ABSTRACT The purpose of this paper is to prioritize which waste should be treated by Lean Healthcare in a medical clinic of a middle-sized Brazilian hospital, using the multicriteria decision support method THOR 2. It focusses on structuring the problem, establishing alternatives through the study hospital and Lean interventions already made in it, and determining the criteria and parameters of THOR 2 with the help of Value Focus Thinking (VFT) and the hospital directors. THOR 2 was able to identify, taking into account its preference relationships in S2, that establishing a Kanban within the hospital’s medical clinic is the preferred and the main contribution and novelty to the literature is the way that multicriteria methods can help in Lean Healthcare decision making. As conclusions, it was possible to establish a prioritization order, maintaining the concept of continuous improvement, arising from Lean Healthcare, while respecting the limits and restrictions of the hospital. middlesized middle sized problem VFT (VFT directors identify S2 S hospitals s making conclusions order improvement

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 The paper presents a structured approach to address decision-making challenges within the medical clinic service of a mid-sized hospital located in Brazil, using Soft System Methodology (SSM). Its application extends to the medical clinic, a previously unexplored domain within the hospital. Within this context, we introduce a novel conceptual framework for healthcare, wherein we integrate Plan-Do-Check-Act (PDCA) tool into SSM framework. The overarching goal is to rectify the pivotal issue of excessive workload allocation among the medical clinic staff. The developed model effectively addresses this issue by optimizing task allocation. It achieves this by designating primary and auxiliary nursing staff for specific sets of tasks, taking into consideration the necessity for displacement and ensuring a fair distribution of workloads. Furthermore, our model incorporates PDCA into the implementation phase of SSM, thereby establishing a mechanism for ongoing improvement in the initial equilibrium achieved in terms of staff deployment and task distribution. decisionmaking decision making midsized mid sized Brazil SSM. . (SSM) context healthcare PlanDoCheckAct Plan Do Check Act (PDCA tasks workloads Furthermore (SSM