Background Surgical Tray Rationalization (STR) consists of a systematic reduction in the number of surgical instruments to perform specific procedures without compromising patient safety while reducing losses in the sterilization and assembly of trays. STR is one example of initiatives to improve process performance that have been widely reported in industrial settings but only recently have gained popularity in healthcare organizations. Methods We conduct a scoping review of the literature to identify and map available evidence on surgical tray management. Five methodological stages are implemented and reported; they are: identifying research questions, identifying relevant studies, study selection, charting the data, and collating, summarizing and reporting the results. Results We reviewed forty-eight articles on STR, which were grouped according to their main proposed approaches: expert analysis, lean practices, and mathematical programming. We identify the most frequently used techniques within each approach and point to their potential contributions to operational and economic dimensions of STR. We also consolidate our findings, proposing a roadmap to STR with four generic steps (prepare, rationalize, implement, and consolidate) and recommended associated techniques. Conclusions To the best of our knowledge, ours is the first study that reviews and systematizes the existing literature on the subject of STR. Our study closes with the proposition of future research directions, which are presented as nine research questions associated with the four generic steps proposed in the STR roadmap.

Construction projects are known to be complex, due to being subject to uncertainty and variability. The use of buffers to protect them from the detrimental impact of variability has been well-researched. A key managerial choice is not whether or not to buffer variability, but rather how to define the necessary combination of buffers. Slack is a concept related to buffers but has been used in the literature to describe a broader range of strategies for coping with complexity. It allows an organisation to adapt to internal pressures for adjustment or to external pressures for change in policy. This paper aims to further develop the concept of slack and to unveil its relationships with other concepts and ideas that are partly overlapping such as buffers, resilience, robustness, flexibility, and redundancy. A concept map was devised in order to articulate the nature of the slack concept. This paper explores in detail this concept map and proposes a conceptual role for slack in the realm of Lean.

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Although the COVID pandemic has challenged the resilience of health services in general, this impact has been most visible in intensive care units (ICUs). This paper presents an exploratory study of how ICUs in Brazil have coped with the complexity stemming from the pandemic. Five guidelines for coping with complexity were adopted as analytical framework. The guidelines were concerned with slack resources, diversity of perspectives, visibility, work-as-done, and unintended consequences. There were three main sources of data: (i) a survey with respondents from 33 ICUs, which indicated their agreement with 23 statements related to the use of the complexity guidelines; (ii) semistructured interviews with seven survey respondents and two public health officials; and (iii) 20 h of observations of the meetings of a municipal bed management committee. Seventy resilience practices were identified from these data sources. Most of these practices (n = 30) were related to the guideline on slack resources, which were commonly obtained from other hospital units. As for the survey data, the statement related to the availability of extra or standby human resources obtained the lowest score, reinforcing the key role of slack resources. Five lessons learned for coping with complexity in ICUs were drawn from our data; one lesson for each guideline. Furthermore, the survey questionnaire is a potential ICU assessment tool, which can be adapted to other health services.

Business Process Management (BPM) is an approach to analyze and improve main activities of a company continuously. It seeks consistent results aligned with the strategic objectives. There are several approaches to the application of BPM, which focus on specific aspects of the company, not meeting all their needs. The Strategy, Indicators and Operations Model (MEIO), developed by Müller (2003), compiles the fundamental points of each isolated approach, creating a single model. The objective of this work is to provide a step-by-step application of the BPM aspects of MEIO in a practical case: a reference company that provides health services. Also, it provides a framework for organizing and connecting the various components of a product or service to its value chain. Through MEIO, a general analyze of the Company under study was made and the process “payment of invoices from providers” was detailed. Improvements were suggested based on a deeper investigation of the activities involved. The results include: (i) creation of rules engine to validate the procedures to be launched according to coverage, shortage, and contract; (ii) receiving procedure and cost audits separately and; (iii) digitalization and automatization of repetitive and manual activities.