Utilização dos conceitos Lean Healthcare na otimização da gestão de leitos de internação hospitalar

Abstract

Introduction: Hospitals have been looking for alternatives to adapt to the reduced bed availability consequences, causing urgency and emergency services overcrowding. Lean Healthcare is a philosophy based on a set of concepts, techniques and tools that improve the way hospitals are organized and managed. It focuses on patient safety, quality of care, cost reduction and increase of efficiency and productivity. The Lean health theme is still little explored in Brazil and its studies are incipient considering the extent of the international literature. Objective: To demonstrates the use of Lean Healthcare concepts in the hospital bed management optimization. Method: Descriptive study case carried out in the Hospital das Clínicas of the Federal University of Minas Gerais medical clinic hospitalization area. Data from the Medical Statistics Service and the hospital management system from January to October of 2016 were used to know the indicators, Patients medical releases and admission processes were evaluated. Lean Healthcare concepts were applied in the Current Value Flow Map elaboration and the evaluation of wastes that generated patient waiting times. The Future Value Flow Map was built based on identified improvement opportunities and total bed demand. The gains and benefits generated with the Future Value Flow Map implementation were projected. Results: Bed movements occurred in greater proportion during the afternoon shift. The linear correlation (p<0.05) between the volumes of admissions and admissions per shift indicated excess production and people movement in the same period of the day. Installed capacity problems were identified as an expense to meet the total demand of the medical clinics beds, leading to the need to hire another 70 beds. The slowness of patients medical releases and admission processes, impacted by the existence of waste and lack of programming, was identified as a productivity aggravation factor. The current value stream map provide a hospitalization flow value chain overview, locating the wastes that generate inefficiencies. With the new flow, there was a 517 minutes reduction in the use of the bed per patient and an increase of 2 day beds or 4 patients per month. If the Lean were applied in conjunction with the increase in installed capacity, it would contribute to reducing the need for 2 days beds. Conclusion: Lean Healthcare makes it possible to improve medical releases and admission processes bed management and is a tool that adds potential in hospital productivity.