PSCPF: planning, scheduling and control of patient flow

Paper aims: Lack of operational planning in healthcare organizations may result in service disconnection and reduced value per effort to the patient. Production Planning, Scheduling and Control assists in determining “what,” “how much,”= “when” and “where” to deliver, which may be of great relevance to healthcare services. This study proposes a structural framework and analyzes the implementation of PPSC concepts in OR management. Originality: The application of concepts from manufacturing applied to healthcare as the PPSC, present in this text, demonstrates the crossing and alignment of global management techniques and tools applicable to both areas. Research method: The discussion is based on data gathered through action-research in a Brazilian public hospital. Main findings: In the hospital under study, the PSCPF implementation resulted in increased production control of surgeries, increased efficiency in management of waiting lists, increased operational efficiency, and motivational gains from staff integration. Implications for theory and practice: The understanding and proper implementation of the concept of PPSC contributed =to mitigate problems related to capacity management, reduced the unawareness of different levels of demand and waiting lists, cut down scheduling errors, and prevented the provision of false information from the disconnection between the various areas of the hospital.- (undefined

Nondisturbing extremum seeking control for multi-agent industrial systems

Industrial applications of extremum seeking control (ESC) can be a hit and miss affair. Although a gain in performance can be achieved, the dither applied to excite the system causes unwanted fluctuations in the performance of the system. The fluctuations in systems with a single extremum seeking loop are generally small. However, for systems with many extremum seeking loops, the fluctuations in each loop may add up to an intolerable amount of fluctuation in the total performance. In this article, we propose a method to cancel the dither-induced fluctuations in the overall system performance to a large extent by smartly constructing the dither signals in each extremum seeking loop using a centralized coordinator. The novelty of our method lies in the direct calculation of the dither signals that avoids the heavy computations required by other methods. Moreover, we provide a solvability analysis for the problem of cancelling dither-induced fluctuations in the total performance of the system. Furthermore, a complete stability analysis of the overall ESC scheme with dither coordination is given.publishedVersio

Operating room effectiveness: a lean health-care performance indicator

Purpose: Overall equipment effectiveness (OEE) is a performance indicator that is been used to measure manufacturing productivity. The purpose of this paper is to propose the operating room effectiveness for hospital operating rooms (ORs), adapted from the OEE, to measure performance and identify losses based on lean health-care principles. Design/methodology/approach: The present study is an exploratory, descriptive and applied research work. Literature review, documents of the hospital, observation and interviews with employees of a large university hospital in southern Brazil were analyzed to organize the proposed effectiveness indicator. After that, historical data of the ORs was collected and the usefulness of the indicator was analyzed. The indicator was applied for 10 months and validated with an expert committee from the hospital. Findings: The present study describes an adaptation of a performance indicator to ORs of hospitals, allowing to classify its types of operational losses in a lean health-care context. The application of this indicator and the development of improvement actions to a university hospital, resulted in operational efficiency gains of 12 per cent and estimated annual savings of US$400,000. Practical implications: ORs are a critical service for hospitals. This paper presents a new way to measure the performance of ORs and identify their main types of wastes. It also shows how to implement it and the potential gains of its application. The main research limitations are related to technical analysis of care data from doctors and nurses involved. Originality/value: This paper fulfills the need to study how ORs performance can be measured and its operational wastes can be identified. In addition, this paper classifies the planning, performance and quality related losses, which can be used by researchers and practitioners to improve the performance of operation rooms.This work was partially supported by Portuguese national funds through FCT–Fundação para aCiência e Tecnologia within the Project Scope: UID/CEC/00319/2019

ATR-FTIR Spectroscopy for the Assessment of Biochemical Changes in Skin Due to Cutaneous Squamous Cell Carcinoma

Nonmelanoma skin cancers represent 95% of cutaneous neoplasms. Among them, squamous cell carcinoma (SCC) is the more aggressive form and shows a pattern of possible metastatic profile. in this work, we used Fourier transform infrared spectroscopy (FTIR) spectroscopy to assess the biochemical changes in normal skin caused by squamous cell carcinoma induced by multi-stage chemical carcinogenesis in mice. Changes in the absorption intensities and shifts were observed in the vibrational modes associated to proteins, indicating changes in secondary conformation in the neoplastic tissue. Hierarchical cluster analysis was performed to evaluate the potential of the technique to differentiate the spectra of neoplastic and normal skin tissue, so that the accuracy obtained for this classification was 86.4%. in this sense, attenuated total reflection (ATR)-FTIR spectroscopy provides a useful tool to complement histopathological analysis in the clinical routine for the diagnosis of cutaneous squamous cell carcinoma.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Instituto Nacional de Ciencia e Tecnologia Fotonica (INCT)Produtividade em Pesquisa (PQ)IPEN CNEN SP, Ctr Lasers & Applicat, Inst Pesquisas Energet & Nucl, BR-05508000 São Paulo, SP, BrazilUniv São Paulo, Sch Dent, BR-05508000 São Paulo, SP, BrazilUniversidade Federal de São Paulo, ICT, BR-1223128 Sao Jose Dos Campos, SP, BrazilUniversidade Federal de São Paulo, ICT, BR-1223128 Sao Jose Dos Campos, SP, BrazilFAPESP: 05/51689-2CAPES: 071/2013-88881.068505/2014-01Instituto Nacional de Ciencia e Tecnologia Fotonica (INCT): 573.916/2008-0Produtividade em Pesquisa (PQ): 312397/2013-5Web of Scienc

Implementation of lean in health care environments: an update of systematic reviews

Purpose – Even though the implementation of Lean in healthcare environments is relatively recent, it has been receiving a lot of attention in recent years. Partly due to the fact that it is a recent field of practice and research and partly because the number of works developed in this field has grown rapidly, it is important to frequently update the perspectives on this field of investigation. Thus, this article aims to systematically review the implementation of Lean tools and techniques applied to hospital organizational areas in a 5-year period, between 2014 to 2018, complementing some of the most relevant reviews already published. The most important criteria such as tools, methods and principles, hospital areas intervened, improvements and difficulties were assessed and quantified. Methodology - As starting point for this systematic literature review, a set of selected pre-existing review publications was used to support the current work and as the ground base for the expansion of the studies about Lean Healthcare. The current study contemplated 114 articles from a 5-year period between 2014 and 2018. A subset of 58 of these articles was critically assessed to understand the application of lean tools and methods in different hospital areas. Findings - The thorough analysis of selected articles show a lack of works in Continuous Improvement approaches when compared to the application of work organization, visual management, and diagnosing and problem-solving tools. The reported improvement results demonstrate alignment with the principles and foundations of lean philosophy, but such results are presented in isolated initiatives and without robust evidence of long-term maintenance. Moreover, this study shows an evolution in the number of articles referring to lean implementation in hospital areas, but in its great majority, such articles report isolated implementations in different areas, not spreading those for the global organization. Thus, some of the main recommendations, are the need to implement studies on complete flows of patients, drugs and materials, instead of isolated initiatives, and strive to promote cultural change of hospitals through structural changes, following new visions and strategic objectives, supported by real models of continuous structural and sustained improvement. Originality – The current work develops a new perspective of the articles published under the thematic of Lean Healthcare, published in a recent period of 5 years, which are not completely covered by other works. Additionally, it explicitly applied, in an innovative way, an approach that used a set of previous reviews as the starting point for this SLR. In this way, it integrates approaches and categories from different SLRs, creating a framework of analysis that can be used by future researchers. Finally, it shows the most recent implementations of Lean Healthcare, exposing the current trends, improvements and also the main gaps.This work has been supported by FCT–Fundação para a Ciência e Tecnologia within the R&D Units Project Scope UIDB/00319/2020 and project POCI-01-0145-FEDER-03029

Prevalent Leadership Profile: A Research on Management of Innovation in the Military Organization

In this work we investigate prevailing leadership in a military organization. Our study has a multi-disciplinarily nature as it focuses on Organizational Innovation and the profile of a leader as well as a little investigation on history of the development of a military organization Our main objective is to identify the profile of a strategic prevalent leadership at the Firemen Corporation in Porto Velho, Rondonia – Northern Brazil. We propose to describe the process of nomination for someone to exercise the role of a leader used in the military structure. In this context, we make a survey of the prevalent elements considering the profile of leadership in the face of organizational innovation having in mind the expectation of the people involved in the process of research. At the end we conduct a critical analysis comparing the prevalent elements identified in our study with the expectation of innovation revealed by the military structure investigated. We apply the method of content analysis through convenient procedures. As a result, we present the elements which show prevalence for the definition of the leadership profile of the investigated military structure. We hope our research can contribute to the studies in the field of leadership, as we still have few references in the area of knowledge