Background Many management tools, such as Discrete Event Simulation (DES) and Lean Healthcare, are efficient to support and assist health care quality. In this sense, the study aims at using Lean Thinking (LT) principles combined with DES to plan a Canadian emergency department (ED) expansion and at meeting the demand that comes from small care centers closed. The project‘s purpose is reducing the patients’ Length of Stay (LOS) in the ED. Additionally, they must be assisted as soon as possible after the triage process. Furthermore, the study aims at determining the ideal number of beds in the Short Stay Unit (SSU). The patients must not wait more than 180 min to be transferred. Methods For this purpose, the hospital decision-makers have suggested planning the expansion, and it was carried out by the simulation and modeling method. The emergency department was simulated by the software FlexSim Healthcare®, and, with the Design of Experiments (DoE), the optimal number of beds, seats, and resources for each shift was determined. Data collection and modeling were executed based on historical data (patients’ arrival) and from some databases that are in use by the hospital, from April 1st, 2017 to March 31st, 2018. The experiments were carried out by running 30 replicates for each scenario. Results The results show that the emergency department cannot meet expected demand in the initial planning scenario. Only 17.2% of the patients were completed treated, and LOS was 2213.7 (average), with a confidence interval of (2131.8–2295.6) min. However, after changing decision variables and applying LT techniques, the treated patients’ number increased to 95.7% (approximately 600%). Average LOS decreased to 461.2, with a confidence interval of (453.7–468.7) min, about 79.0%. The time to be attended after the triage decrease from 404.3 min to 20.8 (19.8–21.8) min, around 95.0%, while the time to be transferred from bed to the SSU decreased by 60.0%. Moreover, the ED reduced human resources downtime, according to Lean Thinking principles.

O principal objetivo do presente artigo é a aplicação da ferramenta gerencial de engenharia value stream mapping (vsm) e a elaboração de um mapa de future state em uma lavanderia hospitalar, buscando uma melhor utilização dos recursos existentes e uma redução na complexidade do fluxo processual, visto que este setor pode ser comparado a um setor industrial por apresentar entradas e saídas específicas e ciclos processuais padronizados. A metodologia utilizada para o desenvolvimento do presente trabalho foi de natureza aplicada, os objetivos foram definidos como descritivos e a abordagem foi qualitativa, por meio do método de estudo de caso, sendo o cenário estudado no presente artigo o setor de lavanderia de um hospital regional do sul de minas gerais. O cenário atual do setor foi mapeado por meio do vsm e esperou-se que a aplicação do mapeamento da cadeia de valor (vsm) trouxesse benefícios analíticos sobre questões processuais, e que o uso dessa técnica ajudasse a identificar desperdícios, perdas processuais e a levantar sugestões de melhorias, as quais possibilitam uma tomada de decisão muito mais efetiva e direcionada às metas buscadas. Os objetivos da aplicação do vsm foram alcançados no presente estudo. Palavras-chave: lavanderia hospitalar; value stream mapping; mapa de estado futuro.

Background. Discrete Event Simulation (DES) and Lean Healthcare are management tools that are efficient and assist in the quality and efficiency of health services. In this sense, the purpose of the study is to use lean principles jointly with DES to plan the expansion of a Canadian emergency department and to the demand that comes from small closed care centers. Methods. For this, we used simulation and modeling method. We simulated the emergency department in FlexSim Healthcare® software and, with the Design of Experiments (DoE), we defined the optimal number of locations and resources for each shift. Results. The results show that the ED cannot meet expected demand in the current state. Only 17.2% of the patients were completed treated, and the Length of Stay (LOS), on average, was 2213.7, with a confidence interval of (2131.8 - 2295.6) minutes. However, after changing decision variables, the number of treated patients increased to 95.7% (approximately 600%). Average LOS decreased to 461.2, with a confidence interval of (453.7 - 468.7) minutes, about 79.0%. In addition, the study shows that emergency department staff are balanced, according to Lean principles.

Background. Discrete Event Simulation (DES) and Lean Healthcare are management tools that are efficient and assist in the quality and efficiency of health services. In this sense, the purpose of the study is to use lean principles jointly with DES to plan the expansion of a Canadian emergency department and to the demand that comes from small closed care centers. Methods. For this, we used simulation and modeling method. We simulated the emergency department in FlexSim Healthcare® software and, with the Design of Experiments (DoE), we defined the optimal number of locations and resources for each shift. Results. The results show that the ED cannot meet expected demand in the current state. Only 17.2% of the patients were completed treated, and the Length of Stay (LOS), on average, was 2213.7, with a confidence interval of (2131.8 - 2295.6) minutes. However, after changing decision variables, the number of treated patients increased to 95.7% (approximately 600%). Average LOS decreased to 461.2, with a confidence interval of (453.7 - 468.7) minutes, about 79.0%. In addition, the study shows that emergency department staff are balanced, according to Lean principles.

Capítulo 14: Aplicação de método multicritério para análise e diagnóstico do uso das práticas de gestão da produção e operações em empresas manufatureiras do Setor Metal-Mecânico da Região de São Luís.