Antonio Freitas Rentes

A new value stream mapping approach for healthcare environments

Hospitals worldwide are giving a growing emphasis to the application of lean concepts in the healthcare sector, commonly known as ‘lean healthcare’. A fundamental tool that allows such implementations is the value stream mapping (VSM). The problem is that VSM models used in implementations of lean healthcare are simple adaptations of the original VSM model, which was initially directed towards manufacturing and may not always represent important support activities for the patient flow that directly impact treatment time. Within this context, this paper presents a new VSM approach for healthcare environments. This new VSM model, specifically designed for healthcare environments, contemplates all activities that directly affect the treatment time. In addition, the present paper also presents an action research in a Brazilian hospital where the proposed VSM model is compared to other VSM models found in the literature. The results shown that the proposed VSM model was able to identify some operational bottlenecks and wastes that interfere in the patient’s treatment that could not be identified by other mapping models studied.

Are BPR practitioners really addressing business processes

Business process re‐engineering (BPR), a management tool that initially advocated a revolution in the way businesses are driven, now carries the stigma of being a major cause of job elimination. This study reveals the depth of involvement of BPR practitioners in what, advocates claim, are the fundamental ingredients of BPR – business processes. The data alert the reader to the different understandings and practices related to business process analysis held by several UK and Brazilian companies. Possible reasons are given, accounting for why some of the companies investigated seemed to lose a BPR focus in favour of more urgent restructuring matters. The authors conclude that companies often lack a basic awareness of the business process concept, and that misconceptions about these issues can lead to unrealised expectations at various levels in the organization.

Corporate communications within a BPR context

Communication aspects within organisational changes have received greater attention since the advent of business process re‐engineering. This fact has been attributed mainly to the necessity of eliminating a higher degree of human resistance on the implementation of such a project. Our argument within this paper is that appropriate corporate communication would promote better chances to dissolve the aforementioned resistance. The research focused on large manufacturing enterprises and it brings to light the industrialists’ practices and expectances related to the communication issue and to the investment in IT to assist in the improvement of the information flow within and outside of the organisation. Based on the experience of the practitioners interviewed, a communication model was implemented aiming to guide companies in building their own communication process framework. Despite some important initiatives, the findings suggest that the improvement in the strategies of communication is not sufficient on its own but there are other key relational aspects to be considered in order to achieve the envisaged outcome.

Lean healthcare in developing countries: evidence from Brazilian hospitals

The present study evaluates how five sectors of two Brazilian hospitals have implemented lean healthcare concepts in their operations. The main characteristics of the implementation process are analyzed in the present study: the motivational factor for implementation, implementation time, form (consultancy or internal), team (hospital and consultants), lean implementation continuity/sustainability, lean healthcare tools and methods implemented, problems/improvement opportunities, lean healthcare barriers faced during the implementation process, and critical factors that affected the implementation and the results obtained in each case. The case studies indicate that reducing patient lead times and costs and making financial improvements were the primary factors that motivated lean healthcare implementation in the hospitals studied. Several tools and methods were used in the cases studied, especially value stream mapping and DMAIC. The barriers found in both hospitals are primarily associated with the human factor. Additionally, the results obtained after implementation were analyzed and improvements in financial aspects, productivity and capacity, and lead time reduction of the analyzed sectors were observed. Further, this study also exhibited four propositions elaborated from the results obtained from the cases that highlighted barriers and challenges to lean healthcare implementation in developing countries. Two of these barriers are hospital organizational structure (and, consequently, how the senior management works with medical staff), and outsourcing hospital activities. This study also concluded that the initialization and maintenance of lean healthcare implementation rely heavily on external support because lean healthcare subject knowledge is not yet available in the healthcare organization, which represents a challenge. Copyright

Improving Hospital Performance by Use of Lean Techniques: An Action Research Project in Brazil

ABSTRACT This article presents the implementation of Lean health care techniques in a surgery department of a Brazilian hospital. The proposed Lean methodology is based on a set of nested improvement cycles that are used to continuously improve the value chain. The results of the implementation showed improvement in cycle time, capacity, and savings in costs. Another important improvement was a significant reduction of 94 percent in the index of delayed surgery due to the lack of materials and a reduction in postsurgery infection.

Um modelo de projeto de layout para ambientes job shop com alta variedade de peças baseado nos conceitos da produção enxuta

According to Canem and Williamson (1998), layout planning is important because it usually represents the largest and most expensive resources for an organization. Moreover, the equipment location on the factory floor has an impact on several factors such as level of in-process inventory, transfer batch sizes, difficulty in managing activities, and moving people and products, among others. Therefore, the study of layout concepts and the development of a layout design that aims at optimizing production are of crucial importance for production system improvement. Thus, this study presents a new layout design model of job shop environments with a high variety of parts. The model was developed as part of a PhD research project and was applied in some companies in the metal-mechanic sector. The results obtained showed the efficiency of the model developed. The purpose of the model is to lead the project team to develop layout alternatives that are consistent with the principles and concepts of lean production. It is worth mentioning again that the model was developed for environments with high variety of parts, and due to the difficulty in designing the layout in these environments, companies end up adopting the functional layout, a concept that presents serious problems such as excessive transport, high levels of in-process inventories, etc.

Contabilidade de custos vs. contabilidade de ganhos: respostas às exigências da produção enxuta

Lean production has provoked significant changes in companies. These changes have not being followed by the economic management systems, which are developed based on mistaken assumptions made by mass production which argues that isolated local optimizations can lead to the global optimization of the company. In this way, it can be affirmed that cost accounting cannot provide the necessary information for decision making in lean companies. On the other hand, consistency is evidenced between the principles of the lean production and the assumptions that support the throughput accounting of the Theory of Constraints. Therefore, the objective of this article is to present arguments that corroborate these assertions and justify the necessity for the use of the throughput accounting as a theoretical basis for the proposal of an economic management method for lean production.A producao enxuta tem provocado mudancas significativas nas empresas, mudancas estas que nao vem sendo acompanhadas pelos sistemas de gestao economica, desenvolvidos sobre pressupostos equivocados da producao em massa que defendem que as otimizacoes locais isoladas resultam na otimizacao global da empresa. Deste modo, pode-se afirmar que a contabilidade de custos nao e capaz de prover as informacoes necessarias a correta tomada de decisao nas empresas enxutas. Por outro lado, constata-se uma coerencia entre os principios da producao enxuta e os pressupostos que sustentam a contabilidade de ganhos da Teoria das Restricoes. Sendo assim, o objetivo deste artigo e apresentar argumentos que respaldem estas afirmacoes, bem como justifiquem a necessidade da utilizacao da contabilidade de ganhos como base teorica para a proposta de um metodo de gestao economica para a producao enxuta.