Cristina Machado de Guimarães

Vendor managed inventory (VMI): evidences from lean deployment in healthcare

Purpose – Understanding how VMI benefits serve lean purposes in healthcare and why its outcomes can be difficult to achieve in healthcare settings is the main purpose of this study.Design/methodology/approach – An in‐depth case study of VMI is presented in the perspective of the downstream member, a public general multi‐site hospital, operating as a small scale consolidated service centre in terms of material management, exploring such dimensions as: VMI benefits, risks, barriers and enablers.Findings – Despite some unawareness of VMI benefits in healthcare, it can present a waste reduction solution not only in costs but in the quality of care for freeing clinical professionals to clinical tasks, among other savings. The multiple benefits are better explored, as in any relationship building, by investing in partnership creation and overcoming the idiosyncratic barriers of the healthcare sector.Research limitations/implications – Although findings of a single case study are difficult to generalize, the pro...

Outsourcing in the Healthcare Sector-A State-of-the-Art Review

Outsourcing has become one of the healthcare sector’s buzzwords. In the supply chain management of healthcare organizations, outsourcing decisions have specific distinctiveness. This article reviews the state-of-the- art literature on outsourcing in the healthcare sector and provides a structured frame of outsourcing in different countries with different healthcare systems. This appears to be the first time evidence on outsourcing practices in the healthcare sector have been systematically collected and structured in order to understand the reality beyond the outsourcing processes and trends.

Strategic outsourcing: a lean tool of healthcare supply chain management

Purpose – Considering lean thinking inside and beyond the organisations boundaries, in the extended supply chain, this paper aims to fill a literature gap clearly stating some outsourcing practices as lean practices and establishing a deployment evolution parallel between both practices.Design/methodology/approach – A literature review was carried out collecting cases of lean deployment in healthcare, from both scientific and grey literature. Cases were classified according to lean deployment taxonomy in healthcare settings, showing some differences in lean journey stages in 15 countries.Findings – There is an alignment between SCM thinking in healthcare and lean thinking that places a SCM decision as outsourcing as a lean practice serving not only strategic intent but solving operational efficiency. There is a match between different outsourcing drivers (transactional, strategic and transformational) and lean maturity levels. The main constraint to deployment of both lean and outsourcing practices are c...

Lean, a Tool Set or a Mind Set? A Healthcare Case Study

Applying “Lean” (Womack and Jones 1996 [2003]; Hines et al. 2004) in healthcare services has been the most visible and recent trend in services industry (Brandao de Souza 2009; Holm and Ahlstrom 2010; Jones 2006). However, is “Lean” in healthcare just a buzzword, a set of tools (Hines and Rich 1997) for quick-wins or a sustainable enterprise process improvement system? Lean thinking has a sustainability issue that needs to be addressed. In order to assess how embedded are Lean principles and tools in healthcare and how organizations sustain the gains, a case study was conducted in a healthcare organization with 21 diagnosis units running Kaizen events. This study aims to bring some answers regarding the regression causes in Lean practices and healthcare organizations priorities in matching customer needs to value streams provided. Conclusions about: (1) translation of Lean models and practices from other settings (manufacturing) to healthcare (services), (2) how elimination of waste in healthcare is made by eliminating non-value-added activities and how customers perceived the value creation, and (3) how is (internal and external) communication of value, are presented, as well as some thoughts concerning the future of Lean in healthcare. In spite of being supported by a single case study, the followed approach and the research design enables any other researcher to replicate it in other units of analysis with similar inclusion criteria.

Impacto econômico da doença de Alzheimer no Brasil: é possível melhorar a assistência e reduzir custos?

The scope of this study is to discuss data relating to the costs involved with Alzheimers Disease and the initiatives in terms of care in order to reduce costs and help family members and caregivers to cope with the disease. The biggest cost for people with mild Alzheimers Disease is the cost of time spent by the unremunerated caregiver, and for those at the advanced stages of the disease it is the cost of institutional care. In this respect, the literature proposes the adoption of models of care that maximize the functional independence of the elderly and maintain their skills, such as Day Care Centers for the Elderly and rehabilitation programs and support offered to the elderly and their family members. These models of care need to be discussed, structured and deployed in the context of the Brazilian reality.

Terceirização em cuidados continuados: uma abordagem de gestão de risco

Este artigo tem como objetivo investigar a decisao de externalizacao, integrada na gestao da cadeia de suprimentos no setor da saude, nomeadamente os motivos e condicionantes da decisao, os criterios de escolha das atividades a entregar a terceiros, os tipos de acordos possiveis e o impacto que a decisao tem na organizacao e na pratica. Atraves do estudo de caso de uma unidade de saude prestadora de cuidados continuados de forma inovadora, com grandes niveis de customizacao e em inicio de atividade, investigou-se todo o processo de terceirizacao em contexto do inicio do ciclo de vida de uma organizacao (nao no contexto comum de mudanca organizacional) e construiu-se uma matriz de avaliacao de risco para atividades terceirizadas de modo a permitir a definicao do processo de monitorizacao da performance a implementar. Este estudo visa compreender como se avaliam e balizam os riscos da adopcao de uma estrategia de terceirizacao e sugere um modelo de monitorizacao, com recurso a ferramentas de gestao de risco. Concluiu-se que uma abordagem de Gestao de Risco pode ser uma solucao para monitorizacao de terceirizacao em atividade que se iniciam. Retiram-se, ainda, conclusoes acerca da insatisfacao com os resultados da estrategia de externalizacao adotada.

Outsourcing in Healthcare Through Process Modularization - A Lean Perspective

Looking for efficiency, quality and profitability gains, healthcare organizations are adopting outsourcing solutions in the attempt of “doing more with less”. Seeking for cost reduction, risk mitigation, adapting to quick changes without compromising internal resources, these organizations also take big risks in control and flexibility variables. In order to understand how healthcare organizations find the best value equation combining internal and external resources in a modular service conception, a case study on a start-up Long-term Care unit with innovative format, great levels of customization and following an outsourcing strategy, was carried out. The main conclusion, among others, is that in ambitious start-ups, having speed of entrance as the conditioning factor, a process orientation and management approach may offer a clear view of the gains related with trade-off decisions regarding time and cost (agility) and cost and quality (Leanness) ie, decisions under the “leagile” paradigm. This study contributes for a wider understanding of the “leagile” concept associated to an outsourcing operational strategy. Additionally, it also provides new insights to the concept of modularity in services settings in a complex service as healthcare.

Leagility in Healthcare A Start-up Case Study

When taking a broader view, ‘leanness’ can be conceptualized in terms of a quest for structural flexibility involving restructuring, downsizing and outsourcing. Looking for efficiency, quality and profitability gains, healthcare organizations adopt outsourcing solutions in the attempt of “doing more with less” seeking for benefits such as cost reduction, risk mitigation, adapting to quick changes without compromising internal resources (value mapping and value chain reconstruction) but also taking big risks as loss of control and flexibility. In order to understand how healthcare organizations find the best value equation combining internal and external resources, a case study on a start-up Long-term Care unit with innovative format, great levels of customization and following an outsourcing strategy, was carried out. The main conclusion, among others, is that in ambitious start-ups, when the speed of entrance is a conditioning factor, trade-offs between cost and quality gains (leanness) and between cost and time gains (agility) can be combined through outsourcing strategies in a so called “leagile” paradigm. This study contributes for a wider understanding of the “leagile” concept associated to an outsourcing strategy as a way of coping with market and services volatility, uncertainty and complexity, hyper competition and market share/sped of entrance goals.