Lean Healthcare: gestão de qualidade em centro cirúrgico

Abstract

The reality of the health landscape regarding organizational, managerial and financial aspects has demonstrated weaknesses that have challenged the sustainability of institutions. In the hospital sphere, the Surgical Center presents itself as a sector very prone to high costs, but also to the generation of high profits; and the nurse is one of the most capable professionals to lead changes and improvements in these challenging scenarios with the use of quality management tools, as this professional acts directly in the patient care and in the management of the units. This study aimed to map the surgical center of a hospital using Lean Healthcare tools; use Lean tools appropriate to every need demanded in the mapping and propose improvements. The research was carried out in a private, medium-level, accredited level 2 hospital in the State of Minas Gerais, Brazil, at the Surgical Center, in interaction with nurses, nursing technicians, physicians and managers. A single case study was developed, being characterized as an applied research, for seeking to generate knowledge for practical application and to return to the solution of problems; with a qualitative approach, for trying to describe the practical reality and to analyze it in a subjective way; exploratory, with the objective of deepening in a research problem in order to make it explicit and / or construct hypotheses; and with technical action research, as it was associated with actions and resolutions of problems. The research-action phases of detailed survey, critical analysis and intervention proposal were developed. Together with the participant observation and the design of hospital flows and data, the following detailed tools were used in the detailed survey: Lean Healthcare philosophy: Current Value Stream Maps (MFVA), waste categorization and 5S Program. As results, the MFVA of the macroprocess of elective surgery and the macroprocess of emergency and emergency surgery were made and discussed. And the results referring to the other two tools used, were detailed in tables and texts described. From the mapping, it was possible to raise what has been developed in the hospital and is positive for the institution, as well as it was also possible to visualize and indicate systemically points that could be improved with proposals for intervention and projection of future realities from the elaboration of Maps of Future Value Flow (MFVF).