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Advisor(s)
Abstract(s)
Introdução: A gestão Lean tem sido adotada como uma solução promissora para enfrentar os desafios dos serviços de urgência como falta de capacidade, tempos de espera prolongados e aumento dos custos. Esta filosofia, com foco na eliminação de desperdícios e criação de valor, fomenta a qualidade através da melhoria contínua de processos. Objetivo: Investigar o contributo da metodologia Lean para a melhoria da qualidade do atendimento nos serviços de urgência. Metodologia: A aplicação da metodologia Lean nos serviços de urgência foi explorada por meio de uma revisão sistemática de literatura (RSL) e um estudo empírico. Os artigos selecionados foram pesquisados nas bases de dados MEDLINE/PubMed, Scopus, Web of Science e Scielo, no portal B-On e no RCAAP, de 2000 a 2020, em português, inglês e espanhol e avaliada a sua qualidade com a ferramenta ROBINS-I. O estudo empírico avaliou o impacto da intervenção Lean no serviço de urgência de um hospital privado da área metropolitana de Lisboa, entre setembro de 2019 (pré-intervenção: n= 4028) e fevereiro de 2020 (pós-intervenção: n= 4219). A equipa multidisciplinar desenvolveu uma série de medidas para melhorar os processos de atendimento, com base na filosofia e ferramentas Lean. Os tempos de espera e permanência foram comparados nos 2 períodos, bem como a satisfação que integrou questionários aos profissionais (n= 109 vs. 114) e clientes (n= 80 vs. n= 83), e dados sobre reclamações e louvores. Resultados: A análise comparativa dos 32 artigos revelou semelhanças no processo de implementação. O tempo foi o principal indicador, com diminuição dos tempos de espera (89,3%) e permanência (92,6%) na maioria. Menos de metade contabilizaram os doentes que saem sem ser atendidos com redução em 66,7%. Existiu aumento da satisfação, no caso dos clientes em 7 dos 10 serviços que a avaliaram, e dos profissionais, nos 6. No estudo prático verificou-se diminuição dos tempos médios de espera e permanência e aumento da satisfação dos clientes e profissionais. Na RSL, 18 estudos identificaram fatores facilitadores e 6 enumeraram dificultadores. A liderança forte, suporte da gestão de topo e envolvimento da linha da frente contrastaram com resistência à mudança e falta de adesão, e com exceção do último, todos salientados no estudo empírico. A sustentabilidade foi mencionada em 24 estudos, dos quais 12 assumiram resultados sustentáveis. Conclusões: As evidências apontam para o impacto positivo da metodologia Lean nos serviços de urgência. Pesquisas futuras devem aprofundar a implementação e sustentabilidade neste ambiente, e comparar a eficiência com outras abordagens de melhoria da qualidade.
ABSTRACT - Introduction: Lean management has been adopted as a promising solution to address the challenges of emergency services such as lack of capacity, prolonged waiting times, and rising costs. This philosophy focused on eliminating waste and creating value and fostering quality through continuous process improvement. Objective: To investigate the contribution of Lean methodology to improve the quality of care in the emergency department. Methodology: The application of Lean methodology in the emergency department was explored through a systematic literature review (RSL) and an empirical study. The selected articles were searched in the MEDLINE/PubMed, Scopus, Web of Science, and Scielo databases, in the B-On portal, and in the RCAAP, from 2000 to 2020, in Portuguese, English, and Spanish, and their quality was evaluated with the ROBINS tool-I. The empirical study evaluated the impact of Lean intervention in the emergency department of a private hospital in the metropolitan area of Lisbon, between September 2019 (pre-intervention: n=4028) and February 2020 (post-intervention: n=4219). The multidisciplinary team developed a series of measures to improve customer service processes, based on Lean philosophy and tools. Waiting and permanence times were compared in the 2 periods, as well as satisfaction, which included questionnaires to professionals (n=109 vs. 114) and customers (n=80 vs. n = 83), and data on complaints and praise. Results: The comparative analysis of 32 articles revealed similarities in the implementation process. Time was the main indicator, with a decrease in waiting times (89.3%) and permanence (92.6%) in the majority. Less than half accounted for patients who leave without being treated, with a reduction of 66.7%. There was an increase in satisfaction, in the case of customers in 7 of the 10 services that evaluated it, and professionals, in 6. In the practical study, there was a decrease in average waiting and permanence times and an increase in customer and professional satisfaction. In RSL, 18 studies identified facilitating factors, and 6 listed hindering factors. Strong leadership, top management support, and frontline involvement contrasted with resistance to change and lack of buy-in, and except for the latter, all highlighted in the empirical study. Sustainability was mentioned in 24 studies, of which 12 assumed sustainable results. Conclusions: Evidence points to the positive impact of Lean methodology in the emergency department. Future research should deepen implementation and sustainability in this environment and compare efficiency with other quality improvement approaches.
ABSTRACT - Introduction: Lean management has been adopted as a promising solution to address the challenges of emergency services such as lack of capacity, prolonged waiting times, and rising costs. This philosophy focused on eliminating waste and creating value and fostering quality through continuous process improvement. Objective: To investigate the contribution of Lean methodology to improve the quality of care in the emergency department. Methodology: The application of Lean methodology in the emergency department was explored through a systematic literature review (RSL) and an empirical study. The selected articles were searched in the MEDLINE/PubMed, Scopus, Web of Science, and Scielo databases, in the B-On portal, and in the RCAAP, from 2000 to 2020, in Portuguese, English, and Spanish, and their quality was evaluated with the ROBINS tool-I. The empirical study evaluated the impact of Lean intervention in the emergency department of a private hospital in the metropolitan area of Lisbon, between September 2019 (pre-intervention: n=4028) and February 2020 (post-intervention: n=4219). The multidisciplinary team developed a series of measures to improve customer service processes, based on Lean philosophy and tools. Waiting and permanence times were compared in the 2 periods, as well as satisfaction, which included questionnaires to professionals (n=109 vs. 114) and customers (n=80 vs. n = 83), and data on complaints and praise. Results: The comparative analysis of 32 articles revealed similarities in the implementation process. Time was the main indicator, with a decrease in waiting times (89.3%) and permanence (92.6%) in the majority. Less than half accounted for patients who leave without being treated, with a reduction of 66.7%. There was an increase in satisfaction, in the case of customers in 7 of the 10 services that evaluated it, and professionals, in 6. In the practical study, there was a decrease in average waiting and permanence times and an increase in customer and professional satisfaction. In RSL, 18 studies identified facilitating factors, and 6 listed hindering factors. Strong leadership, top management support, and frontline involvement contrasted with resistance to change and lack of buy-in, and except for the latter, all highlighted in the empirical study. Sustainability was mentioned in 24 studies, of which 12 assumed sustainable results. Conclusions: Evidence points to the positive impact of Lean methodology in the emergency department. Future research should deepen implementation and sustainability in this environment and compare efficiency with other quality improvement approaches.
Description
Mestrado em Gestão e Avaliação de Tecnologias em Saúde
Keywords
Qualidade em saúde Metodologia Lean Serviço de urgência Melhoria contínua Qualidade dos cuidados de saúde Melhoria de processos Quality in health care Lean methodology Emergency department Continuous improvement Quality of health care Process improvement
Citation
Salvador MC. Otimização de processos como contributo para a melhoria da qualidade: metodologia Lean numa urgência hospitalar [dissertation]. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa/Instituto Politécnico de Lisboa; Escola Superior de Saúde da Universidade do Algarve; 2021.
Publisher
Instituto Politécnico de Lisboa, Escola Superior de Tecnologia da Saúde de Lisboa