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

Resumo O presente artigo refere-se à utilização da metodologia de análise de envoltória de dados (DEA) para determinar e comparar a eficiência técnica de clones de eucalipto dos gêneros Eucaliptus urophylla e Eucaliptus grandis, em escala comercial, produzidos no período de 2016 e 2017 e com idades de corte entre 5 e 7 anos. O plantio desses clones ocorreu em locais com solos arenosos, clima quente e temperado, destinados à produção de celulose e papel, pertencentes a uma empresa situada no interior do estado de São Paulo. Este estudo visa identificar quais clones apresentam ou não melhorias de eficiência técnica relacionadas a sua idade de corte, podendo auxiliar na tomada de decisão das melhores idades de corte e também quais clones deverão ser excluídos ou mantidos nos próximos ciclos produtivos. O cálculo da eficiência técnica e de seus valores atuais, folgas, alvos e benchmarks ao longo dos anos são determinados através das variáveis custo total; volume individual e volume produzido, sendo utilizado o modelo DEA BCC-O, em função da existência de pouca proporcionalidade de alguns pares input-output. Os clones CL02, CL03, CL05 e CL08 mostraram-se eficientes em ambas as idades de corte, caracterizando-os como possíveis benchmarks para os clones ineficientes. Já o clone CL04 foi o único cuja eliminação da lista de clones a serem utilizados nos próximos ciclos de plantio foi sugerida, apresentando diminuição de seu volume individual e densidade básica, quando ocorre o aumento de sua idade de corte. Conclui-se que a metodologia DEA é uma opção para o auxílio da tomada de decisão de quais clones de eucalipto devem ser utilizados, reduzidos e/ou eliminados de seu próximo ciclo, determinando quais são mais eficientes, verificando sua evolução em relação a sua idade de corte.

Abstract This study aims to identify which clones present technical efficiency improvements regarding their cutting age, helping the decision-making as to their best cutting ages and which clones shall be either excluded or maintained in the next production cycles. The data envelopment analysis (DEA) methodology is discussed to determine and to compare the technical efficiency of eucalyptus clones of the genuses Eucaplyptus urophylla and Eucalyptus grandis in commercial scale. They were produced between 2016 and 2017, with cutting ages equal to five and seven years. Their plantation occurred in areas of sandy soils, and warm, temperate climate in order to produce cellulose and paper. The plantation belongs to a company located in the state of São Paulo. The calculation of the technical efficiency and its current values, clearances, targets and benchmarks throughout the years are determined by the variables total cost, individual volume, and produced volume. The DEA BCC-O model was employed due to the little proportionality of some input-output pairs. Clones CL02, CL03, CL05, and CL08 seemed to be efficient in both cutting ages. This indicated that they were likely benchmarks for the inefficient clones. However, clone CL04 was the only one which exclusion of the clone list to be used in the next plantation cycles was suggested since it presented a reduction in its individual volume and basic density, when an improvement in its cutting age occurs. We concluded that the DEA methodology is a good choice for helping the decision-making regarding which eucalyptus clones shall be used, reduced, and/or eliminated from the next cycle, determining which ones are the most efficient ones, verifying their evolution about their cutting ages.