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.

ABSTRACT The main goal of this study is to determine the relative efficiency of the application of Lean Healthcare, based on a set of Brazilian public hospitals, using Data Envelopment Analysis (DEA). The study methodology consisted of establishing na analysis of the efficiency of Lean Healthcare, comparing the hospitals that applied it before and after, establishing the time and displacement as inputs and value as output, expressed in number of hospitalizations, to simulate the development conditions of the Lean in health. For this, the non-oriented SBM-DEA model was used, simulating the conditions of the medical clinics of the established DMUs. As a result, it was possible to observe that the hospitals were all inefficient before the application of Lean and had na improvement in efficiency after the application, but only a part actually became efficient. Thus, it is concluded that a metric that aligns the development of the Lean Healthcare application with DEA may be interesting, given the possibility of improvement arising from the benchmarks for the group of hospitals that remained inefficient.

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.

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.