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 Objective: This study aimed to map the value flow of medical records of a philanthropic hospital, identifying opportunities for improvements in the process. Design/methodology/approach: A qualitative research of descriptive and exploratory bias was developed, in which the sources of evidence emerged from participant observation and documentary analysis. Therefore, data collection took place for three months in 2021, which took place in the administrative sectors of a large philanthropic hospital, and the process chosen to be mapped and analyzed was the surgical record. Result: The analysis of the process took place from the patient’s discharge to the delivery of the accounts to the typing/billing sector, where the routine of the post desks was observed and the current flows were mapped through the Value Stream Mapping tool (VSM), with several wastes being detected. The time spent in the process was approximately 56 days, after the suggested improvements and drawing up the map of the future situation, this time was reduced to 28 days. With the application of the tool, waste was identified and eliminated in the mapped process, generating a possibility of cost reduction. Originality/value: The study stands out as it seeks to link the context of value stream mapping in a hospital space, opening space for new research and contributing to practical results.

RESUMO Objetivo: Este estudo teve como objetivo realizar o mapeamento do fluxo de valor dos prontuários de um hospital filantrópico, identificando oportunidades de melhorias no processo. Design/metodologia/abordagem: Foi desenvolvida uma pesquisa qualitativa de viés descritivo e exploratório, em que as fontes de evidência emergiram de observação participante e análise documental. Para tanto, a coleta de dados aconteceu durante três meses no ano de 2021, a qual ocorreu nos setores administrativos de um hospital filantrópico de grande porte, e o processo escolhido para ser mapeado e analisado, foi o prontuário cirúrgico. Resultados: A análise do processo deu-se desde a alta do paciente até a entrega das contas ao setor de digitação/faturamento, onde foi observada a rotina das secretárias de posto e mapeados os fluxos atuais por meio da ferramenta Mapeamento de Fluxo de Valor (MFV), sendo detectados diversos desperdícios. O tempo gasto no processo era de aproximadamente 56 dias, após as melhorias sugeridas e elaboração do mapa da situação futura, este tempo foi reduzido para 28 dias. Com a aplicação da ferramenta, foram identificados e eliminados desperdícios no processo mapeado, gerando uma possibilidade de redução de custos. Originalidade/valor: O estudo destaca-se à medida que busca atrelar em um espaço hospitalar o contexto do mapeamento do fluxo de valor, abrindo espaço para novas pesquisas e contribuindo com resultados práticos.

Resumo Objetivo: analisar as quedas de pacientes adultos hospitalizados e suas repercussões no trabalhador de Enfermagem como segunda vítima. Método: estudo exploratório, descritivo e qualitativo realizado em duas etapas - identificação das quedas com dano moderado ao grave e a modelagem das quedas com uso do software Functional Resonance Analysis Method e análise das repercussões no trabalhador como segunda vítima por meio de entrevistas semiestruturadas submetidas à Análise de Conteúdo, com 21 trabalhadores de Enfermagem. Resultados: identificadas 447 quedas de pacientes adultos, sendo 12 com dano moderado ao grave, ocorridas na ausência do acompanhante, no uso de medicamentos indutores do sono, hipotensores ou que alteram a força muscular. A modelagem identificou 22 funções relacionadas ao Procedimento Operacional Padrão, ao protocolo de prevenção de quedas e às ações pós-evento. Dessas, oito apresentaram variabilidade em sua execução. Na segunda etapa, emergiram as categorias “A complexidade dos cuidados para prevenir as quedas” e “Sentimentos da segunda vítima”. Conclusão: as quedas são fenômenos complexos e a prevenção exige envolvimento do paciente, família e equipe multiprofissional. Os profissionais envolvidos são segundas vítimas e experimentam sentimentos de culpa, medo, angústia e impotência. Este estudo pode contribuir com a multiprofissionalidade e na abordagem precoce às segundas vítimas.

Abstract Objective: analyze the falls of adult hospitalized patients and their repercussions on the Nursing worker as the second victim. Method: an exploratory, descriptive and qualitative study conducted in two stages - identification of falls with moderate to severe damage and the modeling of falls using the software Functional Resonance Analysis Method; and analysis of the repercussions on the worker as the second victim by means of semi-structured interviews submitted to Content Analysis, with 21 Nursing workers. Results: a total of 447 falls of adult patients were identified, 12 of which with moderate to severe damage, occurred in the absence of the companion, while using sleep inducing, hypotensive or muscle strength altering medications. The modeling identified 22 functions related to the Standard Operating Procedure, to the fall prevention protocol and to the post-event actions. Of these, eight presented variability in their execution. In the second step, the categories “The complexity of care to prevent falls” and “Feelings of the second victim” emerged. Conclusion: falls are complex phenomena and prevention requires involvement of the patient, family and multi-professional team. The professionals involved are second victims and experience feelings of guilt, fear, anguish and helplessness. This study can contribute to the multi-professional spirit and to the early approach to second victims.

Resumen Objetivo: analizar las caídas de pacientes adultos hospitalizados y sus repercusiones en el trabajador de Enfermería como segunda víctima. Método: estudio exploratorio, descriptivo y cualitativo realizado en dos etapas - Identificación de las caídas con daño moderado a grave y el modelaje de las caídas utilizando el software Functional Resonance Analysis Method y Análisis de las repercusiones en el trabajador como segunda víctima por medio de entrevistas semiestructuradas posteriormente sometidas al Análisis de Contenido, en 21 trabajadores de Enfermería. Resultados: fueron identificadas 447 caídas de pacientes adultos, siendo 12 con daño moderado a grave, ocurridas en la ausencia del acompañante, al usar medicamentos inductores de sueño, hipotensores y/o los que alteran la fuerza muscular. El modelaje identificó 22 funciones relacionadas al Procedimiento Operacional Estándar, es decir el protocolo de prevención de caídas y las acciones seguidas después del evento. Entre estas, ocho presentaron variabilidad en su ejecución. En la segunda etapa, surgieron las categorías “La complejidad de los cuidados para prevenir las caídas” y “Sentimientos de la segunda víctima”. Conclusión: las caídas son fenómenos complejos y la prevención exige la participación del paciente, familia y equipo multiprofesional. Los profesionales involucrados son segundas víctimas y experimentan sentimientos de culpa, miedo, angustia e impotencia. Este estudio puede contribuir con la multiprofesionalidad y el abordaje precoz a las segundas víctimas.

Abstract Paper aims Identify the differences in the competences of the production engineering alumni and the importance attributed to it by the job market. Originality This is funded on investigating the gap between the competences the academy and the job market attribute to the professional of production engineering. Research method A questionnaire with production engineers was conducted to collect data that was analyzed using descriptive and predictive quantitative methods. Main findings Soft skills have higher importance to the job market but are the less addressed by universities. Professional competence importance is dependent on the sector. The skills with the higher gaps are associated with the constant transformation of industries and the increasing complexity of decision-making. Implications for theory and practice Theory should adopt a strategic orientation to guide the prioritization of competences and practice must adapt selection mechanisms to test for soft skills and customize it to the professional sector.

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.