Lean healthcare implications in an occupational medicine clinic

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.

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.

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.

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.

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.

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.