of Emergency Medicine [online]. 2009, 37(2), 177–182. DOI 10.1016/j.jemermed.2007.11.108. ISSN 0736- 4679. Available: http://www.sciencedirect.com/science/article/pii/S0736467908002163
DOĞAN, N.Ö and UNUTULMAZ, O. Lean Production in Healthcare: A Simulation-Based Value Stream Mapping in the Physical Therapy and Rehabilitation Department of a Public Hospital. Total Quality Management & Business Excellence [online]. 2016, 27(1-2), 64-80. DOI 10.1080/14783363.2014.945312. ISSN 1478-3371. Available: http://www.tandfonline. com/doi/abs/10.1080/14783363.2014.945312
GRABAN, M. Lean Hospitals – Improving Quality, Patient Safety, and Employee Engagement. Boca Raton: Productivity Press, 2011.
GROUT, J.R and TOUSSAINT, JS. Mistake-Proofing Healthcare: Why Stopping Processes May Be a Good Start. Business Horizons [online]. 2010, 53(2), 149–156. DOI 10.1016/j. bushor.2009.10.007. ISSN 0007-6813. Available: http://www.sciencedirect.com/science/ article/pii/S0007681309001554
GUIMARÃES, C.M and CARVALHO, J.C. Assessing Lean Deployment in Healthcare—A Critical Review and Framework. Journal of Enterprise Transformation [online]. 2014. 4(1), 3–27. DOI 10.1080/19488289.2013.869277. ISSN 1948-8297. Available: http://www. tandfonline.com/doi/abs/10.1080/19488289.2013.869277
HAWTHORNE, H.C and MASTERSON, D.J. Lean Events at Columbus Regional Healthcare System and Sampson Regional Medical Center. North Carolina medical journal [online]. 2013, 74(2), 134–135. ISSN 0029-2559. Available: http://classic.ncmedicaljournal.com/wp-content/ uploads/2013/04/74216_Hawthorne-FINAL.pdf
HERNANDEZ, N., JOHN, D and MITCHEL, J. A Reimagined Discharge Lounge As a Way to an Efficient Discharge Process. BMJ Quality Improvement [online]. 2014, 3(1), u204930. w2080. DOI 10.1136/bmjquality.u204930.w2080. ISSN 2399-6641. Available: http://qir.bmj. com/lookup/doi/10.1136/bmjquality.u204930.w2080
IPSOS. Global Trends: Brasil é o Segundo País Mais Insatisfeito Com Serviço Público. IPSOS [online]. 30 May 2017 [Viewed 24 August 2017]. Available from: https://www.ipsos.com/pt-br/ global-trends-brasil-e-o-segundo-pais-mais-insatisfeito-com-servico-publico
JADHAV, J.R., MANTHA, S.S and RANE, S.B. Exploring Barriers in Lean Implementation. International Journal of Lean Six Sigma [online], 2014, 5(2), 122–148. DOI 10.1108/ IJLSS-12-2012-0014. ISSN 2040-4166. Available: http://www.emeraldinsight.com/doi/ abs/10.1108/IJLSS-12-2012-0014
KENNEY, C and BERWICK, D.M. Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience. Boca Raton: CRC Press, 2010.
MAZZOCATO, P., SAVAGE, C., BROMMELS, M., ARONSSON, H and THOR, J. Lean Thinking in Healthcare: A Realist Review of the Literature. BMJ Quality & Safety [online]. 2010, 19(5), 376–382. DOI 10.1136/qshc.2009.037986. ISSN 2044-5423 Available: http:// qualitysafety.bmj.com/content/19/5/376
RADNOR, Z and WALLEY, P. Learning to Walk Before We Try to Run: Adapting Lean for the Public Sector. Public Money and Management [online]. 2008, 28(1), 3–20. DOI 10.1111/j.1467- 9302.2008.00613.x. ISSN 1467-9302. Available: http://www.tandfonline.com/doi/abs/10.1111/ j.1467-9302.2008.00613.x.
ROTHER, M and HARRIS, R. Creating Continuous Flow. Cambridge: Lean Enterprise Institute, 2001.
SCHEFFER, M. Demografia Médica no Brasil 2015. São Paulo: Conselho Regional de Medicina do Estado de São Paulo, 2015.
SHINGO, S. A Study of the Toyota Production System: From an Industrial Engineering Viewpoint. New York: Productivity Press, 1989.
SIMERS. Falta de Investimento Público Indica que Saúde não é Prioridade no Brasil. SIMERS [online]. 28 December 2016. [cit. 24-August-2017]. Available from: http://www.simers.org. br/2016/12/saude-nao-e-prioridade-no-brasil/
OHNO, T. Toyota Production System: Beyond Large-Scale Production. New York: Productivity Press, 1988.
TORTORELLA, F., UKANOWICZ, D., DOUGLAS-NTAGHA, P., RAY, R and TRILLER, M. Improving Bed Turnover Time With a Bed Management System. The Journal of Nursing Administration [online]. 2013, 43(1), 37–43. DOI 10.1097/NNA.0b013e3182785fe7. ISSN 1539-0721. Available: http://journals.lww.com/jonajournal/Abstract/2013/01000/Improving_ Bed_Turnover_Time_With_a_Bed_Management.8.aspx
WEBER, D.O. Toyota-style management drives Virginia Mason. Physician executive. 2006, 32(february), 12–17. ISSN 0898-2759. Available: https://www.researchgate.net/profile/ David_Weber2/publication/7269195_Toyota-Style_Management_Drives_Virginia_Mason/ links/02bfe50fefe60309bc000000/Toyota-Style-Management-Drives-Virginia-Mason.pdf
WOMACK, J.P and JONES, D.T. Lean Thinking: Banish Waste and Create Wealth in Your Corporation. New York: Productivity Press, 2003.
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2017-04-30
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