Journal of innovation and healtcare management 2016

V Lean Day October 6th – 7th, 2016 Brazil

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V Lean Day October 6th – 7th, 2016 Brazil

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V Lean Day October 6th – 7th, 2016 Brazil

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V Lean Day October 6th – 7th, 2016 Brazil

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V Lean Day October 6th – 7th, 2016 Brazil

Overcrowding Reduction in Emergency department through assignment of key resources: a proposal to optimize through simulation C. Poblete1, L. Lopez2 1

Nurse, Master in management of Health Institutions, University of Talca, Chile, 2 Civil Industrial Engineer, University of Chile, Professor FEN of University of Talca.

Introduction: Emergency departments (EDs) are critical health units that offer an initial treatment of patients for a wide range of illnesses and injuries, some of which can potentially be fatal and require immediate attention. The overcrowding in emergency departments is an international situation that appears to have no effective solution, leaving millions of people in life-threatening situations. This study is a proposal to optimize the number of discharges and the number of patients waiting by assigning different resources through the simulation of an emergency department of a primary care unit.

Materials and Methods: This is an experimental study in silico. The sample was obtained through systematic random sampling, with a known population in 2013 of 1,200 consultations in the month of August (local registration), which it calculates an "n" of 292 per activity. The data collection was conducted through direct observation of executed activities in the ED, identifying processes, creating process descriptions and measurement of the time between the beginning and end of each process, time between a process and other processes in series and in parallel, through direct observation using a chronometer. The analysis of the data obtained from observation on the ED was represented in units of time and flow charts, identifying inputs, throughputs and outputs, according to Workflow or WPM (workflow process model). The classification of emergency department overcrowding was conducted through an Emergency Department Work Index before and after simulation [1]. The modeling of processes was performed by "Process Modeling workflow" [2] which guides the construction of flow through representations associated with information systems. The ExtendSIM7 software was used for simulation. Results of assays were expressed as percentage. ANOVAR results were considered statistically significant when p < 0.05, considering a 95% confidence interval.

Results: We found statistically significant differences in the increase of discharges (p value <0.0001) when compared the control group with the assignment of one bed, or with the assignment of one nursing technician with a bed. We found that from the results of these simulations, we can improve by 53.7% the number of discharges and decrease by 100% the number of patients waiting, allowing us to conclude that it is possible to solve the problem of overgrowding of the EDs. Discussion: While virtual simulations guide for better decision-making, these controlled conditions are limited. They are an excellent statistical approach to the complexity of emergency services, where demand and complexity of care is relatively well known and the service is extremely limited.

Conclusion: This study confirmed that although the overcrowding of emergency services has become a major obstacle to emergency care and timely emergency, it is possible to virtually improve the saturation of these services. If the world's population of older adults increases with constant epidemiological changes, there is also an increase in the complexity of consultations in emergency units, which occurs with a significantly increased progression of new cases and needs for services.

Thus, it is our duty to reduce health spending through the proper allocation based on evidence and improve decision-making.

Keywords: Simulation, overcrowding, Emergency department References: [1] Kulstad EB et al., West J Emerg Med. 11(4): 324â&#x20AC;&#x201C;328, 2010[2] Sharp, A et al .

Workflow modeling, 2001.

Category: Lean Manufacturing.

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V Lean Day October 6th – 7th, 2016 Brazil

Presentation: Poster.

Lean methodology Application in the hospital industry M. Carboneri1 1

Pós Graduação, FMRP, USP-RP

Introduction: Companies have currently been looking to improve its processes seeking to minimize weak points and optimize strengths. In this study, we propose to track and analyse the current purchasing model of a health organization applying the technique of lean, aiming to propose the creation of a shared services center for execution of purchasing activities.

Materials and Methods: This study included five hospitals located in the state of São Paulo; these hospitals buy individually, each of them has its own purchasing department. The study period was related to the items purchased in the year 2013 and 2014, mapping the procurement process using the lean methodology. There was a 6-month pilot study creating a centralized structure of shopping. This comparison used statistical tools to process the data focusing attention to measure the effectiveness and efficiency of the proposed model and it also compared some indicators in common between the two models (cost, order costs, cost structure and cost of failure).

Results: The obtained results, through the indicators comparison, showed that the acquisition cost for products in the centralized model with the readjustment year by year was 5.8%, while inflation and dollar variation in the same period respectively increased 39.9% and 28.9%. The order cost of the centralized model was 23% less than the order cost of the decentralized. The lack cost of the centralized model corresponds to 2.85% of the orders, while in the decentralized model it corresponds to 3.33% of the orders. The structure cost in the centralized model was 19.78% less than in the decentralized model.

Discussion: The obtained results indicate that the purchasing centralized model is rather economic and productive than the purchasing decentralized model, since all indicators studied converge to this conclusion.

Conclusion: With this study, we hope to help both the academy and organizations in continuous improvement processes, since the achieved processes were representative, using the elimination of activities that do not add value to the process and adding synergy in related activities.

Keywords: Purchasing, purchasing process, logistics, hospital logistics, supply chain, hospital management.

References: [1] Bendavid, et al, Business Process Management Journal 16.6: 991-1013(2010); [2] Kumar, et al, International Journal of Health Care Quality Assurance 18.2: 152-166 (2005).

Category: Lean Manufacturing.

Category: Lecture.

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V Lean Day October 6th – 7th, 2016 Brazil

Audit of medical orders to hepatitis B in a tertiary university hospital: less is more D. Falango1, V. R. Bollela2 1 Serology Laboratory Hospital das Clínicas School of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), 2Department of Infectious diseases at FMRP-USP. Introduction: Laboratory tests are essential tools to elucidate medical diagnosis. New technologies are introduced every day in the practice and may lead to unaffordable costs, not always followed by better outcomes. Hospital das Clínicas of Ribeirão Preto (HCRP) is a tertiary university institution.

From 1994-2014 the number of exams ordered at HCRP increased 100% (from 1,400,000/yr to 2,800,000/yr), while the number of beds increased 30%. Serologic hepatitis B (HB) is one of the top 25 tests ordered at HCRP. Evaluation of active/chronic HB has five markers, but the initial screening requires only two. Doctors, mainly the younger, usually order all of them. This study aims to evaluate an intervention designed to adjust HB orders based on established São Paulo state standards, reducing waste and still offering what doctors and patients need.

Materials and Methods: Data collected from medical serologic HB markers received during two periods were analyzed: Phase-1(P1): 7 months (2012-2013) and Phase-2(P2): 9 months (2014-2015).

We evaluated the requested serologic markers and clinical hypothesis for each exam. They were classified as “adequate” (including HBsAg alone or with anti-HBcAg total Ig), or “not adequate” when included others markers. In P1, the adjustment (elimination of incorrect markers) was made manually by the Serological Lab chief, and in P2 the adjustment logic was introduced in the electronic Hospital system, following the same rules. A cost analysis was performed, considering the ordered tests and what was actually performed by the Lab. This project got IRB clearance.

Results: In the studied period there were 24,649 medical requests of hepatitis B serological markers.

Phase-1: From 11,167 ordered tests, 1,143 (10.23%) were considered not adequate, and were adjusted manually. Phase-2: From 13,482 requests analyzed by electronic triages, 251 (1.86%) were considered not adequate. Based on these two screening processes it was possible to save respectively R$33,628.82 (P1) and R$2,245.07 (P2) per year. During P2 it was possible to detect almost 1,000 tests that were justified as: perioperative screening. It is known that HBV test has no formal indication in most of these situations. It represented 7.39% of medical requests and the costs were R$15,398.56.

Discussion: Tertiary university hospitals have high-complexity cases with a diverse medical workforce (experienced & beginners) with an increased risk of unnecessary investigations. This study shows a significant reduction in HB tests expenditure, still offering the best care. Doctors usually complain with restriction, which was not observed in this study. Despite not being exactly what they originally ordered, they still got a useful HB result. It was possible to reverse the trend of excessive and inappropriate HB tests by analyzing the data and reviewing the process focusing on what the patient needs, mapping the value stream and creating a process to eliminate wasting it. Keeping the eyes opened, it was possible to detect new opportunities to improve the process and pursuing perfection by eliminating the perioperative exams.

Conclusion: The manual and electronic sorting processes proved to be cost-effective and reduced the lead time to release relevant results for clinical decision making.

Keywords: Hospital Laboratory, Quality management, Hepatitis B, Lean thinking.

References: [1] Zhi M et al., PLoS ONE 8(11) e78962, 2013; [2] May TA et al., Am. J. Clin. Pathol.

126: 200-206, 2006; [3] Mazzocato P et al., Qual. Saf. HealthCare 19(5): 376-382, 2010; [4] São Paulo State., “RESOLUÇÃO SS 91”, 2016.

Category: Lean Healthcare.

Presentation: Poster.

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V Lean Day October 6th – 7th, 2016 Brazil

Approach for decision taking, using oriented process management for lean manufacturing in Subsea Wellhead System maintenance project R.A. Tavares1 1

Implementation, Management and Production System Evaluation Group,MESC-ICT, UFF.

Introduction: This study aims to conduct an analysis of times and methods as a prior step in creating a pilot project for subsea wellhead system maintenance in a submarine equipment factory which provides repairs to its largest customer in Brazil.

Materials and Methods: This project was structured with the concepts of maintenance and engineering methods, guided by a process management methodology aligned to the concept of lean manufacturing. Following the step by step established by the methodology, it was able to get the data for the overall leadtime and individual processes, accounting the maintenance man-hour and working days for completion of each service in a repair maintenance process.

Results: In formulating the data, these information were provided to project management in order to assist the decision taking to perform pricing and determination of required resources to generate a contract for the provision of maintenance services to the requesting client, aiming their maximum satisfaction, focusing on continuous improvement of processes based on standardization and practical concept of lean manufacturing in subsea equipment repair processes of oil and gas production.

Discussion: This article presents challenges for standardization of production processes and the concept of after marketing oriented by management of equipment maintenance in the petroleum upstream chain designated by a lean manufacturing philosophy.

Conclusion: The study was able to promote the data inherent in the maintenance processes for subsea wellhead systems to develop a service contract, oriented to the promotion of efficiency and profitability of the business for customer and company, in an after-marketing lean manufacturing strategy based on repair standardization.

Keywords: Process Management, Industrial Engineering, After-marketing, Oil and Gas, Subsea Wellhead Systems.

References: [1] CAMPOS, Eneida Rached. Metodologia de Gestão por Processos.

Campinas: UNICAMP, 2007 Available in: <http://www.ccuec.unicamp.br/gepro/pdf/LivroGepro.pdf>Acessed on 05 mar. 2016 [2] CAMPOS, Vicente Falconi. Gerenciamento da rotina do trabalho do dia-a-dia. 8. ed. Nova Lima: INDG Tecnologia e Serviços Ltda., 2004 [3] FUNDAÇÃO NACIONAL DA QUALIDADE. Critérios Rumo à Excelência 2016. São Paulo: Fundação Nacional da Qualidade, 20ªEdição,2016. [4] JACOBS, G. et al. Por Onde Começar a Gestão por Processos? Uma Análise sobre Metodologias. SIMPEP, 2009.

Category: Lean Manufacturing.

Presentation: Lecture.

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V Lean Day October 6th â&#x20AC;&#x201C; 7th, 2016 Brazil

Lean UX to build User Centered solution to improve communication and tracking of the stretcher-bearers team inside hospitals.

A. P. Rosa1 1

Instituto de Pesquisas Eldorado

Introduction: One of the most requested areas in the hospital is the patients transport team. This team is responsible for transfer patients of their wards to exams rooms. At UNICAMP Hospital of Clinics it is a small team and even with a well-defined working scale and with a trained staff, the feeling of delay and slow service created a relatively weak image of the team. The partnership between Instituto de Pesquisas Eldorado and UNICAMP Hospital of Clinics was an opportunity to develop a process of improving communication between the wards and the stretcher-bearers Hospital.

Materials and Methods: The solution is a result of a multidisciplinary team composed by software developers and designers from Instituto de Pesquisas Eldorado and nurses, managers and IT people from the Hospital. The main work process was Lean UX that enabled experiences exchange between the Hospital team and the Eldorado development team, but other techniques like field research, design thinking, ideation and gamification were used during the process. The MVP (Minimum Viable Product) was built based on the Beacons technology and an Android mobile app.

Results: The Lean UX brought maturity to the MVP with speed, was a collaborative process, multifunctional and with emphasis in the value delivered.

Discussion: At the beginning, the first approach was to present the technology and the proposed solution to the hospital team, but due to countless setbacks regarding the use of the technology by health professionals and inside hospitals all work had to be rethought, therefore, the use of Lean UX working methods was chosen, which facilitated teamwork and made the difference for the non-tech staff understand and use the technology of the beacons in their favor while the IT staff was able to approach the reality of users and health professionals. Several factors had to be taken into consideration during the development: the usage of a technology that does not interfere in the work of health staff; the solution should not demand a big learning curve; the solution should not have risk of contamination.

Conclusion: It is expected to have numbers to support the stretcher staff about their work, improve communication between the different roles on the transport process, reduce transport time and provide visibility of the process. In addition, to improve the image of the team and consolidate the usage of tracking technologies like beacons to improve communication and safety in hospitals.

Keywords: Beacons, Lean UX, Healthcare, Indoor location, Tracking References: Gothelf, Jeff, Lean UX Applying Lean Principles to improve User Experience, Oâ&#x20AC;&#x2122;Reilly Media 152, 2013 Category: Lean Healthcare.

Presentation: Lecture.

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V Lean Day October 6th – 7th, 2016 Brazil

Intra-hospital transport monitoring through indoor location E. Pagnano1, A. Alvarez, E. Kitaka1, A. Coelho, J.R. Souza1 1

Eldorado Research Institute and Clinics Hospital of the University of Campinas

Introduction: This study consisted on developing a proof of concept of an application for mobile platform to support stretcher-bearer team management trough indoor location monitoring. The Unicamp Hospital of Clinics stretcher-bearer tem is responsible for the transportation of patients across the hospital facilities. Using the Android app on mobile devices, and a Bluetooth LE equipment (beacons) it is possible to identify the location of each stretcher-bearers in hospital areas, making possible to improve the management of patient transport process, optimize communication between stretcher-bearers and provide performance indicators for processes improvement. Through advanced analytics, you can ask questions of the data — identify process improvement opportunities, and apply predictive analytics to optimize performance.

Materials and Methods: For the idea conception, a study was developed at the hospital, with the involvement of IT, nurses and especially the stretcher-bearer team. Design Thinking and LEAN UX techniques were used to define the problem to be solved, and the solution to be implemented. During the development, the methodology Scrum Agile.

Results: We found that the usage of Bluetooth LE technology to improve the indoor location and automatically trigger actions on systems is effective in improving many hospital´s processes. Realtime location, status and context data holds a wealth of information about the process and flows that happen in the healthcare. We also understand that the process of stretcher-bearers team can be benefited with improvements in quality of service, communications and performance. In addition, other processes can also be indirectly improved.

Discussion: The results founds are probably due to the advantage of using mobile technology in the activities on the day. In addition, the approach of indoor location technology and automatic contextualization bring a new event source to track hospital´s process, identifying exactly where the stretcher-bearer is located, and contextualize to identify what is being performed by stretcher-bearer and automatically switch the status of the patient transport. The evolution of real time location system technology from the location of items support a deeper understanding of patient and resident experience, clinical processes, equipment conditions and asset management flows and utilization.

Conclusion: The present work confirmed that the use of indoor location technology and context for automatic actions in hospital processes is achievable, and it has demonstrated improvements in indicators. Real-time location system adoption in healthcare has expanded rapidly in recent years.

RTLS-based solutions have proven strategically valuable in advancing key goals around capital expenditure control, operational efficiency and quality of care. With the implemented solution for patient transport, it is expected to increase the amount of transport performed, to improve the communication, reducing unnecessary effort of the stretcher-bearer and to increase effectiveness on the identification of combined transports in the same area.

Keywords: beacon, mobile platform, Android, stretcher-bearer, optimizing, Lean UX. References: [1] Gothelf J., O’Reilly Media 152, 2013; [2] "Everything You Always Wanted To Know about Beacons".

Bright Talk. Retrieved 2014-06-12; [3] "Apple Inc. iBeacon with Micromapping can revolutionize retail".

ValueWalk. Retrieved 2014-06-12; [4] Pourhomayou & Fowler (2012). "Spatial Sparsity Based Indoor Localization in Wireless Sensor Network for Assistive Healthcare Systems" (PDF). EMBC2012.

Category: Lean Healthcare.

Presentation: Lecture.

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V Lean Day October 6th â&#x20AC;&#x201C; 7th, 2016 Brazil

Operational analysis of the logistics process integrated the application of Ishikawa diagram, process losses according to the lean philosophy and internal survey F.B. Mendes1, C.C. Silva1, T.B. Barros1, R.D. Calado1 1

MESC Group, ICT, UFF

Introduction: The aim of this study was to demonstrate the use of an analytical model of logistic operations that could prove the interdependence of gains and losses between the various process factors described in the Ishikawa diagram. This study gathered research and concepts with application and reviews of the chosen model. We presented a real case of application and analysis, under the context of all technical, social and cultural aspects of the process.

Materials and Methods: The chosen analysis method is important since it determines the value of the assessment outcome for each process, then it is understood that the research and full understanding regarding analysis models and results is relevant to provide a relevant choice for organizations. We performed literature search, registration and field research. The approach was wide in the documentary and bibliographic research by adopting more specific items in the integration and practice of the concepts throughout the identification work of interdependence and its connection to systems thinking.

Results: Operations analysis precedes the decision-making processes at various levels, therefore, research on this mode of assessment and the consequent proposition of a more efficient model, could give a contribution of intelligence to the evolution of the organization's management activities, demonstrating the interdependence between process factors and the functional scope of the losses in the operation of companies. The work validated an analytical model called "internal survey" as appropriate for logistics processes, as well as other tools and concepts studied by applying the principles of the systemic approach.

Discussion: This resulted in determining a valuation model of managerial relevance within a qualitative perspective with issues that were a guide to the analysis. The study aimed to make a contribution in order to discuss an operational analysis so that best suited to logistics processes. The goal was to integrate concepts and implement an operational assessment tool producing information on losses and reasons prioritizing proposals and troubleshooting as well as process improvements.

Results were aligned with expectations due to the size and the company's operating time, and according to the standards (ISO, Petrobras, NRs).

Conclusion: The operational analysis term was defined and contextualized the concept within the segment of internal logistics. The success was achieved also in finding an operational analysis model that had been developed with a focus on examining the logistics activities and its peculiarities. The internal survey model presented by Bowersox (2010) proved to be effective in identifying problems in the management and operation of an organization already structured and operating for at least three years. But the best lesson of this study was that the analysis revealed the interdependence between the process factors in generating expected or no effect. Addressing the root causes of loss listed through the exercise of systems thinking considering the connections between factors with a specific function, such as reports Falconi (2009).

Keywords: Ishikawa; diagram; losses; logistics; analyses.

Category: Lean Services.

Presentation: Lecture.

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V Lean Day October 6th – 7th, 2016 Brazil

Process Improvement of central vascular catheters management applying Lean thinking S.R.P.E. Dantas 1, T. Martins 1, T. Giraldi 1, M.A. Boes 1, N.A.C. Almeida1, B.O. Oliveira1, L.M. Leichsenring1, M.J. Meszaros1, L.T.D. Monteiro1, P.M. Piovesana1, M.A. Lima1 , G. S. Spagnol2, A. Sarantopoulos2.

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Hospital of Clinics, University of Campinas, Brazil, 2School of Medical Sciences, University of Campinas, Brazil.

Introduction: Infusion therapy is widely used in health care to administer solutions through a central or peripheral vascular catheter. The central venous catheter (CVC) is an intravascular system used for drug administration, infusion of blood products, parenteral nutrition, hemodynamic monitoring and renal replacement therapy. Critically ill patients in Intensive Care Units (ICU) often need a central vascular access due to the high complexity of care. Adverse events such as bloodstream infection, thrombosis and pulmonary complications related to the catheter have a severe impact on morbidity and mortality of patients, the quality of care, costs and effectiveness of treatment. Risks vary according to the client's clinical conditions, duration and type of therapy, anatomical site of catheter insertion, type of coverage and ability of professionals involved in integration. The prevention and control of adverse effects related to the use of vascular catheters rely on the existence of institutional criteria to manage these devices, to document and evaluate its use through indicators, and to organize continuous professional education.

Materials and Methods: Report of application of Lean thinking as a management tool to improve the process of central venous catheters at an Intensive Care Unit.

Results: In March 2016, we gathered a team of two intensive care doctors, five nurses and nurse technicians, an infection control nurse, a nursing supervisor, a nursing professor and an advisor from the Department of Nursing in order to analyse and discuss possibilities of improvements related to the process of insertion and maintenance of the central vascular catheters at an intensive care unit with 20 beds, in a tertiary university hospital in the state of São Paulo. Lean thinking was applied together with two experts, in biweekly meetings held at the unit.

Discussion: We held four meetings of the interdisciplinary team using tools such as the SWOT. Through this tool, we raised important data to characterize the internal environment (strengths and weaknesses) and external (opportunities and threats) of the CVC use process in the ICU. Among our strengths, we identified the team's technical capacity; as weaknesses, the non-conformity in care; as opportunities, the possibility of a multidisciplinary training, and as threats, the resistance to change.

Also, the team performed a “walk to gemba” to identify problems related to CVC. This step was carried out during a specific audit of catheters to identify problems and it was structured as a bundle in a check-list format to evaluate the process in three distinct stages: before, during and after catheter insertion (until the treatment conclusion). Twelve bundles were distributed to five nurses and a nurse technician. Bundles will be applying to assist in mapping the value stream during our next steps.

Conclusion: The application of Lean thinking and tools was effective to motivate our team and to enable interdisciplinary discussion. This report comprises initial results of an ongoing process.

Keywords (DeCS): Catheters, Process Improvement, Quality of Health Care, Patient Care Team.

References: [1] Chopra V, Flanders SA, Saint S, Woller SC, O'Grady NP, Safdar N. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Ann Intern Med. 2015;163 (6_Supplement). [2] Pinto FC. Em Busca do Cuidado Perfeito: aplicando LEAN na Saúde. Lean Institute Brasil, 2014.

Category: Lean Healthcare.

Presentation: Poster.

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V Lean Day October 6th – 7th, 2016 Brazil

Mandalas of emotions: Lean yourself L. H. Ling1, G.S. Spagnol2 1

Espaço Médico e Cultural Pró Ativo, Curitiba, Brazil 2RN, MSc in Sciences, PhD candidate at School of Medical Sciences, University of Campinas, Brazil.

Introduction: the growing market demand also increases performances requirements for professionals. In this sense, it is essential to apply tools to manage time and efforts. The course "Intelligence flow to the integrative management" aims to fulfill this need, in order to integrate the basic theory of Deming’s PDCA with the Kaizen perspective, which sees both individuals and the company in an integrated perspective. This new practice, that has a reference in the traditional Chinese medicine (TCM), aims at aligning the capabilities inherent to the human being through simple practices. The method works with the capacity to decide, focus, persist, to be flexible and to trust [1]. This study aims to report the experience of applying this method in five cases.

Materials and Methods: The method consists of applying five stones according to a chosen emotion and the need of the volunteer during 4 to 5 months, followed by qualitative assessment with questions: Part I: "1) What is your work field and experience? ; 2) What is your goal ?; 3) How have you used the method? 4) Has the method helped you? 5) Have you reached 80% of your goal? Are you satisfied? 6) Do you have any complaints about the method? "and Part II (Yes / No answers):" 1) Have you easily identified in which stage you are?; 2) Did the method endorse your skills ?; 3) Have you reached your goal more easily?; 4) If you have not reached your goal, did the method facilitate identification of corrective actions?".

Results: from five volunteers, four were women (two psychologists, one nurse, one student) and one man (businessman). Four volunteers are professionals, and only one is preparing to enter the university. Their goals (I: Q1) included activities related to work or study: to enter the university, to obtain a research scholarship, to meet patients more efficiently and to finish a project in the construction business. Volunteers confirmed using the method on a daily basis or according to guidance. Among contributions for personal development, volunteers reported: "I feel safer"; "I can see my goal more clearly"; "I realized immediate change in my feelings," "The method helped me to identify and work on negative emotions that were interfering in achieving the goal." In the question I: Q6, volunteers reported that there is no deficiency in the method. One participant stressed the need to focus in only one goal. As for alternative questions (yes / no), all volunteers answered "yes", except those who had not reached the goal (Q3), and they answered "yes" on Question 4.

Discussion: method application contributed to recognize emotions in order to enhance personal ability to solve problems and cope with situations in work and study.

Conclusion: This new way of working, the PDCA cycle, offers a quick and easy way to understand emotions related to all stages of the process. In a short period, the person is empowered to timely activate the action required in order to achieve his/her goal.

Keywords: PDCA, improvement, training, Lean, Chinese Medicine.

References: [1] Ling H.L. Dialogando com as emoções e promovendo a saúde. Curitiba: Insight, 2013 Category: Lean Education.

Presentation: Lecture.

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V Lean Day October 6th â&#x20AC;&#x201C; 7th, 2016 Brazil

Improvement initiative in stroke care: our first steps G.S. Spagnol1, L. Valler2, W. M. Avelar3, Li Min Li4 1

RN MSc, PhD candidate at School of Medical Sciences, University of Campinas, SP, Brazil; 2MD MSc, Intensive Care Unit and Neurology Outpatient Clinic, Hospital of Clinics, University of Campinas, SP, Brazil; 3MD PhD, Leader of the Neurovascular Research Group, University of Campinas, SP, Brazil; 4MD, PhD, BBA Professor, School of Medical Sciences, UNICAMP.

Introduction: Public healthcare services, universities and research institutions in Brazil face a scenario of higher demands for quality and production and lack of resources and funding [1,2]. Lean thinking has been applied worldwide and proved to be efficient in responding to this urgent need, in a sense that it directs efforts into cost-effective solutions, by eliminating waste and focusing in what really matters for the patient [3,4].

Materials and Methods: This study reports the Lean thinking application in a Neurovascular Research Group in order to improve quality and production in patient care and research.

Results: In April 2015, we gathered a team of neurologists, researchers, two nurses, a physiotherapist and a secretary to start an improvement initiative in post-stroke care. Our first workshop comprised the application of SWOT analysis to investigate the current status of the Neurology Outpatient Clinic.

During this workshop, the team listed its greatest strengths, weaknesses, opportunities and threats, and chose one for each item as follows, respectively: high quality professionals and institution, lack of an administrative manager, opportunity to publish and, at last, lack of funding. In the following meetings, we developed an A3 to guide our actions.

Discussion: This analysis allowed the team to understand the need to focus in research projects that could promote a higher quality in patient care, by relying in its multidisciplinary expertise, and also to publish papers reporting results, which would support the application for further funding. After twelve months, we were able to design and start a new research project, which aims to establish a multidisciplinary consultation in post-stroke care.

Conclusion: In bimonthly 60-minutes meetings, endless problems and nightmares were transformed into a clear pathway for an effective group effort in service and research improvement. Besides our main goal, our meetings also promoted a greater capacity to develop rapid improvement events, such as to solve IT problems, to support analysis of a database, among others. Most important, the whole team is now willing to embrace changes and improvements, creating a network of mutual support and knowledge exchange towards a patient cantered care.

Keywords (DeCS): Process Improvement, Quality of Health Care, Patient Care Team, Stroke.

References: [1] Li LM, Johnson S. Lean thinking turns 'time is brain' into reality. Arq Neuropsiquiatr.

2015;73(6):526-30. doi:10.1590/0004-282X20150047. [2] Li LM, Johnson S. Stroke care within the golden hour. JAMA Neurol. 2015;72(4):475. doi:10.1001/jamaneurol.2014.4568. [3] Souza LB. Trends and approaches in lean healthcare. Leadership in Health Services 2009;22(2):121-39. doi:10.1108/17511870910953788. [4] Pinto FC. Em Busca do Cuidado Perfeito: aplicando LEAN na SaĂşde. Lean Institute Brasil, 2014.

Category: Lean Healthcare.

Presentation: Lecture.

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V Lean Day October 6th – 7th, 2016 Brazil

Implementation of a Continuous Flow in a Post-machining Process L. R. P. Claudino1, P. de Senna Junior², I. Tammela1, R. D. Calado1 1

Departament of Engineering, Science and Technology Institute, UFF; ² Departament of Production, Vallourec Afiliation

Introduction: This work is aimed at the implementation of a continuous flow process using concepts of the Lean Thinking, as applied to operational performance improvement in the steel industry.

According to Womack (2010), the following principles should be implemented when applying Lean Manufacturing tools: value identification, value stream mapping, and the creation of a continuous flow. Rother et al. (1999) define continuous flow to as producing a piece at time, with each item passing immediately from a process step to the next without waste creation between them. This approach provides several benefits such as reduced lead-time, quality improvement, and lower costs.

Materials and Methods: The method applied in this project consists of seven steps based on Rother et al.'s (2002) proposed tools and assumptions for continuous flow implementation: a) Analysis of actual situation; b) Identification of processes and product families with potential for continuous flow implementation; c) Identification of value flow; d) Definition of the working elements needed for the process chosen and the optimal time of each element, with waste elimination; e) Creation of Operator Balance Chart; f) Development of Standardized Work; and g) Routine Audits creation, in order to promote continuous process improvement.

Results: We found that before the implementation of the continuous flow there were some losses at the process level, such as excessive movement, inventory between processes, idles, and waiting caused by the lack of necessary tools and rework. Thus, after the implementation of the continuous flow, the productivity increased by 67% and the internal rework decreased by 100%. Through this project, the production area reduced by one work shift, with annual cost savings around R$1,152,200.00.

Discussion: The results found are due to implementation of the Lean Manufacturing principles and tools, specifically continuous flow. The post-machining process inefficiencies were identified by a root cause analysis, then the improvements were applied by tools such as process diagram, line balancing, 5S, visual management, standardized work and operator activities synchronization.

Together these form the basis of continuous flow implementation for this case.

Conclusion: The present work confirmed that the implementation of continuous flow through the concepts of the Lean Thinking in a process of post-machining improved operational performance, increased productivity by 67% and eliminated rework. Next steps include executing the audit routine in order to sustain and improve continually the work completed.

Keywords: Lean Manufacturing, continuous flow, post-machining process, line balancing References: [1] Womack, J. P. Gemba Walks. Cambridge, MA USA: Lean Enterprise Institute, 2010.

[2] Rother, M. et al. Aprendendo a Enxergar: mapeando o fluxo de valor para agregar valor e eliminar o desperdício. São Paulo: Lean Institute Brasil, 1999; [3] Rother, M. et al. Criando o Fluxo Contínuo: um guia de ação para gerentes, engenheiros e associados da produção. São Paulo: Lean Institute Brasil, 2002.

Category: Lean Manufacturing.

Presentation: Lecture.

Computer system to reduce the Lead Time of the Enterprise Diagnostic Method 15

V Lean Day October 6th – 7th, 2016 Brazil

S. C. Hermenegildo1, R. D. Calado1, I. Tammela1, E. R. Soares2 Institute of Science and Technology, ICT, UFF, 2Paulista State University, UNESP

Introduction: This work intends to propose a computer system in order to reduce the lead time of the Enterprise Diagnostic Method (EDM). This method diagnoses the maturity level of companies, and the system analyzes if the evaluated companies are considered World Class Organizations (WCO), identifying its management strengths and weaknesses, to provide input for improvement opportunities in their companies. This study value lies in the ability of increasing the confidence and security of the data collected, the accuracy of mathematical calculations of Gray System, as well as obtain instant results, reducing significantly the time between the data collection and it´s results.

Materials and Methods: The computer system was created using a free programming language (PHP), and a free Data Base Management System(MySQL). The methodology applied consisted in the observance of aspects like: analysis of the time taken to input the information, the probability of error, the process flexibility and the accuracy of the results. To this purpose, the analysis starts from the stage of obtaining the answers of the questionnaire paper, transcription of several records to Excel spreadsheets and the form of the results representation. The Questionnaire Benchmarking Industrial was achieved from the Institute Euvaldo Lodi of Santa Catarina (IEL / SC). The Questionnaire was applied with the EDM, imputing the answers directly into the system by the person that was answering it. Hereafter, the system performed a quantitative analysis regarding the degree of companies’ maturity, applying the Grey Correlation Analysis System, and gives the results.

Results: Based on the observed aspects, it was developed a computer system that reduced the lead time for obtaining the processes to be improved and the company´s position in WCO. This system has the possibility of decentralized data entry, security information, possibility of review of the items already answered, and after completed the entry of all questionnaires, the system instantly informs the results. Thus, we expect to reduce, at least, 30% of total Lead time, besides of all the benefits above.

Discussion: Considering this research limitations and implications, its results are classified as exploratory. Future research can focus and study the correlation between a greater number of companies. Broad-based and larger sample size would provide a better picture for each organizations maturity state.

Conclusion: The study resulted in a new, fast and reliable way to measure a company´s maturity level with the identification of a systematic way to guide new projects and initiatives, to support and develop strategic planning and to identify how organizations are establishing world class standards.

Keywords: Lean, World Class Benchmarking, Gray System, Lead Time.

Category: Process Improvement & Innovation.

Presentation: Lecture.

Evaluation of the physical aspects of the work environment through a study in an engineering office 16

V Lean Day October 6th – 7th, 2016 Brazil

P. I. S. Peres1, R. A. Caldeira2, R. D. Calado3 1

Engenheira Metalúrgica, Mestranda UFF, 2Engenheira de Produção, Mestranda UFF, 3Pós Doc, Professor UFF

Introduction: In engineering offices, where concentration and attention are needed all the time, the open concept called “landscape” layout (in which the division of space is delimitated by low partitions) may not be the most appropriate solution to be adopted to define the environment arrangement. This article presents a study about an office, in which integrated engineering activities are executed, showing the advantages and disadvantages of using this kind of layout concerning the performance and the physical comfort of employees. Concerning the physical aspect, it is possible to adjust the office´s environment by applying the concepts of some regulatory standards guidelines, like ABNT (Associação Brasileira de Normas Técnicas - Brazilian Association for Technical Standards) and like the NR (Normas Regulamentadoras – Compliance Standards). The NR´s guidelines must be carefully analyzed because they are a Technical Standard supported by the Brazilian Law. The NR-17 is focused in ergonomics aspects, so it specifies important conditions that must be followed to guarantee the comfort in offices, laboratories, control rooms and other places where people have to work [1]. Companies should provide a safe and comfortable place where employees develop their work – a task which is done by the methods analyst of these companies [2].

A work environment well created or developed enables a healthy work environment which could help improve performance and consequently increase their productivity. Doing so, a reduction in the absenteeism costs, late arrivals and in the staff turnover costs can be observed. The morale as well as the relationships among the employees also become better.

Materials and Methods: A questionnaire with specific questions related to thermal, acoustic and lighting comfort was used as a tool to evaluate the employee´s satisfaction about their work environment. The questionnaire was created based on technical specifications from Ergonomics Compliance Standards and also Ergonomics Brazilian Technical Standards. In addition, a relationship map was designed in order to propose a more suitable layout for this team [3].

Results: The result of this study showed that the employees were not satisfied concerning the noise aspect. The noise, caused mainly by conversations between colleagues and the bells phones, provides the loss of concentration and the performance fall. It has been found that the acoustic treatment was not prioritized in this workplace.

Discussion: One solution suggested by this study was a new proposal for the layout concerning the relevant points to guarantee a better workflow among the activities and also to provide their interaction. Besides, the study also presented a proposal to minimize the acoustic problems in this office. The acoustic´s office landscape layout can be technically improved by three main factors: a) the room absorption, which can reduce reverberation and recent reflections; b) the barriers that can control the direct sound; and c) the artificial masking sound, which provides a uniform acoustic environment in offices that adopts landscape layout [2]. In order to have a better noise absorption, it must be used absorbent material on the walls and on the ceiling. With a simple acoustic design, you can reduce the sound pressure level. By using acoustic material on the ceiling and part of the walls, a reduction of approximately 5 dB can be achieved.

Conclusion: This article aims to evaluate the physical aspects in the work environment studied and to present a proposal to improve it. Besides, it is worth to emphasize the need for an awareness, especially of the managers, to reduce the unnecessary conversations in the work environment, turning it a new habit of the group.

Keywords: Work environment, noise, temperature, lighting, layout.

References: [1] NR17. 59. ed. São Paulo: Atlas, 2006.; [2] Niebel, B. & Freivalds, A. 12. ed. Mexico: Mcgrawhill, 2009.; [3] Kliemann, A.H. et al. Guia de referência para layout em escritório envolvendo aspectos ergonômicos. In: ENEGEP, XVIII, 1998, Niterói. Encontro Nacional de Engenharia de Produção.

Category: Lean Manufacturing. / Presentation: Lecture.

Process Improvement in a Cancer Outpatient Chemotherapy Unit using Lean Healthcare 17

V Lean Day October 6th – 7th, 2016 Brazil

C.F. Pinto1, S. M. A. Coelho2, M.B. Silva3 1

FEG-UNESP, 2 FEG-UNESP, 3 EELUSP

Introduction: The concept called of “lean thinking” is most commonly associated with Japanese manufacturing, particularly the Toyota Production System (TPS). Much of the TPS way of thinking is based on the work of quality Edwards Deming, who taught, among other things, that managers should stop depending on mass inspection to achieve quality and, instead, focus on improving the production process and building quality into the product in the first place. (Institute for Healthcare Improvement Cambridge, Massachusetts© 2005 Institute for Healthcare Improvement).

Materials and Methods: We developed a multi professional team involving the stakeholders (chemotherapy nurses, triage nurse, doctor, pharmacist, lean team, director). We used the value stream mapping (VSM) to design our current state and develop our future state and action plans.

The short-duration chemotherapy (green circle) and the breast chemotherapy (red circle) was scheduled as the patient’s availability or without a standard. The chemotherapy long-duration agenda was overloaded not only by the number, but by the complexity of the protocols.

Figure 1: Chemotherapy schedule representation before the improvements.

The unit used the FIFO (First In-First Out) system for all of its queues and delivering poor services due long waiting time: Using the queue theory was settled bundles; The two larger volumes are colon/ rectum and breast cancer. We distributed then as follows: Patients of colon and rectum cancer from Mondays to Wednesdays; Patients with breast cancer from Thursdays to Fridays; The rest of the cancers would be distributed according to the complexity: low complexity from Mondays to Wednesdays and high complexity from Thursdays to Fridays.

Figure 1: Chemotherapy schedule representation after the improvements.

Results: With the first generation map, after distributing the patients in bundles, the variation of the agenda was decreased in 60%. With the second generation of the map we were able to reduce 92% of waiting time for patient to get inside chemotherapy room and start treatment Discussion: We developed a multi professional team involving the stakeholders (chemotherapy nurses, triage nurse, doctor, pharmacist, lean team, director). We used the value stream mapping (VSM) to design our current state and develop our future state and action plans.

Conclusion: This study showed the unit was able to leveling the agenda in 60% and reduce 92% of waiting time per day using value stream mapping; queue management; and gathering information to improve and connect major flows in the process: the patient, the information and involved personnel.

Keywords: Lean Value Stream Mapping, Queue Theory.

References: [1] Shook J and Rother M, (1999) “Learning to See”, Lean Enterprise Institute, Boston.

Category: Lean Healthcare / Presentation: Lecture.

Lean Thinking to Improving Access to Cancer Patients in a Public General Hospital 18

V Lean Day October 6th – 7th, 2016 Brazil

S. M. A. Coelho1, C. F. Pinto2, M. B. Silva3 1

FEG-UNESP, 2 FEG-UNESP, 3 EEL-USP

Introduction: Lean thinking in healthcare proposes creation of value and better quality services for the patient and the society. The elimination of non-value added activities along with all other wastes, helps to establish a flow value for the patient, increasing the efficiency of operations, while simultaneously improving the quality of care.

Materials and Methods: We used the value stream mapping (VSM) to design our current state (Shook, J. Rother, M. Aprendendo a Enxergar, 2ª edição, LIB, São Paulo, 2010), to identify the current state, perform the analysis of the problem and propose a future state ideal with a plan to implement and sustain these improvements (a complete PDSA cycle).

Figure 1: Current state: time line for breast cancer treatment access

The future state aim was to develop a “FAST TRACK” for newly diagnosed or “highly suspected” breast cancer patients. The track was designed to accomplish 4-7 weeks activities in one single day by coordinating care and patient and processes flow.

Figure 2: Future State: “FAST TRACK” for breast cancer patients

Results: A significant reduction in the waiting time for treatment not only ensures faster treatment but also dramatically reduced the number of hospital visits, eliminating between 5-7 visits (for starting the process) to begin chemotherapy. This performance not only improves the quality of service but also reduces the physical and emotional distress of patients, and eliminates waste in the value chain as dozens of hours of waiting, unnecessary travel, excessive movement within the hospital and disconnection of the information in care processes.

Discussion: Patients who were diagnosed with cancer treated in public service suffer significant delays at various stages of their diagnoses and cancer treatment. Reduce access to initial treatment seems to be the most effective strategy, but it is imperative that the system has means and organization to act on the abnormalities found in the flow.

Conclusion: The use of the lean tools are able to improve the healthcare flow without adding cost to the process. The project was able to significantly reduce waste in the processes (handling, overprocessing, defects, waiting, transport) without increasing the workload for the stakeholders.

Keywords: Lean Manufecturing, Production Control, Queues.

References: [1] Shook J and Rother M, (1999) “Learning to See”, Lean Enterprise Institute, Boston.

Category: Lean Healthcare.

Presentation: Lecture.

Application of information time and motion study to improve supply chain process of an oil and gas services company N. Gastardelli1, B. Gastardelli1, R. Calado1 19

V Lean Day October 6th – 7th, 2016 Brazil 1

Process management Group, ITC, UFF

Introduction: This work consisted on a study regarding the information about time and motion in association with process modeling techniques to improve the overall process flow of an oil and gas services company, focused on the international logistics department. With the oil and gas crisis, the need of improvement and operational excellence overlaps the once suitable results based on high profit margins that no longer exist.

Materials and Methods: The export form analysis process was assessed and modeled based on flowcharts presented by Barnes (1977) [1]. It was possible to verify information flowing through lots of non-added value steps and manual labor. Microsoft SharePoint was used to optimize process automation, without any extra costs to the company. The Westinghouse method was used to analyze time and motion patterns of the process, making possible to create a standard time for the process and adjust resources to demand.

Results: We found, during processes modeling, that the export form analysis, the first step in an asset export, had many steps without added value. The analysis flow was remodeled and reduced from 12 steps to 4 steps, with a lean format. The study of information flow regarding time and motion during the process allowed to standardize the process flow and reduce non-added value steps. The average time of export form analysis was reduced by 56%.

Discussion: Results showed the low level of process management in the asset export department of the company. The work was not measured nor standardized, making impossible to create a good balance between resources and export demand. There is still a big room for improvement, since the only process studied was export form analysis.

Conclusion: This work confirmed that designing and implementing a lean process can bring operational excellence to daily operations. Measuring and standardizing work increases capacity to adjust the process to a variable demand, assuring the best lead time and outcomes. The current oil and gas situation is stimulating companies to become more competitive and assuring its survival during turbulent periods.

Keywords: Methods engineering, time and motion study, process improvement, international logistics References: [1] Barnes, R.M. Estudo de Movimentos e de Tempos, Projeto e Medida de Trabalho.

Tradução da 6ª edição Americana, Editora Edgard Blücher Ltda, 1977. [2] Dantas, A.. Organização, Sistemas e Métodos. Notas de aula. Faculdades Integradas Einstein de Limeira. Limeira/SP, 2007.

[3] ROCHA, Duilio. Fundamentos Técnicos da Produção. São Paulo: Makron, 1996. [4] Slack, N. Administração da Produção. São Paulo: Atlas, 1997. [5] Taylor, F.W. Princípios de Administração Cientifica. São Paulo: Atlas, 7ª edição, 1970.

Category: Lean Services.

Presentation: Poster.

New container for manual radiographic processing: an alternative to save chemical solutions and environment preservation 20

V Lean Day October 6th â&#x20AC;&#x201C; 7th, 2016 Brazil

N. L. M. Eid1, L. M. Li2 1

Oral Diagnosis Dept., Faculdade de Odontologia, UNIRG e ITPAC-Porto, 2Neurology Dept., FCM, UNICAMP

Introduction: Technological advances have allowed the utilization of digital systems for acquisition of radiographic images. Nevertheless, conventional radiographic films are still the most used in dental offices in Brazil. Radiographic films are processed in chemical solutions to change the latent stored images into visible images for diagnostic purposes. Both the developer and fixer contain toxic chemical substances that may endanger the health of professionals, public health, and risks to the environment by contamination of the fauna and flora if these chemical solutions are improperly discarded after their utilization. Therefore, this study aimed to evaluate the efficacy of a new container using different reduced amount of chemicals for manual radiographic processing in portable darkrooms for utilization in dental offices.

Materials and Methods: Radiographic images were obtained from the posterior teeth of a phantom dry human mandible and processed in four portable darkrooms. One darkroom had two conventional containers (R1) filled with 200ml of processing solutions. Each of the other darkrooms had one pair of the three types of containers designed by the authors, patented under the registration MU89036491 and licensed to the Angelus Company, namely R2, R3 and R4, filled with 12, 19.2 and 24ml of developing and fixer solutions. The films were digitized and followed subjective analysis by five radiologists as well as objective assessment using the software MaZda for imaging texture analysis.

Results: The subjective analysis revealed good agreement between the five examiners concerning the images considered acceptable for diagnosis for all four containers investigated. The objective analysis demonstrated that the images were considered satisfactory for diagnosis until the 15th day of investigation for R1, fourth day for R2 and R3, and fifth day for R4. A total of 184 films were processed in R1, 40 in R2, 48 in R3 and 56 in R4.

Discussion: Dental offices often discard chemical solutions every week, thus the new models would represent a waste reduction of chemical use up to 86%. This represents a direct annual cost saving from utilizing 8L (200mlx40weeks) to 1L (24mlx40weeks) for a single dental clinic. Moreover, indirect costs involved to properly dispose radiographic processing chemical are also diminished with overall reduction in the environmental impact.

Conclusion: The new container model is as effective as the conventional one, maintaining the quality standards radiographic image (density and contrast) of a satisfactory number of radiographs as a routine in dental clinics. The new model brings significant cost savings, and potentially less environmental issues.

Keywords: Medical waste disposal, Environment and public health, Environmental impact.

References: [1] Chartier Y et al., Safe management of wastes from health-care activities. 2nd ed.

Geneva, 2014. 308p.

Category: Lean Manufacturing.

Presentation: Poster.

PERT / CPM network application as an aid in planning technique: a case study on maintenance of gas turbines of a gas processing unit 21

V Lean Day October 6th – 7th, 2016 Brazil

H.S. Guimarães1, Z.R. Mazzoco2, R.D. Calado3 1

Master's degree in production engineering, MESC, UFF, 2Master's degree in production engineering, MESC, UFF, 3 PhD

Introduction: This work presents a simple preventive maintenance of 4,000 hours in gas turbines in a processing unit and gas handling, to analyze the process individual tasks surveys were conducted with their respective durations and applied the CPM / PERT method to find the critical path.

Materials and Methods: The methodology of this study was applied the deductive method and is justified because it is based on general laws for the understanding of specific issues to the location to be searched. The realization of procedure of the research was by direct observation and based on the history of maintenance activities. [1]The maintenance process can be considered a group of technical activities that must be performed to continue the machinery working.

Results: The analysis results indicated that the activities A, B, D, E, F, H, I, J, and K, shown above, are the critical path and therefore deserve more attention in the planning and execution. It was identified that the total expected time for the execution of the turbine maintenance due to existing clearances between certain activities is 7 days (168 hours). It was also possible to identify the activities that consume more runtime and higher variance, are the activities of "maintenance of instruments" (D) and "mechanical maintenance" (F). Besides being activities that are on the critical path identified in the PERT / CPM network, which further reinforces the importance of careful attention in these activities. [2] The relationship between the projects activities, create an organization that we call to net diagram, or only PERT. Discussion: The results of this survey also made it possible, highlight the importance of using the PERT planning method / CPM for maintenance activities. However, it is suggested that this technical be applied to other processes in several segments and sizes companies Conclusion: In the case studied, the technique PERT / CPM proved efficient planning of maintenance activities, allowed to know the interdependence between the activities and the existing gaps, showing how long each task may have to delay. It was also possible to identify the activities with zero slack, this is, activities that are part of the critical path maintenance and cannot have delays in their implementation, that is, you can identify which activities should be under special care that there is no delay at the end of maintenance time.

Keywords: Standard, Operations, Maintenance, CPM/PERT References: [1] Moro N. Introdução a gestão da manutenção. Florianópolis, 2007.; [2] Vargas, R.V. Gerenciamento de Projetos Estabelecendo Diferenciais Competitivos. 6. ed. Rio de Janeiro: Brasport, 2005.

Category: Process Improvement & Innovation.

Presentation: Poster.

Lean Office: information flow improvement in a Public University J. P. B. Glória1; H. M. Cosme1; R. D. Calado1 1

Instituto de Ciência e Tecnologia, Universidade Federal Fluminense

22

V Lean Day October 6th â&#x20AC;&#x201C; 7th, 2016 Brazil

Introduction: This work consist on grow up productivity and finish waste in administrative proceedings of the Federal University of Rio de Janeiro. To achieve these objectives will be used thoughts and instruments that are based on the Toyota Production System, which in administrative environments is known as Lean Office. The phases of implementation are described the technique used and the results achieved in the selection of fellows monitors organized by monitoring and internships sector. With the application of philosophy and resulting tools of lean production it was possible to achieve the expected goals, attesting the efficiency of resource use and demonstrate the potential for improvement there is in the administrative processes of the institutions.

Materials and Methods: The VSM technique was applied at a university department to eliminate non-value-adding waste in the selection process.

The current state VSM was created according to the standard of value stream mapping using of the current department. The future VSM was created after the discovery of the processes that generate waste for the sector.

Results: We found that the objective was achieved mainly using mapping the value stream, to solve the practical problem of time-wasting in the sector. The prioritization of lead time reduction has a great impact, given that it was reduced by approximately 65% and reduced processing time by approximately 10%. The reduced lead time of 5 days, 21 hours and 5 minutes to 21 hours and 5 minutes. Since the processing time reduced from 21 hours and 10 minutes to 19 hours and 10 minutes.

Thus we see that a process that adds much value to the flow, contained much waste of time, after the analysis and automation of the process through the implementation of a system that manages the entire registration process.

Discussion: One important factor in gaining control over an organization is to know and profoundly understand its basic processes. Especially the Toyota Production System is frequently applied in optimizing workflow in administrative process institutions. This includes VSM techniques to finish the waste in sector. The elimination of waste is the main goal of VSM. Waste is often not apparent.

The term activity is often confused with value-added work. It is important to distinguish value-adding and non-value-adding wastes from useful efforts. There are many activities, which create confusion or debate about their value-adding status: among others for example inspection, transportation, and administrative and support activities Conclusion: The results obtained by monitoring industry and stages of university exceeds expectations and clearly demonstrates the rationalization that is obtained in the process analyzed.

After all the study on Lean Manufacturing, Lean Office and the value stream mapping, then one can see that there was a big waste of time in a step that no aggregated value for the flow of information.

Keywords: Toyota Production System, Lean Office, Value Stream Mapping.

Category: Lean Services.

Presentation: Lecture.

Proposal to implement the Lean healthcare approach on health environments P. A. C. Oliveira1 23

V Lean Day October 6th – 7th, 2016 Brazil 1

Industrial Engineering Dept., Universidade São Francisco

Introduction: The increase on the demand on global markets has forced the search for different alternatives to streamline the growth of efficiency levels on the organizations. With that in place, the need to have operations – whether on manufacturing or on the third sector – more profitable and retain its clients brought up to the creation Toyota Production System in Japan on the middle 1940’s. Since then it has been improved in different types of industry and, on the last decades, has reached also the services area – coming to the health environmental on the 2000’s. As it is relatively new on the academy, the lean healthcare may pass the impression of being wispily diffused and have no application standards, yet it is possible to notice that its results have shown themselves as grateful as the ones seen in other areas, as the reduce on treatment time to the patient, lower inventory costs and the increase on the profits.

Materials and Methods: The present work considered a quantitative approach based on exploratory research from a bibliography and documents review, which include case studies to create an overview about the lean healthcare approach that needs to be tested on future works.

Results: The research shows that 25% of the works mention improvement trigger tools, like Value Stream Mapping and/or pull systems, and 26% use standardization tools as 5S and Standard Operational Procedures. This leads to unsustainable lean culture as the focus is on the short term and quick wins via basic results, although not affecting in many times the companies’ financial results or the customer satisfaction.

Discussion: It is possible to imply the results on the bibliography focus on losses and wastes elimination and implementation of improvements, which were not sustained for most of them focus on operational initiatives instead of engaging the strategic level and them deploying to the lower levels. The solution proposed requires nine steps based on hoshin kanri: diagnose the company; define what is value; map the stream value; plan hoshin’s long term view; align hoshin’s long term objectives; stablish medium and short term objectives and goals; plan hoshin’s implementation; engage the stakeholders; map current and define future states.

Conclusion: As a contribution, this work aims to identify what are the good practices on the application of lean healthcare and the main tools used – as the top management support and the application of a hoshin kanri model. Combined, they can assure the sustainability of the system independently of the size of the health organizations and of your(s) focus area(s) evolving the top management on the lean approach and structure it in a certain way it is continuously accompany and revised.

Keywords: Lean Healthcare, Lean Implementation, Hoshin Kanri.

Category: Lean Healthcare.

Presentation: Lecture.

Proposal for an instrument of measurement and evaluation of Lean Program in a chemical company: according approach of BDM, basis Lesat & Baldrige 24

V Lean Day October 6th â&#x20AC;&#x201C; 7th, 2016 Brazil

E. R. Soares Jr.1, R. D. Calado2, M. B. Silva3 1,3

Production Dept, Paulista State University, UNESP, 2Engineering Dept., Fluminense Federal University, UFF

Introduction: This research aims to develop a questionnaire and to apply it order to diagnose the level of maturity of the several production plants of a chemical industry. In addition, evaluate if they can be consider World Class, in order to identify the strengths and weaknesses of the management of each of the analyzed factories and to identify opportunities for improvement in its Management System.

Materials and Methods: The study method was the combined questionnaire Lean Advancement Initiative (LAI) Enterprise Self-assessment Tool (LESAT) of Massachusetts Institute of Technology (MIT) and Baldrige Performance Excellence Program of the National Institute of Standards and Technology (NIST) of the United States Department of Commerce, using the Business Diagnostic Method (BDM) [1]. Concerning the method used, research limitations and implications, results of investigation and research are exploratory [2]. This study done through a survey combined initially qualitative and then quantitative analysis, concerning the degree of maturity of the companies analyzed, using Grey Correlation analysis method. This Grey analysis was used in order to maintain recommended statistics technique by BDM method. Future research can be carried out and correlation studies among a larger number of other branches manufacturing companies can be performed. A larger study with a diversity of organizations will provide a better understanding of the maturity level of organizations.

Results: The value of this study is the ability to diagnose the organization's maturity level. There are six levels of maturity: punching bag, counterweights, vulnerable, promising, challenging, and world class. It evaluates if the application of BDM, Lesat, Baldrige and Grey System tools between the different factories inside a chemical company surveyed have been able to identify the strengths and weaknesses of this organization. The study resulted in the identification of a systemic way to guide the need for new projects and initiatives to support and develop the strategic planning. It was identified how these factories are world class.

Discussion: After performing the Lesat & Baldrige survey, four production plants were considered challenging and one production plant was considered world class. The strengths and weaknesses were defined. Based on the research results, a Hoshin Kanri [3] concept application could be introduced inside the chemical company researched to contribute in the company strategic planning.

Conclusion: Considering these research limitations and implications the results are classify as exploratory. Future research can be done considering the application of a new electronic survey to research the operation level (botton up) in order to compare the results were gotten from Lesat & Baldrige (top down). Additionally, it can be create a computer system or an IT tool for the Lesat & Baldrige application.

References: [1] Calado, R. D.; [et al.]. Business Diagnostic Method (BDM). USA. 1st. Edition.

Global South Press. 2014. p.121; [2] Miguel, P. A. C., et. al. Research Methodology in Production Engineering and Operations Management. 2nd. Edition. Elsevier. SĂŁo Paulo. 2012; [3] Cudney, E. A. Using Hoshin Kanri to Improve the Value Stream. New York: Productivity, 2009.

Category: Lean Manufacturing.

Presentation: Lecture.

A study of an Implementation of Lean System using Kaizen/Kaikaku or Kaizen Project on Large and Small manufacturing companies 25

V Lean Day October 6th – 7th, 2016 Brazil

M. A. do Nascimento1, R. D. Calado2, M. B. Silva3 1

School of Engineering, Guaratinguetá (FEG/UNESP), 2School of Engineering of Federal Fluminense University, 3 School of Engineering of Lorena (EEL-USP)

Introduction: The objective of the research was to evaluate the implementation of Lean system in two companies, using the Kaizen / Kaikaku method, a large metallurgical with more than 1,000 employees, multinational and other small metal with less than 200 employees National belonging to two owners.

Materials and Methods: The research method used is the study of comparative multiple case between two companies in the same industry. A questionnaire with two approaches, strategic and operational, related to the implementation of Lean System was developed in these two companies.

On this questionnaire were included seven questions concerning the strategic questions and thirteen operating on the application of Lean concepts.

Results: In both companies there has been a major breakthrough, both on strategic issues such as the operational and the speedy of implementation was faster due to the use of Kaikaku methodology.

Discussion: The survey was conducted in two industrial companies, and a large one, with over 1000 employees, multinational in the area of animal protein production with several plants in Brazil and in other countries. The other company, small, national, belonging to two owners with fewer than 200 employees, manufacturing of hospital equipment.

Conclusion: The results of this paper show very clearly the differences that occur when a company has a strategic direction at the corporate level and clearly shows the firmness of purpose, organization and change in organizational performance by comparing one with the small business in the Implementation of Lean system.

Keywords: Kaizen, Kaikaku, Kaizen Project, Lean System, Quality, Productivity.

References: BARRAZA, M.; SMITH, T.; PARK, S. M. Lean-Kaizen public services: an empirical approach in Spanish local governments, The TQM Journal, p. 143-167, 2009, Vol.21. BARRAZA, M.; PUJOL, J. Implementation of Lean-Kaizen in the human resource service process, Emerald – Journal of Manufacturing Technology Management, p. 388-410, 2010, Volume 21. MURATA, K.; KATAYAMA, H. Development of Kaizen case-base for effective technology transfer – a case of visual management technology, International Journal of Production Research – Taylor & Francis, p 4901-4917, 2010, Volume 48.

Category: Lean Manufacturing.

Presentation: Lecture.

Health workers profile of a municipal hospital after work accident 26

V Lean Day October 6th – 7th, 2016 Brazil

S.A. Chaves1,Y. C. Ribeiro1, T.Q. Louro1, R. L. D. da Silva1, M. R. Silva1, P.A. Mussumeci1 1

Nursing Department, PURO, UFF

Introduction: The Health, Work and Environment Program consists of a group of actions to the quality of life of workers in the work environment. Biosecurity corresponds to the adoption of policies, actions, safe and necessary procedures to maintain the health of patients and health professionals, having as primary factor knowledge about safety , its implications and applications, whether in hospitals or health centers. The rules and awarded guidelines have a key role and need to be present daily in the life of the professional nurse, since one performs uninterrupted actions during 24 hours, thus requiring education that fortifies and ensures effective adherence to the standards of higher risk exposures. The overall goal of this extension project was to identify the numbers of work accident occurrences with cutting perforating material.

Materials and Methods: It was developed through a survey of CATs provided by the STD/SIDA service of SMSRO from July 2014 to July 2015.

Results: It was identified 24 records of accidents with cutting perforating material. It is considered of paramount importance to understand the continuing education and permanent education as a nurse tool in adherence of biosafety resources, because through proper adhesion of preventive measures, it can ensure a better worker´s and multidisciplinary team quality of life.

Discussion: Designing biosecurity as an educative action means consider and respect knowledge of workers, proposing solutions from empirical knowledge of agents about risks in their work environment, which constitutes one assumptions of the idea of a worker's health, instead of related, belonging to the worker himself.

Conclusion: The nurse has a key role in encouraging workers to adopt preventive measures and monitoring use of PPEs and CPEs in the routine of workers.

Keywords: biosecurity, worker, accidents.

References: [1] Almeida, A.B.S .; Alburqueque, M.B.M. Biosecurity: a historical approach through oral history.

Hist. Cienc. Manguinhos health. 2000. In PORTO, A.R; et al. Biosecurity in nursing: aimed at promoting healthy work environment. 3rd SITEN - International Seminar on the nursing work in 2011.; [2] Trapé, A.Z. Toxicological effects and Intoxication registration for Pesticides. sd. Available in: http://www.feagri.unicamp.br/tomates/pdfs/eftoxic.pdf.

Category: Lean Healthcare.

Presentation: Lecture.

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V Lean Day October 6th – 7th, 2016 Brazil

Development of a successful model to sustain quality after a health surveillance project M.R.C. Colombrini1; C.S. Tozzi1; R.F.R. Silva1; S.M.Q. Costa1; R. Higa1; C.R.G. Machado1; M.R. Guimaraes1; M.D.S.B. Rodrigues1; P.M. Silva1; A.S. Iaderozza1; V.S. Ito2; G.S. Spagnol3.

1

Hospital of Clinics, University of Campinas. email: hospdia@hc.unicamp.br, 2Secretaria Municipal de Saúde de Campinas, 3Faculdade de Ciências Médicas da UNICAMP e Grupo de Inovação e Gestão na Saúde (GIGS-CNPq).

Introduction: the Health Surveillance Project (VISA Project) began in May, 2006, developed by nurses from the Day Hospital (DH) at the Hospital of Clinics (HC), University of Campinas (Unicamp) after a series of inspections performed by the Health Surveillance Agency (VISA-Norte) at the Hospital of Clinics. These inspections pointed nonconformities in order to promote improvements towards a higher service quality. From that time to the present day, our team has improved work processes related to hygiene, infrastructure and care processes. Thus, we seek to sustain quality in health care, incorporating new technologies, learning and technical enhancements.

For this reason, we developed a specific worksheet based on the criteria of VISA for the Day Hospital.

Materials and Methods: nurses, nurse technicians and administrative staff, together with the advisor of the Department of Nursing / HC (DENF) conducted this study in the Day Hospital (HC/UNICAMP), a unit aimed to allow deinstitutionalization of patients. The worksheet was implemented in the DH in December, 2011. Between 2011 and 2016, we conducted 13 surveys.

Results were registered and analysed in Excel®. Events of non-compliance were categorized into themes: "Nursing / Processes", "Structure" and "Cleaning".

Results: formal requests were sent to the Division of Engineering in order to perform and monitor corrections in the infrastructure. There was in-service training and follow-up for cleaning teams, nursing and administrative staff. Runtime: 3-4 hours / quarter / survey. The first survey in 2011 had 821 items and the last (in 2016), 1479. The median percentages of approval were: 88.2% for "Nursing / Process", 91.6% for "Structure" and 79.7% to "Cleaning", with a total average of 82.2%.

Discussion: The literature proposes to conceptualize as "great" when approval is between 90-100% of the items; "Good" between 70-89%; "Regular" between 50-69% and "Bad" when less than 49% [2]. We applied the management tool Plan-Do-Study-Act progressively, continuous and in spiral [3].

Conclusion: data shows that the inspection process has guaranteed a continuous improment of the area and processes, keeping them within the concept of "good" and "great". Respect between professionals was essential, and DENF was a facilitator for the development of indicators. The Division of General Services / HC (responsible for outsourced cleaning contract) and the Division of Engineering / HC have been partners in the correct execution of cleaning and preservation of public property.

Keywords: service quality, health surveillance, improvement, team, health services.

References: [1] ANVISA (Brasil). A Vigilância Sanitária no Sistema Único de Saúde. 2008; [2] Setz VG; D´Innocenzo M. Acta Paul Enferm. 2009; 22(3):313-7 [3] NHS Institute for Innovation and Improvement. Quality and Service Improvement Tools, Plan, Do, Study, Act. Category: Process Improvement & Innovation.

Presentation: Poster.

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V Lean Day October 6th â&#x20AC;&#x201C; 7th, 2016 Brazil

Big data analysis: a multidisciplinary strategy for health services and cost effective improvements Bastos A. C.1,2, M. Wadt1, M. T. Marmol1, G.S. Spagnol1,3 1

HealthBit, 2School of Philosophy, Letters and Human Sciences, UNICAMP, 3School of Medical Sciences, UNICAMP

Introduction: Increasing demands in both cost and healthcare quality have led to an urgent need to provide more efficient and cost effective utilization of healthcare services. Using artificial intelligence, statistics and big data tools the team identified patterns in order to promote more efficient health model systems. This experience report aims to present a strategy in cost reduction and health systems improvement based on big data analysis by a multidisciplinary teams.

Materials and Methods: a multidisciplinary team gathers managers, nurses, statisticians, computer programmers and engineers who implemented a method of data analysis, changing implementation and evaluation of evolution in health and financial metrics. This team analyzed 24 months of health events in health insurances of 7.000 people, 18 months of registration data, and 24 months of human resources data, such as sector and education. Descriptive analysis, cost projections and Bayesian networks were applied to understand usage patterns of the healthcare system and propose changes.

After one year, a new set of data was collected and analyzed to check variations on clinical and cost metrics.

Results: data analysis showed inefficient patters of health services usage, caused by specific triggers, as: 1) difficult diagnosis identification, and consequently high number of appointments, emergency services, exams and hospitalizations; associated with a decentralized physician network and low education among patients; 2) above average and localized usage of high cost and risky procedures, as bariatric surgeries, due to lack of prevention programs and incentives to surgeries. Changes on the health plan structure and implementation of health programs reduced number of patients with difficulties to identify diagnosis and rate of surgeries, improving health and reducing costs (claims per person) from R$247,37 to R$154,96 per month (2013-2014 vs. 2014-2015).

Discussion: There are several concepts about new technologies of big data. Big data is a large volume of data, with particularities involved in its treatment and processing, capable of combining various sources, not necessarily structured, to draw any conclusion. Health studies have used peripheral data to assist an early diagnosis and real time responses [1-3]. Likewise, our study applies Bayesian networks and other forecasters (regressions, time series and related) to distinguish which patients present specific needs and/or are under investigation. Another strategy is to search for outliers and organize responses according to multi-source information to analyze financial data usage, and track chronic or critical patients to provide specific health assistance [4, 5]. Finally, we also measure the impact of specific health actions, performed through a pre-post-action analysis on health usage regarding clinical and financial (health cost) outcomes.

Conclusion: This report reveals that data analysis may provide an efficient and effective tool to continuously improve health system utilization in the corporate market. During one year (2015) of follow up, results have revealed that decisions based on historical data, data linkage and statistical analysis have improved health of the studied population and reduced costs. This case study indicates that a multidisciplinary team, analyzing historical data, is a cost effective approach to base decisions of system improvements for large populations.

Keywords: health systems, healthcare improvement, data analysis, big data, corporate health.

References: [1] Bhattacharjee P et al., Chest S0012-3692(16), 2016; [2] Mao L et al., Acta Trop S0001-706X(16)30129-2, 2016; [3] Woo H et al., J Med Internet Res 18(7):e177, 2016; [4] Torii M et al., Biomed Inform Insights 8(1): 1-11, 2016; [5] Coates J et al., Front Oncol 6:149, 2016; [6] Iacovacci J et al., Chaos (6):065306, 2016; [7] Meller R., J Clin Res Bioeth. (6), 2015; [8] Woo H et al., J Med Internet Res. 18(7):e177, 2016.

Category: Process Improvement & Innovation / Presentation: Poster 29

V Lean Day October 6th – 7th, 2016 Brazil

How to improve continuously using Lean Thinking A. Sarantopoulos1; L. M. Li1 1

School of Medical Sciences, UNICAMP

Introduction: In an effort to improve operational efficiency, manufactures industry and others services around the world, including in Brazil, have adopted process improvement methodologies such as Lean Thinking. This experience report aims to present a study about the Lean Implementation trough the view of employees and how it is important to understand the model of continuous improvement to advance in the lean implementation.

Materials and Methods: The questionnaire “Employee Perception to Assess Lean Implementation Tool” was applied in 5 different manufactures in Brazil (n=147). The questionnaire has 29 questions and is based on a Likert scale. The answers were analyzed using factorial analyses.

Results: Data analysis showed a substantial difference between the “knowledge of the value” from the “application of tools and techniques” to target the value and the difficult to implement lean as a cultural philosophy in the institution. The results came with a model of continuous improvement that has five principles that must be evaluated when lean is implemented: 1) Culture of continuous improvement; 2) Value Flow; 3) Tools and techniques; 4) Discipline and 5) Voice of the consumer.

Discussion: The study created from this model, shows the importance of having a program of evaluation always when implementing lean thinking. Moreover, this study shows that the leadership should continuously evaluate these five principles of lean implementation as a guide that gives direction for all the effort in training, development and practice about lean thinking. The culture of continuous improvement is the most important factor for training, implementation and sustenance of Lean at various levels in the organization. This factor should over-arching for any Lean improvement effort. The value flow strives at keeping a balance between all processes so that there are no bottlenecks in the system. Tools and techniques comprises of most of the tangibles with regard to implementation of a Lean system. This helps in the training effort of each and every employee.

Discipline is over-arching to the tool and technique and the value flow factors of the organization.

This will be existent only if the other two prevail successfully. And finally, the voice of consumer, that is at the core of every lean improvement effort. Every improvement effort should first begin by answering the question, “How will this positively effect the customer?”

Conclusion: This study came with a guide to leaders and managers that are implement lean in their company. The orientation is that they should continuously evaluate the stage and maturity of implementation, always considering the 5 principles of lean implementation. They should know that, implementing only some tools and technique without change the culture and understanding the voice of the consumer it will not sustain the improvement. The questionnaire EPLIT is one of the ways to evaluate this lean implementation effort through the view of employee and can help managers to continuously improve.

Keywords: Lean thinking, continuous improvement, evaluation.

Category: Lean manufacturing.

Presentation: Poster.

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V Lean Day October 6th â&#x20AC;&#x201C; 7th, 2016 Brazil

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