Abstract: Manufacturing companies face demand fluctuations and must deliver the required quantity of parts to their customers within the required time; however, companies face different challenges in fulfilling them. One is technological advances, which make it impossible for them to compete with other countries, such as China, due to financial issues. Therefore, manufacturing companies use continuous improvement methodologies to achieve better performance in their processes. Six Sigma and Lean Manufacturing are some of the best-known approaches. This article briefly presents the application of a lean sigma approach oriented to solving problems. This research proposes a methodology based on Lean Sigma that contrasts what different authors currently do: continuous improvement projects that take up to 12 months to produce results and do not solve a problem. This implementation is conducted in a process that manufactures metal parts and fails to deliver them on time to its customers. Using tools such as the Single Minute Exchange of Die (SMED) in a production line, on-time deliveries were increased from 89 % to 96 %; at the same time, the model change times were reduced by approximately 60 %, which is required for the implementation of this methodology for only four weeks, unlike the traditional six-sigma approach that can take up to 12 months to improve the process.

Resumen: Las empresas manufactureras presentan fluctuaciones en sus demandas y no entregan a sus clientes la cantidad de partes en el tiempo requerido. Son diferentes los retos que enfrentan estas empresas, uno de ellos son los avances tecnológicos que, por cuestiones financieras, no es posible competir con otros países, tales como China. Es por esto, que las empresas manufactureras hacen uso de metodologías de mejora continua para lograr un mayor desempeño en sus procesos. Algunos de los enfoques más conocidos son Seis Sigma y Manufactura Esbelta. En este artículo se presenta una aplicación de un enfoque Lean-Sigma, el cual se orienta a resolver problemas en un corto periodo de tiempo. El propósito de esta investigación es proponer una metodología basada en Lean-Sigma que permita contrastar lo que hacen diferentes autores en la actualidad, que básicamente son proyectos de mejora continua que tardan hasta doce meses en dar resultados y que no resuelven un problema. Esta implementación se lleva a cabo en un proceso que fabrica partes metálicas, el cual está incumpliendo con su cliente en las entregas a tiempo. Utilizando la herramienta de cambios rápidos de modelo (SMED) se lograron incrementar las entregas a tiempo de un 89 % a un 96 %. A su vez, los tiempos de cambio de modelo se reducen aproximadamente un 60 %, siendo requeridas para la implementación de esta metodología solo cuatro semanas, a diferencia del enfoque tradicional de seis sigma que puede tomar hasta doce meses para mejorar un proceso.

The objective of this study is to increase the efficiency and productivity of a business that offers sandblasting and painting services. An integrated model incorporating lean manufacturing tools, including preventative and autonomous maintenance, 5S, and SMED, is presented in this article. The model consists of four distinct phases. The initial stage consists of diagnosing the company's beginning state. The second stage entails the execution of the 5S methodology to arrange workstations. Following this, a maintenance programme was implemented, which ultimately resulted in the reduction of setup times for the painting machine configuration. Furthermore, an assessment was conducted on the realised enhancements, and metrics were compared both before and after deployment. Statistical validation was performed via a pilot study that occupied an extended period. The findings validated a productivity improvement of 10% and an efficiency increase of 23.8%. In addition, a 32.04% reduction in setup time was observed.

Die doel van hierdie studie is om die doeltreffendheid en produktiwiteit van 'n besigheid wat sandblaas- en verfdienste bied, te verhoog. 'n Geïntegreerde model wat skraal vervaardigingsgereedskap insluit, insluitend voorkomende en outonome instandhouding, 5S en SMED, word bespreek. Die model bestaan uit vier verskillende fases. Die aanvanklike stadium bestaan uit die diagnose van die maatskappy se begintoestand. Die tweede fase behels die uitvoering van die 5S-metodologie om werkstasies te bestuur. Hierna is 'n instandhoudingsprogram geïmplementeer, wat uiteindelik gelei het tot die vermindering van opsteltye vir die verfmasjienkonfigurasie. Verder is 'n assessering gedoen oor die gerealiseerde verbeterings, en numeriese uitsette is beide voor en na ontplooiing vergelyk. Statistiese validering is uitgevoer via 'n loodsstudie wat 'n lang tydperk in beslag geneem het. Die bevindinge het 'n produktiwiteitsverbetering van 10 persent en 'n doeltreffendheidverhoging van 23.8 persent bevestig. Daarbenewens is 'n vermindering van 32.04 persent in opstel tyd waargeneem.

Abstract: This investigation was a case of study in the powder detergent packaging line and aimed to reduce all those wastes that do not add value to the product, increasing the cost of production. Reducing or eliminating waste within the manufacturing industry becomes necessary for sustainable businesses over time and keeps generating development. To achieve it, the Lean Six Sigma DMAIC methodology was implemented in a detergent powder packaging line, to identify the problems that afflicted and made production more expensive. By using quality tools (such as Pareto and Ishikawa diagrams, 5S application, Poka-Yokes, SMED, training personnel, and standardizing processes) it was possible to reduce unproductive times. Energy consumption was reduced by up to 20 %, also efficiency and machine availability increased by 10.98 % and 7.32 %, respectively. The general performance of the line increased by 15.16 %, which translates into significant monthly savings of USD 71 442.05. By applying these improvement techniques, the most significant efficiency was registered in 1 kg packages, going from 47 % to 89 %, approximately. To maintain this productivity and even to perfect it, it is necessary to hire specialized personnel who know the production processes and industrial operations.

Resumen: Esta investigación fue un estudio de caso en una línea de empaque de detergente, con el objetivo de reducir todos los desperdicios que no añaden valor al producto y que aumentan el costo de producción. La disminución o eliminación de desperdicios de cualquier tipo dentro de la industria manufacturera se convierte en una necesidad para que los negocios continúen siendo sustentables en el tiempo y generan desarrollo. Para alcanzar este objetivo, se implementó la metodología Lean Six Sigma DMAIC en una línea de envasado de polvo detergente, permitiendo descubrir los problemas que agobiaban y encarecían la producción. Al utilizar herramientas de calidad (como Diagramas de Pareto e Ishikawa, la aplicación de la metodología 5S, Poka-Yokes, SMED, capacitando al personal, y estandarizando procesos) se logró reducir tiempos improductivos. El consumo de energía se redujo hasta en un 20 %, la eficiencia y la disponibilidad de la máquina aumentaron en 10.98 % y 7.32 %, respectivamente. También se incrementó el rendimiento general de la línea en 15.16 %, lo cual se tradujo en un ahorro significativo mensual de USD 71 442.05. Mediante la aplicación de estas técnicas de mejora, la eficiencia más significativa se registró en los empaques de 1 kg, pasando de 47 hasta 89 %, aproximadamente. Para mantener esta productividad y perfeccionarla, es necesario contratar personal especializado, que conozca los procesos productivos y operaciones industriales.

ABSTRACT This research was conducted in a farinaceous products company that was facing a problem of low productivity due to frequent downtime, leading to underutilization of their capacity. The lean manufacturing methodology was used to address this issue, specifically value stream mapping (VSM) and single-minute exchange of die (SMED) tools. These tools were applied in stages, including a diagnostic pretest (current map), followed by design, implementation, and a posttest (final map). The results were evaluated after the completion of the process, and it was found that the application of SMED led to a significant reduction in downtime. The product changeover time was decreased from 82 minutes to 42 minutes, reducing plant downtime or waste by 40 minutes and improving lean manufacturing indicators.

RESUMEN Esta investigación se realizó en una empresa de productos farináceos que presentaba un problema de baja productividad debido a las constantes paradas de planta, por lo que no operaba a toda su capacidad. Para abordar este problema, se consideró necesario aplicar las herramientas «mapeo de la cadena de valor» (VSM) y «cambios rápidos» (SMED) de la metodología lean manufacturing o manufactura esbelta. La aplicación de estas herramientas se realizó por etapas, que incluyeron un pretest de diagnóstico (mapa actual), seguido por el diseño, implementación y, finalmente, un postest (mapa final). Una vez finalizado el proceso, se evaluaron los resultados y se comprobó que la aplicación del procedimiento que incluía cambios rápidos (SMED) permitía reducir considerablemente los tiempos de inactividad; se pasó de 82 min a 42 min por cada cambio de producto, con lo que el tiempo muerto de planta o desperdicio se redujo en 40 min y mejoraron los indicadores de lean manufacturing.

RESUMEN Objetivo: investigar las contribuciones de la aplicación de la metodología Lean a la mejora de los procesos de trabajo en salud y enfermería y su impacto en los aspectos financieros asociados. Método: revisión integradora, realizada en seis bases de datos, cuya muestra de diez (100,0%) estudios fue analizada y resumida de forma descriptiva. Resultados: los resultados obtenidos se estratificaron en: beneficios/barreras para la implementación de Lean Healthcare; aspectos económicos que implican la implementación de Lean Healthcare; y mejoras de procesos mediante la implementación de Lean Healthcare. La mayoría de los estudios (60,0%) se realizaron en hospitales universitarios, contextos que necesitan mejorar continuamente la calidad de los servicios prestados, generalmente con recursos escasos y limitados, que sustentan la viabilidad de mantener el trípode de docencia, investigación y extensión. Conclusión: tres (30,0%) estudios destacaron los aspectos financieros asociados a la aplicación de la metodología Lean. Los demás solo mencionaron la posibilidad de obtener ganancias financieras mejorando los procesos y reduciendo el desperdicio. Objetivo Método integradora datos 100,0% 1000 100 0 (100,0% descriptiva Resultados beneficiosbarreras beneficios barreras Healthcare 60,0% 600 60 (60,0% universitarios prestados limitados docencia extensión Conclusión 30,0% 300 30 (30,0% desperdicio 100,0 10 (100,0 60,0 6 (60,0 30,0 3 (30,0 100, 1 (100, 60, (60, 30, (30, (100 (60 (30 (10 (6 (3 (1 (

ABSTRACT Objective: to investigate the contributions of applying the Lean methodology to improve work processes in health and nursing and its impact on associated financial aspects. Method: an integrative review, carried out in six databases, whose sample of ten (100.0%) studies was analyzed and summarized descriptively. Results: the outcomes obtained were stratified into: benefits/barriers to Lean Healthcare implementation; economic aspects involving Lean Healthcare implementation; and process improvements through Lean Healthcare implementation. The majority of studies (60.0%) were carried out in university hospitals, contexts that need to continually improve the quality of services provided, generally with scarce and limited resources, which support the viability of maintaining the teaching, research and extension tripod. Conclusion: three (30.0%) studies highlighted the financial aspects associated with Lean methodology application. The others only mentioned the possibility of financial gains through improving processes and reducing waste. Objective Method review databases 100.0% 1000 100 0 (100.0% descriptively Results into benefitsbarriers benefits barriers implementation 60.0% 600 60 (60.0% hospitals provided resources teaching tripod Conclusion 30.0% 300 30 (30.0% application waste 100.0 10 (100.0 60.0 6 (60.0 30.0 3 (30.0 100. 1 (100. 60. (60. 30. (30. (100 (60 (30 (10 (6 (3 (1 (

RESUMO Objetivo: investigar as contribuições da aplicação da metodologia Lean para melhoria dos processos de trabalho em saúde e enfermagem e sua repercussão nos aspectos financeiros associados. Método: revisão integrativa, realizada em seis bases de dados, cuja amostra de dez (100,0%) estudos foi analisada e sintetizada descritivamente. Resultados: os desfechos obtidos foram estratificados em: benefícios/barreiras para implantação do Lean Healthcare; aspectos econômicos envolvendo a implantação do Lean Healthcare; e melhorias em processos por meio da implantação do Lean Healthcare. A maioria dos estudos (60,0%) foi realizada em hospitais universitários, contextos que precisam melhorar, continuamente, a qualidade dos serviços prestados, geralmente com recursos escassos e limitados, os quais sustentam a viabilidade da manutenção do tripé ensino, pesquisa e extensão. Conclusão: três (30,0%) estudos evidenciaram os aspectos financeiros associados à aplicação da metodologia Lean. Os demais apenas mencionaram a possibilidade de ganhos financeiros por meio da melhoria de processos e redução de desperdícios. Objetivo Método integrativa dados 100,0% 1000 100 0 (100,0% descritivamente Resultados benefíciosbarreiras benefícios barreiras Healthcare 60,0% 600 60 (60,0% universitários melhorar continuamente prestados limitados ensino extensão Conclusão 30,0% 300 30 (30,0% desperdícios 100,0 10 (100,0 60,0 6 (60,0 30,0 3 (30,0 100, 1 (100, 60, (60, 30, (30, (100 (60 (30 (10 (6 (3 (1 (

RESUMEN Introducción: La búsqueda continua de la mejora de la atención de enfermería conlleva la aplicación de instrumentos contemporáneos. Objetivo: Identificar buenas prácticas para la mejora de procesos relacionados con la calidad de la atención de enfermería en el Instituto Cubano de Oftalmología “Ramón Pando Ferrer”. Métodos: Se realizó un proyecto de desarrollo tecnológico, descriptivo, que empleó las tecnologías gerenciales de referenciación competitiva y gestión por procesos entre el 2018-2021. La institución de referencia fue la Clínica Central “Cira García”. El grupo de estudio quedó conformado por personal vinculado a los procesos. Para la recolección de la información se diseñaron 10 instrumentos que se validaron con expertos por el método de Barraza. El estudio de los procesos de urgencias, esterilización y hospitalización se realizó en dos momentos: en el “Ramón Pando Ferrer” con el empleo de la metodología Lean y en la institución de referencia para conocer las buenas prácticas. Para el procesamiento de la información se utilizó la metodología planteada por Rodríguez y de Souza, para ello se tuvo en cuenta el referencial teórico del enfoque Lean y el de la referenciación competitiva. Resultados: Se identificaron mudas como espera, movimiento, sobreprocesamiento y defecto, se confeccionaron los diagramas de flujo y se identificaron indicadores de calidad. Conclusión: El procedimiento utilizado mostró resultados satisfactorios que evidencian la aplicabilidad de la integración de tecnologías en la identificación e incorporación de buenas prácticas.

ABSTRACT Introduction: The continuous search for the improvement of nursing care leads to the application of contemporary instruments. Objective: To identify good practices for the improvement of processes related to the quality of nursing care at Instituto Cubano de Oftalmología Ramón Pando Ferrer. Methods: A descriptive technological development project was carried out between 2018-2021, using the managerial technologies of competitive benchmarking and process management. The reference institution was Clínica Central Cira García. The study group was made up of personnel involved in the processes. For the collection of information, 10 instruments were designed and validated with experts by the Barraza method. The study of the emergency, sterilization and hospitalization processes was carried out in two stages: at the Ramón Pando Ferrer institution, with the use of the Lean methodology; and at the reference institution, to learn about good practices. The methodology proposed by Rodriguez and de Souza was used to process the information; also taking into account the theoretical referential of the Lean approach and that of competitive benchmarking. Results: Shortfalls were identified, such as waiting, movement, overprocessing and defect. Flow charts were drawn up and quality indicators were identified. Conclusion: The used procedure showed satisfactory results that demonstrate the applicability of integrating technologies in the identification and incorporation of good practices.

Abstract Paper aims The purpose of this paper is to applied systematically Lean Healthcare to improve mobility accessibility in the medical clinic ward of a medium-sized hospital. Originality The study focuses on the wheelchair’s availability, as well as their provisions in the hospital, since this approach was not identified in the literature. In addition, this study is part of a branch of a project, based on the non-identification of applications in the medical clinic ward of hospitals, in order to formalize a systematic application of Lean Healthcare in the wing worked. Research method The study's methodology was divided into two phases, Survey and Lean Proposal, following a systematic approach established in prior papers, with a focus on addressing various hospital waste scenarios that affect patient mobility. The Survey phase aimed to identify the root cause of waste related to wheelchair use within the hospital, while the Lean Proposal phase sought to mitigate this waste using Lean tools, ultimately improving patient mobility in the medical clinic by reducing non-added value. Main findings The implementation of systematically Lean Healthcare led to a 72.2% reduction in the total activity time, dropping from 20 to 7 minutes, primarily by cutting non-value-added time from 18 to 5 minutes. This change increased the value-added time by 19%. Additionally, the unnecessary movement to retrieve wheelchairs decreased by 83%, with occurrences reducing by 100%. Furthermore, Lean Healthcare improved mobility and demonstrates how this effective approach not only enhanced the quality of medical services but also created a more favorable work environment and inspired a culture of continuous improvement within the hospital. Implications for theory and practice For the theory, this research highlights a hospital wing previously unexamined within the context of Lean Healthcare, thereby reinforcing a culture of systematic application and continuous improvement within the hospital. Furthermore, it delves into the hospital's accessibility, specifically focusing on mobility accessibility, addressing a gap in the literature. In practice, the research has significant implications, as it effectively reduces non-added value elements within an actual process in a medium-sized hospital, ultimately enhancing the quality of clinical healthcare delivery in the Brazilian public healthcare system. mediumsized medium sized s availability literature addition project nonidentification non identification hospitals worked studys phases papers tools nonadded added 722 72 2 72.2 minutes nonvalueadded 1 valueadded 19 19% Additionally 83 83% 100 100% Furthermore implications system 72. 8 10

ABSTRACT With a growing population, the construction sector is continually expanding due to societal demands. Hence, this research focused on implementing Lean Construction methodology in an urban pavement project. This non-experimental methodology relies on field data collection for measurements during specific timelines, leading to quantifiable results for analysis. Prior to implementing this methodology, the project experienced delays. However, with the application of Lean Construction methodology and its tools, objectives were successfully achieved. Planning was carried out using Look Ahead, organizing workflow, and achieving a plan fulfillment percentage exceeding 70% of the projected values. Consequently, favorable schedule indices were evident, surpassing budget projections in executed budgets. The application of Lean Construction methodology successfully completed the entire project within the set timeframe. Furthermore, productivity and crew performance improvements were observed in a specific task.

RESUMEN Con una población creciente, el rubro de la construcción día a día se va incrementado por las exigencias de la sociedad, por ello es por lo que la presente investigación se focalizó en la aplicación de la metodología Lean Construction en una obra de pavimentación urbana. Dicha metodología es no experimental y se basa en la recolección de datos en campo que permiten realizar mediciones durante la ejecución de las actividades en una línea de tiempo determinada y conlleva a cuantificar resultados para ser analizados. Antes de la aplicación de la metodología se presentaban atrasos en la ejecución de la obra, pero con la implementación y la aplicación de la metodología Lean Construction mediante sus herramientas, se lograron cumplir los objetivos trazados, con una planificación realizada mediante Look Ahead. Esto permitió ordenar los flujos de trabajo y obtener resultados como el del porcentaje del plan cumplido, el cual fue mayor al 70% de lo proyectado. Por consiguiente, se evidencia en los índices del cronograma que se lograron valores favorables para el avance de obra, cuyos presupuestos ejecutados superaron a los presupuestos proyectados. Por lo tanto, la aplicación de la metodología Lean Construction logró cumplir con la totalidad del proyecto en un plazo fijado. Además, se evidenciaron mejoras en la productividad y los rendimientos de las cuadrillas en una partida específica.

PURPOSE: This paper explores the influence of ISO 9001:2015 certification on business performance in the packaging industry in South Africa. Additionally, the study proposes a comprehensive and sustainable quality management system (QMS) framework that harmonises with the stipulated requirements of the standard to address the challenges posed by the unpredictable and volatile business landscape DESIGN/METHODOLOGY/APPROACH: This study adopted a quantitative research method and collected empirical data through surveys conducted in various mainstream packaging material sectors across South Africa. The participants were selected using a stratified sampling technique. The collected data underwent descriptive and inferential analysis FINDINGS/RESULTS: The findings confirmed that the implementation of the ISO 9001:2015 certification has a significant influence on organisational performance. However, organisations should focus on integrating all business processes, prioritising lean manufacturing and ensuring effective leadership engagement at the strategic, tactical and operational levels to maximise the potential benefits of ISO 9001:2015 PRACTICAL IMPLICATIONS: The proposed integrated framework facilitates the detection and analysis of ineffective activities across organisational structures and processes within the supply chain. This comprehensive approach measures and improves all risk parameters, enabling sustainable development and providing insights into the impact and contributions of input variables to business operations ORIGINALITY/VALUE: This study addresses a practical gap in the industry by examining how ISO 9001:2015 certification can be effectively applied to enhance business improvement, even in the absence of the standard being overdue for revision. It provides valuable insights into strategies for leveraging the certification's potential to optimise business performance in such dynamic environments

Abstract Objective: To explore the gaps that exist for access to cataract surgery in people with type 2 diabetes. Materials and methods: A qualitative research of a phenomenological type with a managerial approach was carried out. Management tools and techniques by health processes and Lean-health methodology were used. The field work was carried out in the municipalities of La Lisa, Marianao and Playa where the experiences and expectations of 46 patients were explored in six discussion groups, the criteria of nine family doctors and six ophthalmologists from the primary health level were obtained, in two discussion groups. Results: The experiences of patients, family doctors and ophthalmologists, organized by categories (diagnosis, continuity and communication, social support and workload) have in their content the gaps present in the care process. Conclusion: The gaps identified in this study are sufficient to explain why many patients do not access cataract surgery in a timely manner.

Resumen Objetivo: Explorar las brechas que existen para el acceso a la cirugía de catarata en personas con diabetes tipo 2. Materiales y métodos: Se realizó una investigación cualitativa de tipo fenomenológica con enfoque gerencial. Se emplearon herramientas y técnicas de gestión por procesos en salud y metodología Lean- sanidad. El trabajo de campo se realizó en los municipios La Lisa, Marianao y Playa donde se exploraron las experiencias y expectativas de 46 pacientes en seis grupos de discusión, se obtuvo el criterio de nueve médicos de familia y seis oftalmólogos del nivel primario de salud, en dos grupos de discusión. Resultados: Las experiencias de pacientes, médicos de familia y oftalmólogos, organizadas por categorías (diagnóstico, continuidad y comunicación, apoyo social y carga laboral) tienen en su contenido las brechas presentes en el proceso asistencial. Conclusión: Las brechas identificadas en este estudio son suficientes para explicar por qué muchos pacientes no acceden de manera oportuna a la cirugía de catarata.

Abstract Purpose The study aims to explore the argument of implementing the lean method to part or whole of an operation by examining the moderating impact of varying levels of the extent of implementation of four different lean methods, along with their functionalities, in predicting productivity improvement (PI). Design/methodology/approach As the focus of understanding the efficacy of lean principles is shifting from process to industry level, this study tried to generalize the approach by gathering data from 132 large Indian auto component manufacturers. This involves an assessing/monitoring approach rather than measurement. Findings Results highlighted the interdependence or individuality of the extent of implementation of lean methods and their functionalities. Findings revealed a significant moderating effect in improving productivity to a greater extent of 50%. Research limitations/implications Adopting an assessment approach to a measurement study provides a noteworthy contribution to bridging theory and practical consequences. The findings can be appropriately extrapolated to medium and small enterprises forming a critical connection in the entire automobile manufacturing ecosystem. Practical implications The study showed that even if a lean method is applied to a certain extent of operations the chances of PI are significant. This is important for decision makers as they confront problems of optimum resource allocation. Social implications PI, reduced cost and generalization of results would enable the auto component industry to become more competitive. Originality/value The examination of the moderation effect of a lean principle implementation extent, along with that of its functionalities to predict the improvement in productivity from its existing level, is a major outcome of this study. PI. . (PI) Designmethodologyapproach Design methodology level 13 manufacturers assessingmonitoring assessing monitoring 50 50% limitationsimplications limitations consequences ecosystem allocation competitive Originalityvalue Originality value (PI 1 5

Peruvian companies' craft brick stands currently experience significant growth in sales. Thus brickyards seek to reduce the amount of waste to increase productivity and reduce cost overruns. In this study, the problem that has the greatest economic impact on a brick company is the excessive amount of waste. For this reason, the implementation of a model based on the Lean Six Sigma (LSS) methodology is proposed, applying Poka Yoke, Jidoka, Standardised Work, and Just in Time in order to reduce the number of defective bricks and cost overruns. The research project focused on the tambourine brick, the type whose percentage of generated waste is the highest in the production batch. To do this, the current situation was analysed; the main causes of the problem were identified and measured; and then Lean Six Sigma tools were used to attack the root cause. Finally, the proposed design reduced overheated bricks by 2.36%, wet bricks by 2.01%, and poorly stacked bricks by 1.8%, obtaining a 6.92% reduction in shrinkage and increasing the level of Six Sigma to 3.9, which contributed to the reduction of losses in the brickyard.

Tans ervaar Peruaanse handwerkbaksteenmaatskappye aansienlike groei in verkope. Daarom poog die steenwerwe om die hoeveelheid afval te verminder om produktiwiteit te verhoog en koste-oorskryding te verminder. In hierdie studie is die probleem wat die grootste ekonomiese impak vir die baksteenmaatskappy genereer die oormatige hoeveelheid afval. Om hierdie rede word die implementering van 'n model gebaseer op die Lean Six Sigma metodologie voorgestel, deur die toepassing van Poka Yoke, Jidoka, Standardised Work en Just in Time, met die doel om die aantal gebrekkige stene en koste-oorskryding te verminder. Die navorsingsprojek fokus op die tipe tamboerynsteen waarvan die persentasie afval wat gegenereer word die hoogste van sy produksiegroep is. Om dit te doen, is die huidige situasie ontleed, waar die hoofoorsake van die probleem geïdentifiseer en gemeet is, en daarna is Lean Six Sigma-instrumente gebruik om die hoofoorsaak aan te pak. Laastens verminder die voorgestelde ontwerp oorverhitte stene met 2.36%, nat stene met 2.01%, en swak gestapelde stene met 1.8%, wat 'n vermindering van 6.92% in krimping verkry en die vlak van Six Sigma tot 3.9 verhoog, wat bygedra het tot die vermindering van verliese in die baksteenwerf.

Abstract The Lean philosophy has demonstrated benefits in organizations of different business sectors through the elimination of waste and the generation of value; research conducted in this field has sought to identify the critical success factors for its implementation. The objective of this study is to understand the relationships between the factors of Health Care Providing Institutions in Colombia, through surveys with experts, and then classify them according to their power of influence and dependence using the Interpretative Structural Modelling- ISM methodology. The results of this research contribute to identifying the key factors for the implementation of Lean Healthcare in the Colombian context: Management commitment, management understanding, and employee training, and finally recommendations and future research work are presented.

Resumen La filosofía lean ha demostrado beneficios en organizaciones de diferentes sectores empresariales por medio de la eliminación de desperdicios y la generación de valor. Las investigaciones realizadas en este campo han buscado identificar los factores críticos de éxito para su implementación. El objetivo de este estudio es comprender las relaciones entre los factores de las Instituciones Prestadoras de Salud en Colombia. Para lograrlo, se realizaron encuestas a expertos y posteriormente se clasificaron estos factores según su poder de influencia y dependencia utilizando la metodología de Interpretative Structural Modelling- ISM. Los resultados de esta investigación contribuyen a identificar los factores claves para la implementación Lean Healthcare en el contexto colombiano: el compromiso de la dirección, la comprensión de la dirección y la formación de los empleados. Por último se presentan recomendaciones y futuros trabajos de investigación.

ABSTRACT Introduction: Physical Therapy and Rehabilitation services are a fundamental pillar in the diagnosis, evaluation, treatment and recovery of patients. Objective: To identify the actions, routes or activities that can be considered as waste of the health processes and the proposals for the general organization of the Department of Physical Therapy and Rehabilitation that allow improvements of its processes. Methods: A descriptive research with a qualitative approach was carried out, and it was applied to the management process in the Department of Physical Therapy and Rehabilitation of the "Nguyen Van Troi" Polyclinic; 2021-2022 period. All the department's workers participated in different techniques and methods related to determination, analysis, design and processes aimed at quality problems within the framework of health systems and services. Results: Waste was identified from the perspective of process management, Lean methodology was applied to eliminate or reduce waste, and organizational and functional aspects that required adjustments were reviewed. A comparison was made of how key process activities are performed and how they should be performed, which would increase work efficiency, reduce current delays, and improve patient and worker satisfaction in the service. Conclusions: The identified waste affects the technical and professional work that must be carried out in the service to raise the quality of health care for patients. The improvements are aimed at adjustments in the organization of the working procedures of the service and of the institutions responsible for the maintenance and supply of medicines and materials.

RESUMEN Introducción: Los servicios de Terapia Física y Rehabilitación constituyen pilar fundamental en el diagnóstico, evaluación, tratamiento y recuperación de pacientes. Objetivo: Presentar una propuesta de organización general del Departamento de Terapia Física y Rehabilitación que permita mejoras de sus procesos. Métodos: Se realizó una investigación descriptiva con enfoque cualitativo, aplicada al proceso de gestión en el Departamento de Terapia Física Rehabilitación del Policlínico “Nguyen Van Troi”; período 2021-2022. Participaron el total de trabajadores del departamento en diferentes técnicas y métodos relacionados con determinación, análisis, diseño y procesos orientados a problemas de la calidad en el marco de los sistemas y servicios de salud. Resultados: Se identificaron los desperdicios desde la óptica de la gestión por procesos, se aplicó la metodología Lean para eliminar o reducir estos y se revisaron aspectos organizativos y funcionales que requerían ajustes. Se realizó una comparación de cómo se realizan y cómo deberían realizarse las actividades del proceso clave, lo cual elevaría la eficiencia del trabajo, se reducirían los retrasos actuales y se mejoraría la satisfacción de los pacientes y los trabajadores en el servicio. Conclusiones: Los desperdicios identificados afectan el trabajo técnico y profesional que debe realizarse en el servicio para elevar la calidad de la atención sanitaria a los pacientes. Las mejoras están en encaminadas a ajustes en la organización de los procedimientos de trabajo del servicio y de las instituciones encargadas del mantenimiento y el suministro de medicamentos y materiales.

Resumen: La industria de la construcción es una parte importante del sector económico de un país, por lo que es importante verificar los nuevos sistemas de gestión que se implementan en las principales industrias de la construcción del mundo. Este artículo hace una revisión bibliográfica de la filosofía Lean Construction (LC), introducida por el profesor Lauri Koskela en 1992, a partir del modelo utilizado por la industria del automóvil en los años 80, denominado “Lean Production”. Las bases teóricas de LC pretenden ver la producción en construcción como un proceso de transformación, flujo y generador de valor, en consecuencia, el objetivo de Lean Construction es crear buenos sistemas de producción que permitan optimizar, reducir o eliminar flujos para mejorar los tiempos de entrega. En el marco de la creación de herramientas Lean para mejorar la gestión de proyectos de construcción, surge el Last Planner System para mejorar el proceso de programación de obra y el modelo Integrated Project Delivery (IPD), que al unificarlo con LC se convierte en Lean Project Delivery System (LPDS), que propone la metodología para desarrollar proyectos de construcción en cinco fases y 12 etapas “Lean”, en las que se desarrollan herramientas que contribuyan a la generación de valor. Finalmente, la tecnología de modelado 3D Building Information Modeling (BIM), aunque no es parte de LC, es una importante herramienta de ayuda para el modelo LPDS, ayudando a comprender mejor los procesos de construcción de diseños complejos para ahorrar tiempo en su construcción. Bajo este paradigma, el surgimiento de nuevas herramientas nos da una mejor visión del futuro de la Lean Construction.

Abstract: The construction industry is an important part of the economic sector of a country, therefore, it is important to verify the new management systems that are implemented in the main construction industries of the world. This article makes a bibliographic review of the Lean Construction (LC) philosophy, introduced by Professor Lauri Koskela in 1992, based on the model used by the automobile industry in the 1980s, called “Lean production”. The theoretical bases of LC intend to see production in construction as a process of transformation, flow and value generator, consequently, the objective of Lean Construction is to create good production systems that allow optimizing, reducing, or eliminating flows to improve delivery times. Within the framework of creating Lean tools to improve the management of construction projects, the Last Planner System arises to improve the work scheduling process and the Integrated Project Delivery (IPD) model, which by unifying it with LC becomes the Lean Project Delivery System (LPDS) project execution system, which proposes the methodology to develop construction projects under five phases and 12 “Lean” stages, in which the development of tools that contribute to the generation of value. Finally, the 3D Building Information Modeling (BIM) modeling technology, although not part of LC, is an important help tool for the LPDS model, helping to better understand the construction processes of complex designs to save time in their construction. Under this paradigm, the emergence of new tools gives us a better vision of the future of Lean Construction.