Value stream mapping: an application lean in the process of accountability in a philanthropic hospital

Moraes, Cristine Frare; Bonato, Samuel Vinícius; Junges, Vanessa de Campos; Moura, Gilnei Luiz de; Wachs, Priscila

doi:10.5902/1983465970957

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Original Article • Rev. Adm. UFSM 16 (2) • 2023 • https://doi.org/10.5902/1983465970957 copy

Value stream mapping: an application lean in the process of accountability in a philanthropic hospital

Mapeamento do fluxo de valor: uma aplicação lean no processo de entregas de contas em um hospital filantrópico

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

This study aimed to map the value flow of medical records of a philanthropic hospital, identifying opportunities for improvements in the process.

Design/methodology/approach:

A qualitative research of descriptive and exploratory bias was developed, in which the sources of evidence emerged from participant observation and documentary analysis. Therefore, data collection took place for three months in 2021, which took place in the administrative sectors of a large philanthropic hospital, and the process chosen to be mapped and analyzed was the surgical record.

Result:

The analysis of the process took place from the patient’s discharge to the delivery of the accounts to the typing/billing sector, where the routine of the post desks was observed and the current flows were mapped through the Value Stream Mapping tool (VSM), with several wastes being detected. The time spent in the process was approximately 56 days, after the suggested improvements and drawing up the map of the future situation, this time was reduced to 28 days. With the application of the tool, waste was identified and eliminated in the mapped process, generating a possibility of cost reduction.

Originality/value:

The study stands out as it seeks to link the context of value stream mapping in a hospital space, opening space for new research and contributing to practical results.

Keywords:
Lean Healthcare ; Value stream mapping; Philanthropic hospital

Universidade Federal de Santa Maria Avenida Roraima nº 1000, Prédio 74C, Sala 4210 - Cidade Universitária - Centro de Ciências Sociais e Humanas (CCSH) - Universidade Federal de Santa Maria (UFSM), Cep: 97105-900, Tel: +55 (55) 3220-9242 - Santa Maria - RS - Brazil
E-mail: rea@ufsm.br

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[1] E-mail:
cristine_frare@hotmail.com

Waste	Setting	Exemples in health
Defect/ Error/ Rework	Frequent errors in processing information or time spent doing some activities incorrectly.	Medication errors, surgeries performed on the wrong limb, or lack of information in the patient’s medical record.
Overproduction	Do more than the defendant or before it becomes necessary.	Prepare medications in search of accelerating their demand or perform/repeat unnecessary tests.
Transport	Unnecessary movements of goods or information, resulting in wasted time or cost Generation.	Excessive transport of patients or medicines due to layout unsuitable, which may cause wear or loss of materials.
Standby	Waits for the next event to occur or next work activity.	Employees waiting for information, patients or work to be done; patients waiting for consultation, tests or discharge.
Inventory/ Stock	Cost of excess inventory is represented in financial costs, storage, and transportation costs.	Supplies or drugs that are out of date or laboratory results to be analyzed.
Movement	Unnecessary movements by employees within the system itself.	Or administrative staff walking in excess due to inefficient planning of the layout of the institution.
Super Processing	Do something with higher quality than necessary, something unnecessary with ineffective methods or extra processing.	Filling out duplicate documentation, and information collected, but not used.
Human potential	Competencies, capabilities, and skills of employees that are not used to improve processes.	Employees who are demotivated by lack of opportunity stop making suggestions for improvements.

Step	Description
1. Commit to the lean	Senior management and all employees should support lean transformation efforts to reduce and eliminate waste. Therefore, teamwork must be stimulated so that everyone involved in the application of lean concepts has a commitment.
2. Choosing the value stream	It is understood that what is being created has some value for customers, who are willing to pay. In addition, the flow refers to a series of activities necessary to perform the service requested by the customer. In this case, the step involves selecting the value stream in such a way that, in addition to observing the individual process, the previous and subsequent processes that will be impacted are also observed.
3. Learn about the lean	Each organization has a different learning process for learning, which makes it necessary to explain concepts and tools to employees. Such knowledge on the part of employees can emerge from courses and delivery of materials. However, it is necessary to develop a training plan, because each person learns in one way.
4. Map the current state	It consists of a visual representation by means of symbols or icons of the flow in general. For good mapping, one must observe and understand the value stream and start it at the point closest to the customer and then return to the initial value stream process or activity.
5. Identify the metrics of lean	The Selected Value Stream will always have a specific indicator and will be determined based on this value stream. In search of determining an index lean effective, one should look for the one that allows stratification into components that address the identified wastes. However, indicators should be easy to understand and collect data.
6. Mapping the future state	Everyone involved in the process should collaborate with ideas for the plan and to achieve the future state, it should be understood as a process ofvolution.
7. Create continuous improvement plans	This is a fundamental step, as it allows improvements and that the work efforts are recognized. Therefore, in order to implement the idea of improving the value stream, it is necessary to divide it into several stages.
8. Execute continuous improvement plans	For a successful transformation in an organization, people must always look for ways to improve the value stream. In addition, it should be noted that every plan can be improved, so it needs to be adequate and adjusted.

General Hospital and cardiology / oncology Hospital
	June/21	July/21	August/21
UHS	663	700	737
Health insurance	204	198	209
Private Practice	58	72	55
Total	925	970	1.001
Average discharges /day	30	31	32

Accounts not invoiced by competence
	June/21	July/21	August/21
UHS	447	551	626
Health insurance	112	108	137
Private Practice	0	0	0
Total	559	659	763

Suggested improvements	Expected Results
Organization of physical space	Availability of shelves and bins for centralization of documents in only one place, reducing future losses of the same.
Determination of mandatory document	At the time of assembling the medical record, the documents will already be ready.
Daily billing to the sectors responsible for conducting the exams and printing them directly in the system	Decreased waiting time for medical records since they were “stagnated” waiting for their arrival.
Placement of a post secretary within the operating room	To conference the room sheets immediately after the end of the procedure, detecting the problems in the same act and correcting them with the professionals who are still in the sector.
Negotiation with OPSM suppliers	Send invoices and labels by e-mail and print them at the hospital itself, reducing the waiting time for them.
Training	Conducting training, at least once a month to share knowledge, and pass on improvements and changes.
Inclusion of medical references	To determine in each service unit a doctor “responsible” for resolving medical pending issues in your sector.
Contracting an integrated Hospital Information System	With the implementation of an integrated system, it is possible to monitor the patient’s flow, reduce the amount of paper, as well as make the process faster and more efficient.