Gestão em saúde: um estudo sobre a análise de melhorias em um processo de montagem de kits cirúrgicos a partir da adoção do formulário A3 sob a perspectiva Lean Healthcare

Abstract

PAZ, R. J. da. HEALTH MANAGEMENT: A study on the analysis of improvements in a surgical kit assembly process through the adoption of the A3 form, from a Lean Healthcare perspective. 2023. 128f. Dissertation (Professional Master’s in Health Services Management) - School of Nursing, Federal University of Minas Gerais. Belo Horizonte, MG, 2023. Due to its structural complexity and the diversity of specialized human and material resources required for its operation, hospitals require high and constant financial investments, often surpassing profits and posing challenges to their sustainability. In recent years, the dissemination of Lean Manufacturing concepts, widely applied in manufacturing industries, has generated systematic efforts for their implementation in healthcare services. Lean Healthcare, known as a Lean approach in the healthcare field, was developed to support professionals in eliminating or reducing obstacles in patient flows. Its philosophy and available tools generate a cultural transformation within the organization, as they require new attitudes and habits that provide conditions for improving the quality of care through waste reduction and waiting time. In this research, the problem under analysis is to reduce waste, strengthen safety, and contribute to the development of the institution, thus improving the work process of a hospital pharmacy. Therefore, the following guiding question was formulated: How to assist a hospital pharmacy in improving the process of assembling surgical kits using Lean Healthcare methodology tools? In this sense, the main aim of this research was to understand the process of assembling surgical kits in a hospital pharmacy for the development of improvements using Lean methodology tools. The specific aims were: (a) to map the routine activities of the pharmacy; (b) to describe how the assembly and delivery of the product, which are the surgical kits, are done to the internal customer: the Operating Room; (c) to identify weaknesses in the department, including possible sources of waste, activities that add value or not, and potential improvements; (d) to develop proposed changes using the widely spread A3 Matrix by Lean Philosophy. A qualitative approach was used, with a descriptive nature, as a single case study. In this study, the scenario studied is a private institution specialized in Ophthalmology, located in the central region of Belo Horizonte City, MG, with an area distributed across 7 floors, mostly consisting of clinics and examination departments. Regarding the unit of analysis, it is the pharmacy, located on the third floor of the institution, which serves the entire hospital, including the Surgery Room, which averages 600 procedures per month. The inclusion criteria were: being a professional who works in the study setting, whether in a leadership or operational position; being trained in the assembly and disassembly of surgical kits and in the inventory control system; and having more than 3 months of experience in the unit. The exclusion criterion was employees on medical or any other type of medical leave during the data collection period. The sample size resulted in 04 participants, and there were no dropouts in this research. The data collection techniques included analysis of institutional documents, direct observation, and conducting a focus group. Transcription of findings from direct observation and content analysis of excerpts from the focus group were used for data analysis. In order to facilitate the understanding of the kit assembly process, it was necessary to map the Work Process using SIPOC and Process Flowchart. Finally, a proposal for improvement is presented, totaling 16 A3 Forms, which represent the technical product delivered to the study institution. Each Form represents an improvement opportunity from a Lean Healthcare perspective. The main projected results include a reduction of 39 annual hours for the employee in the kit identification activity if automated, a decrease of 14.4 km in annual travel distance for the operator in the kit assembly activity if workstations are rearranged, and an elimination of 19.2 km in annual travel distance for kit delivery activity if the proposed measures in the A3 Forms are adopted by the institution. Data triangulation allowed for a comprehensive understanding of the investigated scenario, enabling the use of Lean methodology techniques to create improvement proposals, identify bottlenecks, waste, and optimization opportunities in the activity. The study has demonstrated that Lean Healthcare tools can be applied as improvement proposals for daily activities in a department such as the hospital pharmacy, with the A3 Forms as the product, based on its concepts and based on its methodology. However, attention was drawn to the lack of description in the documentary analysis of the Standard Operating Procedures for some activities. Likewise, it is important to highlight the opportunity for improvement in terms of enhancing visual management in the department, reallocating poorly distributed workstations, and minimizing constant interruptions caused by phone calls. As a limitation of the study, it is necessary to promote the implementation of the proposed improvement in different healthcare facilities and study Lean Healthcare methodology to compare and analyze the results, taking into consideration the specificities of each hospital, its individuals, and the availability of human and financial resources. It is expected that this study will encourage further investigations using different data collection methods, contributing to expanding knowledge on this subjec of interest not only for healthcare service managers but also for researchers in general.