Lean healthcare: aplicação dos conceitos de gestão de operações em centros cirúrgicos

Abstract

Brazilian hospitals typically work with a depression between capacity and demand. The public and private subsystems are unable to coordinate situations of shortage and excess capacity identified in their respective structures, concomitantly. Costs become a focal element in both cases, aiming to quality and safety or to increase capacity, focusing on key areas of hospital service: surgical services, admission, emergency and diagnostic. In this context, Lean Healthcare becomes an attractive philosophy for organizational change of hospital processes aiming at increasing its efficiency. This study discusses the application of Lean Healthcare concepts in surgical services, based on evidence collected from three studies integrally in a large University Hospital, part of the Brazilian public health subsystem. The first study focuses on the operating room efficiency analysis, proposing and applying the indicator Operating Room Effectiveness (ORE). The second study analyzes and proposes alternatives to level the production of surgeries (Heijunka) of different brands, competing for the same operating room, at a low capacity context. The third study develops the concept of Planning, Programming and Control of Patient Flow (PPCPF), to establish integrated planning consultations, surgeries, preoperative and acquisition of materials. The application of the proposed conceptual models reveals potential advantages, yet to be studied in amplitude and longitude as an alternative to other industry organizations. As local gains, in addition to the approximation of Industrial Engineering concepts to the health context, it have been identified: 12% increase in the surgical center’s average efficiency; 40% reduction in the average waiting time for elective surgery; 50% reduction in the number of queued consultations; better planning and control efficiency and production; and savings of about R$ 5,000,000.00 resulting from the three cases.