Abstract Paper aims This study demonstrates the complexity of the patient flow from admission to discharge of an adult Intensive Care Unit (ICU) through the application of the Functional Resonance Analysis Method (FRAM). Originality This paper shows the daily functioning of the patient flow, shedding light on the high levels of interdependence and variabilities in Complex Sociotechnical Systems. Research method The research was developed according to the four steps for FRAM analysis. Sources of evidence involved empirical data collection in a leading teaching public hospital in Brazil. Main findings There were identified 34 functions performed mainly by caregivers and support staff. Five instantiations were described to illustrate the functional resonance scenarios caused by the variability propagation across the functions. Implications for theory and practice Limitations of this study and suggestions for future research are pointed out. The resulting model is a basis for context understanding for ongoing and following studies.

Abstract Paper aims This article aims to study the logistics problems in Brazilian hospitals through Lean methods, approaching different aspects of logistics and the procedures adopted in health institutions such as receiving, storage and transporting. Originality The rising of hospitals’ costs is importantly impacted by hospital logistics. They are caused by aspects such as unstandardized processes and inadequate layout and equipment in critical stages of logistic operations. However, these problems are rarely addressed in literature. Research method We developed, through Design Science Research and lean tools, a model based on route, rhythm and routine (3 R’s) that enables the identification of logistics problems. Main findings Hospitals present complex logistic operations. The application of the model developed identified improvement opportunities due to unnecessary activities, lack of space and infrastructure, and lack of standardized procedures. These findings enable improvements in operations and a better comprehension of the factors that impact the processes of internal logistics. Implications for theory and practice The model provides a comprehensive view of the logistical process, its stages and aspects of improvement. Therefore, hospital managers can better identify and address logistical problems directly at non-value adding activities. Adaptations may be required due to the healthcare environment specificities.