<i>LEAN HEALTHCARE</i>: UNA HERRAMIENTA DE APOYO PARA EL EQUIPO DE ATENCIÓN AL PACIENTE

Silva, Dulcilene Diniz de Menezes; Marques, Julia Fernada Miranda; Ramos, Flávia Regina Souza; Souza, Aldalice Aguiar de

doi:10.1590/1980-265X-TCE-2025-0058en

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Original Article • Texto contexto - enferm. 34 • 2025 • https://doi.org/10.1590/1980-265X-TCE-2025-0058en linkcopiar

LEAN HEALTHCARE: UNA HERRAMIENTA DE APOYO PARA EL EQUIPO DE ATENCIÓN AL PACIENTE

Autoría SCIMAGO INSTITUTIONS RANKINGS

Objetivo: desarrollar una tecnología en formato de Guía Educativa e Instruccional con y para los profesionales de la salud, en relación con la aplicabilidad del Lean Healthcare en los servicios de urgencia y emergencia.

Método: estudio de desarrollo tecnológico con enfoque cualitativo, utilizando como estrategia metodológica la Investigación Convergente Asistencial. El estudio se realizó en el municipio de Manaus, Amazonas, Brasil. Participaron 13 profesionales de la salud, y la recolección de datos se llevó a cabo mediante grupos de convergencia y la ejecución de las fases de concepción, instrumentación, indagación y análisis.

Resultados: la Guía fue desarrollada con contenido extraído de las categorías experiencia y conocimiento sobre la metodología Lean, opiniones, facilidades y dificultades identificadas, y necesidades consideradas para la evaluación y mejora de la práctica profesional. La Guía fue estructurada en 33 páginas y 11 capítulos, con textos, diagramas de flujo y esquemas que representan las etapas, secuencias y toma de decisiones en el flujo de trabajo.

Conclusión: la tecnología desarrollada de forma participativa y colaborativa entre investigadores y participantes constituye un instrumento importante de apoyo para el equipo de profesionales de los servicios de urgencia y emergencia, especialmente para el enfermero, quien posee amplia capacidad y responsabilidad técnica en la conducción del flujo y gestión de las herramientas Lean. Se destaca que la Investigación Convergente Asistencial fue esencial para el compromiso y la implicación del equipo en la búsqueda de una evaluación continua y la sostenibilidad del modelo Lean implantado en la institución. Sin embargo, la tecnología producida aún requiere la realización de etapas futuras de continuidad, como la validación de contenido y la evaluación de la efectividad, para que pueda ser aplicada y lograr los impactos esperados.

DESCRIPTORES:
Tecnología educativa; Equipo de atención al paciente; Enfermería; Servicio hospitalario de emergencia; Atención sanitaria basada en valores

Lean Tools	Description
5S Methodology	Developed to improve discipline and workplace organization, it consists of five organizational steps: sense of use, organization, cleaning, standardization, and discipline. Its application over time aims to provide comfort, safety, and quality of life for workers.
VSM	A tool that helps to understand and analyze the production process of a service or product, highlighting the identified critical points. It allows for the identification of the departments the patient passes through and records the waiting time in each area until hospital discharge.
Flow Manager	A professional assigned to guide patients and eliminate unnecessary steps within a workflow.
Kanban	It is a visual management tool that is simple, easy to understand, and effective, based on the principles of standardized work and the 5S methodology.
MR and STP	A visit carried out jointly by the team at the patient's bedside, aimed at identifying possible actions to improve the patient's treatment.
Daily Huddle	A brief and frequent meeting among team members to align goals and prioritize challenges.
FCP	Supports decision-making in situations where demand exceeds the hospital's installed capacity.
Clinical Decision Unit	A department dedicated to determining the diagnostic decision and the patient's outcome within the hospital unit.
Fast Track	Rapid patient discharge. This tool ensures that a portion of emergency care users are assessed and released during the initial triage stage.
Satellite Pharmacy	A service that encompasses the receipt of prescriptions, pharmaceutical analysis, and the distribution of medications to each admitted patient.

Investigative Category	Perception/Contextualization	Change in professional practice
Experience with Lean methodology	Improvement in work processes and service organization. Greater synergy among professionals. Low-cost, high-impact tool that promotes multiple improvements in workflow. Reduction in the cancellation of surgeries and laboratory tests.	Identification and elimination of non-value-added activities, such as redundant steps in patient care, unnecessary tests, or bureaucratic procedures that delay processes. Team integration: improved communication between departments, optimizing the diagnostic and treatment process (e.g., integration of laboratory tests into the unit’s system). Work time optimization through the use of value stream mapping.
Knowledge about Lean methodology	Awareness of the Lean Project in emergency services through Sírio-Libanês Hospital and PROADI-SUS. The management tools of the Lean methodology enable improvements in the organizational culture of institutions, aiming to standardize care, optimize patient flow and length of stay, reduce costs, and leverage the full potential of healthcare teams.	Optimization of resource use: minimizing waste of hospital supplies through the 5S tool. Strengthening the permanent education unit in disseminating information through training and capacity-building on the methodology. Standardization of work processes, preventing overload for the healthcare team, reducing waiting times, and promoting patient-centered care.
Opinions about a Lean and its tools	Facilitate and guide care delivery. Improve communication among team members. Standardize processes. Promote workflow organization and indicator monitoring.	Redesign of operational flows: mapping the steps the patient goes through from admission to discharge, aiming to eliminate bottlenecks and delays. Culture of continuous improvement: encouraging healthcare professionals to identify opportunities for enhancement and propose solutions.
Identified facilitators and challenges	Facilitators: Low cost. Improves standardization of care and organizational processes. Presence of consultants during the implementation of tools. Optimizes bed turnover. Reduces patient length of stay Enhances communication among teams. Challenges: Low team adherence. Complex departments with strong resistance to change and to the culture of continuous improvement. Limited involvement of senior management in sustaining the use of tools and the implemented project. Huddle scheduled during peak demand hours in the unit. Need to acquire knowledge and disseminate it throughout the institution. Ongoing monitoring of actions.	Greater engagement: commitment and involvement from organizational management and healthcare teams. Awareness-raising about the methodology among healthcare staff. Itinerant Huddle, promoting greater adherence from professionals. Development of a tool for indicator evaluation.
Needs considered for evaluating the use of Lean methodology tools	Provide feedback to staff on the outcomes of implemented actions, using visual management tools. Develop evaluation instruments, such as satisfaction surveys (e.g., Google Forms). Continuously monitor actions, making adjustments whenever necessary.	Improved experience: providing clear information and making care processes more transparent. Focus on quality: implementing audits and performance indicators to ensure excellence in care delivery.
Need for improvement in professional practice regarding the Lean methodology	Active participation of management. Ongoing involvement in applied processes through meetings among stakeholders. Necessary human and material resources.	Evaluation and reorganization of the work schedule. Commitment from senior organizational management and department coordinators. Sector-specific material checklists to identify excesses and prevent waste.

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