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Cited by 150Healthcare Quality and ManagementHealthcare Operations and Scheduling OptimizationQuality and Supply Management

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Lean healthcare in developing countries: evidence from Brazilian hospitals

Costa, Luana Bonome Message, Filho, Moacir Godinho, Rentes, Antonio Freitas, Bertani, Thiago Moreno, Mardegan, Ronaldo·2017·The International Journal of Health Planning and Management
DOI 10.1002/hpm.2331
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Abstract

The present study evaluates how five sectors of two Brazilian hospitals have implemented lean healthcare concepts in their operations. The main characteristics of the implementation process are analyzed in the present study: the motivational factor for implementation, implementation time, form (consultancy or internal), team (hospital and consultants), lean implementation continuity/sustainability, lean healthcare tools and methods implemented, problems/improvement opportunities, lean healthcare barriers faced during the implementation process, and critical factors that affected the implementation and the results obtained in each case. The case studies indicate that reducing patient lead times and costs and making financial improvements were the primary factors that motivated lean healthcare implementation in the hospitals studied. Several tools and methods were used in the cases studied, especially value stream mapping and DMAIC. The barriers found in both hospitals are primarily associated with the human factor. Additionally, the results obtained after implementation were analyzed and improvements in financial aspects, productivity and capacity, and lead time reduction of the analyzed sectors were observed. Further, this study also exhibited four propositions elaborated from the results obtained from the cases that highlighted barriers and challenges to lean healthcare implementation in developing countries. Two of these barriers are hospital organizational structure (and, consequently, how the senior management works with medical staff), and outsourcing hospital activities. This study also concluded that the initialization and maintenance of lean healthcare implementation rely heavily on external support because lean healthcare subject knowledge is not yet available in the healthcare organization, which represents a challenge. Copyright © 2015 John Wiley & Sons, Ltd.

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  • Economic benefits of lean healthcare include increase in revenue and costs reduction.

    “there are effects of “increase in revenue” and “costs reduction” [21,38,48].”

    From Lean Healthcare Tools for Processes Evaluation: An Integrative Review. (2021) · cites this paper as [21]

  • From an organizational point of view, lean tools help to change healthcare service flows and can obtain decrease in length of stay and lead time, increased productivity, reduction of errors and increased time allocated for assistance.

    “From an organizational point of view, tools help to change healthcare service flows and, as an effect of this, for example, one can obtain a “decrease in length of stay and lead time”, “increased productivity”, “reduction of errors” and time “increased in the time allocated for assistance” [20,21,32,50,51,56].”

    From Lean Healthcare Tools for Processes Evaluation: An Integrative Review. (2021) · cites this paper as [21]

  • With the use of DMAIC, the most prominent results were decreased lead time, reduced length of stay and decreased costs.

    “with the use of DMAIC, the ones that stood out the most were decreased lead time, reduced length of stay and decreased costs [21,30,38,48,55].”

    From Lean Healthcare Tools for Processes Evaluation: An Integrative Review. (2021) · cites this paper as [21]

  • Results such as increased time for patient care, restructuring of the physical structure, visual management, reduction of lead time and improvement financial performance were achieved with 5S and VSM.

    “results such as increased time for patient care, restructuring of the physical structure, visual management, reduction of lead time and improvement financial performance were also achieved [21,22,41,56,59].”

    From Lean Healthcare Tools for Processes Evaluation: An Integrative Review. (2021) · cites this paper as [21]

  • Brazilian authors have also published in international journals, which shows that the results achieved in Brazil have supported research around the world.

    “These Brazilian authors have also published in international journals, which shows that the results achieved in Brazil have supported research around the world [21,29,30,31].”

    From Lean Healthcare Tools for Processes Evaluation: An Integrative Review. (2021) · cites this paper as [21]

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Metadata

Authors
Costa, L. B. M., Filho, M. G., Rentes, A. F., Bertani, T. M., & Mardegan, R.
Affiliations
  • Universidade Federal de São Carlos (BR)
  • Universidade de São Paulo (BR)
Corresponding author
Filho, Moacir Godinho
ORCID
Venue
The International Journal of Health Planning and Management
Publisher
Wiley
Published
2015-12-17
Volume
32
Issue
1
Pages
e99-e120
ISSN
0749-6753 (ISSN-L)
DOI
10.1002/hpm.2331
OpenAlex
W2215654593
Cited by
150
References
0
Citations by year
2026: 8 · 2025: 7 · 2024: 11 · 2023: 14 · 2022: 13 · 2021: 28 · 2020: 43 · 2019: 13 · 2018: 8 · 2016: 4
FWCI
7.71
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The International Journal of Health Planning and Management (publishedVersion)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Healthcare Operations and Scheduling Optimization
  • Social Sciences › Business, Management and Accounting › Management Information Systems › Quality and Supply Management
Keywords
lean healthcare, hospital operations, implementation barriers, value stream mapping, DMAIC, hospital cost savings, organizational structure, implementation sustainability, developing countries, Brazilian hospitals
MeSH terms
Delivery of Health Care, Developing Countries, Emergency Service, Hospital, Hospitals, Efficiency, Organizational, Total Quality Management, Quality Improvement

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