Otimização em processos hospitalares: metodologia Lean Six Sigma

Abstract

The increase in costs of hospital services, the limitations of public financing, and increased demand in the healthcare sector required new management models focused on process rearrangements. Process with goals of eliminating loss, reducing costs, optimizing time and improving the patient’s experience. The lean six sigma methodology (LSS), originally from manufacturing, was introduced in many areas, including healthcare, and it is based on three pillars: patient focus, time and value. The goal of the study was to apply the lean six sigma guide in the different areas of the EBSERH Network hospital environment, based on the implementation of these concepts in the chemotherapy clinic of the Hospital das Clínicas of the Federal University of Goiás / EBSERH between the period from January 2018 to April 2018. A qualitative, quantitative, applied and exploratory approach was used. As a technical procedure, it was used a bibliographic and action research. The work was conducted using the lean six sigma DMAIC methodology in its 5 steps: define, measure, analyze, implement and control. The current and future value stream map (VSM) was elaborated and the waste was analyzed in the process. Patient scheduling for chemotherapy was changed from manual to electronic, via network communication, based on the available spots in the sector and infusion time of the chemotherapy protocol. The average occupancy rate of the sector was 48.75%, with an increase of 9.32% among the analyzed periods. The total lead time was decreased from 15 days 1 hour and 24 minutes to 9 days and 24 minutes (reduction of 42.8%). A takt (labor rate to meet the daily demand of the sector) was obtained with an average value of 26.9 minutes for the activities performed during the infusion of chemotherapy. The average billing of oncological procedures between january and april/ 2018 was R$ 492,361.54. This value corresponded to the use of 48.75% of the chemotherapy outpatient capacity. A projection of 75% occupancy target for the sector would lead to a proportional billing in the amount of R$ 757,479.29. That is, the sector could bill more R$ 265.117,75 monthly, using the structure and human resources already available. A major advantage of lean methodology as an instrument for healthcare management and innovation lies in the ability to make major changes, optimize processes and eliminate loss without the need for hard technology or high financial investments. Changes can be provided using simple materials, or even without the need for any material, once the redesign of the process, reallocating human resources and activities, can be the solution to the problems under analysis.