Purpose

The increase in demand for health services requires companies in the segment to seek management tools and techniques that focus on reducing waste such as waiting, unnecessary displacement and low people productivity. The purpose of this paper is to present the value stream mapping (VSM) of patients at an occupational medicine clinic, proposing a new scenario with the aid of the simulation of discrete events to reduce the total waiting time during the patient's journey.

Design/methodology/approach

The methodology consisted of a case study developed in an occupational health clinic, involving the analysis of the patients' arrival times, time of attendance, number of employees and their functions. Data collection considered 100 random samples from the patients' arrival interval and 40 random samples for each of the operational processes performed by the clinic in a work shift. The collected data served as input for the simulation of scenarios and prioritization of the times for the proposal of the future VSM.

Findings

With the study it was possible to propose the reduction of time wasted in the patient's journey, mainly the waiting times (37.92%) and the lead time (29.86%), making it possible for the patient to go through the entire process without waiting for queues. In addition, the increase in employee productivity and efficiency in patient care during the work shift is considered.

Research limitations/implications

Despite the considerable gains obtained with the realization of this study in relation to the processing times, total waiting time and lead time, the analysis was not considered, the mode of execution of the processes performed by the professionals and the influence of the layout to improve the flow of patients, being some of the challenges for future studies to consolidate lean culture in the health segment.

Practical implications

The simulation of discrete events indicated that it is possible to attend a larger number of patients with the same professional structure, in case the delay in the arrival time of doctors and speech therapists is resolved. There was a reduction in the average total waiting time of 37.92%, a reduction in lead time to 29.86% and identification of the steps that most contributed to the increase in queues for patients in a 05:30 min work shift.

Originality/value

The work proposed the constitution of a VSM based on a discrete simulation with data from the entire health unit system, considering everything from the reception for patient registration, collection of laboratory and image exams to medical assistance. The work differs from the others in that it considers the patient's entire journey in the occupational medicine clinic, instead of prioritizing only one service department. The analysis of the results considered the scenario that presented the maximum efficiency of the available resources, respecting the patient's individualized care times, which is one of the complaints of the therapeutic teams to the use of standardization by the VSM.

中文翻译：

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职业医学诊所的精益医疗意义

目的

对卫生服务需求的增加要求该领域的公司寻求专注于减少浪费的管理工具和技术，例如等待、不必要的流离失所和低生产力。本文的目的是展示职业医学诊所患者的价值流图 (VSM)，提出一种借助离散事件模拟的新场景，以减少患者旅途中的总等待时间。

设计/方法/方法

该方法包括在职业健康诊所开发的案例研究，涉及对患者到达时间、就诊时间、员工人数及其职能的分析。数据收集考虑了来自患者到达间隔的 100 个随机样本和诊所在轮班中执行的每个操作流程的 40 个随机样本。收集到的数据作为场景模拟和未来 VSM 提案时间优先级的输入。

发现

通过该研究，可以提出减少患者旅途中浪费的时间，主要是等待时间（37.92%）和前置时间（29.86%），让患者无需等待即可完成整个过程队列。此外，还考虑了轮班期间员工生产力和患者护理效率的提高。

研究限制/影响

尽管本研究在处理时间、总等待时间和前置时间方面取得了可观的收益，但并未考虑分析、专业人员执行的流程的执行模式以及布局对改进的影响患者的流动，这是未来研究在健康领域巩固精益文化的一些挑战。

实际影响

离散事件的模拟表明，在解决医生和语言治疗师到达时间延迟的情况下，有可能以相同的专业结构接诊更多的患者。平均总等待时间减少了 37.92%，准备时间减少到 29.86%，并确定了最有助于增加 05:30 分钟工作班次中患者排队的步骤。

原创性/价值

该工作提出了基于离散模拟的 VSM 的构成，其中包括来自整个卫生单元系统的数据，考虑到从患者登记的接收、实验室和图像检查的收集到医疗援助的所有方面。这项工作与其他工作的不同之处在于它考虑了患者在职业医学诊所的整个旅程，而不是仅优先考虑一个服务部门。结果分析考虑了呈现可用资源最大效率的场景，尊重患者的个性化护理时间，这是治疗团队对 VSM 使用标准化的抱怨之一。