Lean healthcare: improving surgical process indicators through prioritization projects

Purpose: Implementing process management methodology through Lean Management and Design Thinking provides a new way to manage surgical blocks, maximize efficiency and adapt to the high variability of demand. This article presents our experience of implementing a set of improvement actions within the surgical process in the context of Lean Healthcare Processes. The project involved a total of 900 healthcare professionals over a 3-year period (2017-2019) and has impacted over 38,000 surgical patients each year at the Vall d’Hebron University Hospital in Barcelona, Spain. The purpose of this article is to present a set of improvement projects within the surgical process and show the indicators that monitor its evolution. These projects have been implemented successfully in a hospital with high surgical complexity and indicate how health care professionals and process engineers can work together as a team to improve healthcare resources. Design/methodology/approach: To evaluate the effectiveness of the actions presented, we propose a series of standardized indicators showing how our findings increase the efficiency of the surgical process. We also indicate Lean projects that can reduce patient waiting times and increase capacity. Below is a management model for the surgical process that considers industrial production criteria such as resource planning, optimizing the use of operating rooms and professionals’ time and generating the best surgery combinations. Findings: Projects that have increased efficiency in the surgical block the most have been standardized and converted into a model of action. This is designed to adapt to any level of complexity within the hospital process. The set of improvement projects has been divided into 6 stages: Programming, Material logistics process, pre-surgical stage, intra-surgical stage, post-surgical stage and transversal projects; each affecting a different area of the general hospital (not only the surgical unit). Furthermore, a visual flow chart was designed using the results of the project. Findings from the study have led to a 15% increase in surgical capacity without the need for new resources. The average hospital stay also dropped from 7.2 days to 4.1 days. The flow vision in the care process improves the experience of both patients and health care professionals, who see their participation as part of the whole health care process. Research limitations/implications: the projects were mainly developed at the Vall d’Hebron University Hospital. Although several of these projects have been carried out in other hospitals in Spain by the same team of process engineers, results may be biased when the team provides support within its own process department, compared to when it supports the local team in another hospital temporarily. Another important limitation is that it takes several months to implement and consolidate the improvement projects and demonstrate improved indicators in a sustainable way over time. This matrix of projects is more than a specific action, a cultural change with the entire surgical department. Originality/value: This study sets out a proposed practical example of applying surgery management tools in the surgical process. Our proposal can offer hospital managers and surgical coordinators an orderly, streamlined project guide for overall surgical performance indicators. The main results from developing the model include the degree of satisfaction shown by healthcare professionals and the determined commitment from the center’s management team to promote process management using Lean methodology. This commitment continued despite the challenges of shifting the organizational structure towards process management, which is a complex task requiring a period of adaptation and learning. Healthcare management has always prioritized increasing surgical patient safety and satisfaction. Patient flows are increased and resources used more efficiency by shifting the focus to the patient and the processes gone through during their hospital stay. This improvement project provides us with the best example of Lean methodology implementation if reinvested in bettering healthcare. This in turn increases the value perceived by patients, which is the ultimate purpose of the processPeer Reviewe

Análise microestrutural do esmalte decíduo desmineralizado após escovação dentária in vitro

The aim of this study was to investigate, in vitro, the morphological characteristics of demineralized primary enamel subjected to brushing with a dentifrice with or without fluoride. In order to do so, 32 enamel blocks were divided in 4 different groups containing 8 blocks each. They were separately immersed in artificial saliva for 15 days. The experimental groups were: C - control; E - submitted to etching with 37% phosphoric acid gel (30 s); EB - submitted to etching and brushing 3 times a day with a non-fluoridated dentifrice; EBF = submitted to etching and brushing 3 times a day with a fluoridated dentifrice. The toothbrushing force was standardized at 0.2 kgf and 15 double strokes were performed on each block. After the experimental period, the samples were prepared and examined under SEM. The control group (C) showed a smooth surface, presenting scratches caused by habitual toothbrushing. The etched samples (E) exhibited different degrees of surface disintegration, but the pattern of acid etching was predominantly the type II dissolution. The brushed surfaces were smooth, with elevations which corresponded to the exposure of Tomes process pits and depressions which corresponded to interrod enamel. Particles resembling calcium carbonate were found in the most protected parts of the grooves. No morphological differences were observed between brushing with fluoridated (EBF) and non-fluoridated (EB) dentifrice. The results suggest that the mechanical abrasion caused by brushing demineralized enamel with dentifrice smoothes the rough etched surface, and the presence of fluoride does not cause morphological modifications in this pattern.O objetivo do estudo foi investigar as características morfológicas do esmalte decíduo desmineralizado submetido à escovação com dentifrício fluoretado ou não fluoretado. Para isto, 32 blocos de esmalte foram separados em 4 grupos diferentes, contendo 8 elementos cada que foram imersos em saliva artificial por 15 dias: C = controle; E = atacado com gel de ácido fosfórico a 37% por 30 segundos; EB = atacado e escovado 3 vezes ao dia com dentifrício não fluoretado; EBF = atacado e escovado 3 vezes ao dia com dentifrício fluoretado. A escovação foi padronizada em 0,2 kgf e 15 movimentos de vai-e-vem foram executados em cada bloco. Após o período experimental, as amostras foram preparadas e examinadas no MEV. O grupo controle (C) apresentou lisura superficial e riscos causados pela escovação habitual; as amostras atacadas (E) apresentaram diferentes graus de desintegração superficial, porém o padrão de ataque ácido foi predominantemente a dissolução do tipo II. As superfícies escovadas apresentaram-se alisadas, com exposição das elevações correspondentes aos processos de Tomes e as depressões de esmalte interprismático. Partículas semelhantes a carbonato de cálcio foram encontradas nas partes mais protegidas das depressões. Não houve diferença quando os grupos foram escovados com dentifrício fluoretado (EBF) e dentifrício sem fluoreto (EB). Os resultados sugerem que a abrasão mecânica da escovação com dentifrício sobre o esmalte desmineralizado alisa a superfície rugosa causada pelo condicionamento ácido e que a presença do fluoreto não altera morfologicamente este padrão

How much does Lean Manufacturing need environmental and information technologies?

This paper analyses the role played by Environmental and Information Technologies (ET&IT) in the capability of Lean Manufacturing (LM) to achieve improved industrial performance. In contrast to seminal literature about lean practices, and in view of increasing consumer requirements regarding response times and environmental concerns, we suggest that shop-floor technologies are crucial for transforming lean routines into enhanced performance. Hypotheses were tested in a multisectoral sample of 763 manufacturing plants (NACE codes 15–37) from five different European countries. Results confirm total mediation by both technologies between lean routines and industrial performance, which entails that LM establishes efficient conditions on the shop floor for developing technology-enabled capabilities that can be leveraged to improve industrial performance. From a managerial perspective our findings highlight the need for avoiding short-sighted attitudes and for internalising plant technologies within lean transformation projects. This is important not only because such technologies are determinant for maximising the potential of organisational routines in current manufacturing systems but also because of their intrinsic benefits.Ministerio de Economía y Competitividad | Ref. ECO2016-76625-

Blue-green infrastructure (BGI) in dense urban watersheds. The case of the Medrano stream basin (MSB) in Buenos Aires

Conventional urban drainage approaches have historically focused on the volume of stormwater to be displaced with the aim of moving it as fast and as far as possible from the city. They have also been negligent regarding water quality and the inherent value of watercourses to distinct forms of life in cities, from maintaining biodiversity to providing recreational space for residents. Contemporary responses to these issues point to a paradigm change: They seek to replicate the natural mechanisms of absorption and retention, with the aim of addressing pluvial drainage needs closer to the site of origin. This article aims to explore the extent to which such an approach could be accommodated in one dense and highly impervious setting in the Global South. Specifically, it compares urban morphology, land value, hydraulic performance, and politico-institutional conditions of grey and Blue-Green Infrastructure (BGI) scenarios in Buenos Aires, Argentina. The findings suggest that even in very dense and impervious urban basins it is possible to implement BGI with a significant effect in achieving urban-sustainability goals. Furthermore, the results demonstrate that it is possible to deculvert watercourses in line with Compact City principles through the development of hybrid BGI/grey-infrastructure systems.Fil: Kozak, Daniel Matias. Universidad de Buenos Aires. Facultad de Arquitectura y Urbanismo. Centro de Investigación Hábitat y Energía; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Centro de Estudios Urbanos y Regionales; ArgentinaFil: Henderson, Hayley. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Centro de Estudios Urbanos y Regionales; Argentina. Australian National University; AustraliaFil: de Castro Mazarro, Alejandro. Leibniz Institute of Ecological Urban and Regional Development,; AlemaniaFil: Rotbart, Demián. Universidad de Buenos Aires. Facultad de Arquitectura, Diseño y Urbanismo; ArgentinaFil: Aradas, Rodolfo. Universidad de Buenos Aires. Facultad de Ingeniería; Argentin

Result from the partnership between RBSO and Abrasco's worker's health technical comitee

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Medicina PreventivaFundacentro Centro Estadual do Rio de JaneiroSuperintendência Regional do Trabalho de São PauloUniversidade de São Paulo Faculdade de Saúde PúblicaUNIFESP, EPM, Depto. de Medicina PreventivaSciEL

ReonV: uma versão RISC-V do processador SPARC LEON3

Este artigo reforça a importância de reutilização e contribuição para o desenvolvimento de hardware de código aberto, mostrando o exemplo de desenvolvimento de um processador soft-core RISC-V, dado o nome de ReonV, que foi desenvolvido reutilizando todos os módulos de um processador SPARC V8 de 32 bits já consolidado, modificando apenas seu pipeline para a nova ISA e herdando todos os outros módulos e o Board Support Package (BSP) do processador original

HISAR : hydrologic Indices of South American Rivers

This is a preview of the HISAR dataset (Hydrologic Indices of South American Rivers). The HISAR dataset is freely available for non-commercial use. The files provided are (i) drainage line shapefile with river reaches as represented by the MGB model and 73 attributes corresponding to hydrologic indices derived from simulated time series; (ii) gauge points shapefile with 73 attributes corresponding to hydrologic indices derived from observed time series; (iii) maps with hydrologic indices, (iv) maps with information of the error of some indices and (v) the scripts used to calculate the indices. This database provides a spatial view of the variability of the river flow regime characteristics. The line shapefile has 33,749 river reaches with an average length of 15 km and drainage area > 1000 km². The ESRI shapefile also has the attributes of drainage area (Upst_Area_ in km²), length (Ltr_Km_ in km), UC (corresponding catchment attribute from hydrological modelling), HYear_min (starting month of the hydrological year of minimum flow) and HYear_max (starting month of the hydrological year of maximum flow). A value of -9999999 is used as a symbol of ‘no data’. Some river reaches do not have all hydrologic indices calculated, due to series of streamflows that could not meet specific criteria. For instance, the baseflow recession constant was automatically calculated using at least five consecutive days of decreasing streamflow, all of which below the Q90 (streamflow value that is exceeded 90% of the time), and this condition was not found in all cases. The gauge points shapefile has 1329 points with 73 attributes corresponding to hydrologic indices derived from observed time series. The drainage area of the gauges ranging from 1,000 to 4,703,503 km2. The ESRI shapefile also has the attributes of code, name, latitude (lat), longitude (long), drainage area (Upst_Area_ in km²), Country were the gauge point are located, HYear_min (starting month of the hydrological year of minimum flow) and HYear_max (starting month of the hydrological year of maximum flow). A value of -9999999 is used as a symbol of ‘no data’. For more information about HISAR dataset see the journal article DOI: in preparation

Fortalecimiento de la escritura en los estudiantes del grado tercero de básica primaria de la Institución Educativa Bazán a través de versos regionales a partir del área de español.

Este proyecto aplicado se diseñó con el ánimo de dar repuesta la problemas presenten en la Institución educativa Bazán en la comunidad el cual tiene el mismo nombre de la Institución buscando alternativas de solución al problema. La escritura como procesos de aprendizaje que se dan a lo largo de toda la vida y que involucran una serie de subprocesos; en el grado tercero de primaria de la Institución educativa Bazán. Que deben ser coordenado entre sí para logra éxito en la tarea de escribir. El problema encentrados en los estudiantes de tercero de primaria fue. La problemática de la escritura y que era palpable en los chicos y chicas de la Institución que se menciona anteriormente. El cual se diseñó entrevista, propuesta y unos planes de aula con el fin de dar soluciones a la dificultad encontrada en los niños y niñas. Este trabajo o proyecto proponemos que desde en el aula de clase debemos valerlos de herramientas que sean útiles para diseñar estrategias y fomentar actividades para mejorar la escritura en el grado tercero debemos tener en cuenta el conocimiento previo de los estudiantes, a fin de apoyarse en él y promover avances en los procesos de escritura por lo tanto utilizando los versos regionales y la lúdica como estrategia pedagógica.This applied project was designed with the aim of giving answers to the problems presented in the educational institution Bazán in the community which has the same name of the institution looking for alternative solutions to the problem. Writing as learning processes that occur throughout life and that involve a series of subprocesses; in the third grade of primary education Bazán Institution. They must be coordinated with each other to achieve success in the task of writing. The problem found in third grade students was. The problem of writing and that was palpable in the boys and girls of the institution mentioned above. Which was designed interview, proposal and classroom plans in order to provide solutions to the difficulty found in children. This work or project we propose that from the classroom we should use tools that are useful to design strategies and encourage activities to improve writing in the third grade we must take into account the prior knowledge of students, in order to rely on it and promote advances in the writing process, therefore using the regional verses and the playful as a pedagogical strategy

O desenvolvimento curricular em estrutura modular : um estudo do sistema modular em duas escolas profissionais

O presente estudo de investigação, inserido na Dissertação de Mestrado em Ciências da Educação, especialidade de Supervisão Pedagógica e Avaliação de Docentes, apresentado à Faculdade de Educação e Psicologia da Universidade Católica Portuguesa, tem como eixo principal o Desenvolvimento Curricular em Estrutura Modular, tendo em conta a sua especificidade e potencialidades. Neste sentido, a investigação desenvolvida visou averiguar, nas escolas profissionais em estudo, se e de que forma o sistema modular se encontra em implementação/desenvolvimento, como é considerado pelas lideranças das escolas em causa, como é operacionalizado o ensino e como se processa a aprendizagem, e que perspetivas têm os diferentes intervenientes acerca deste modelo. O estudo de investigação sustentou-se num quadro teórico ligado às áreas do currículo e do desenvolvimento curricular, com um enquadramento no tempo (década de 30 a década de 90 do século XX) de forma a percecionarem-se algumas teorias que fundamentam esta prática curricular, de modo a permitir perceber de que modo este modelo organizativo do currículo corresponde ou não a uma melhor adaptação à nova escola que emergiu: a “escola de massas”, uma escola para todos. Na componente empírica, seguiu uma metodologia de abordagem qualitativa, centrada em entrevistas a atores relevantes bem como em observação de aulas e análise documental, em que o tratamento dos dados recolhidos, através de instrumentos adequados, que no estudo se descrevem e fundamentam, permitiu evidenciar conclusões sustentadas, com a objetividade inerente a um estudo de carácter descritivo. Desenvolveu-se em duas escolas profissionais privadas do Porto, e os dados foram recolhidos através de entrevistas semiestruturadas realizadas às diretoras pedagógicas, coordenadores de curso, professores e alunos, observação de aulas de quatro disciplinas e análise de conteúdo documental dos projetos educativos das duas escolas. O estudo demonstrou que decorridos mais de 25 anos, de existência de escolas profissionais, a estrutura modular continua a ser implementada, com fragilidades, sendo os seus princípios estruturantes conhecidos pelos atores educativos das escolas em estudo, mas pouco aplicados. A estrutura modular é operacionalizada com contradições, no sentido em que se detetaram aberturas a lógicas tradicionais, sendo as práticas de ensino mistas. Na avaliação, o “modo teste” verifica-se como elemento predominante o que indicia uma divergência relativamente aos pressupostos curriculares do modelo. Os espaços onde decorre o ensino e a aprendizagem, e a sua configuração, são de natureza tradicional, contudo, verificaram-se práticas que decorrem para além da “sala de aula”. As duas escolas revelam à comunidade, não só a nível de atividades inseridas em módulos, de atividades inseridas em programas comunitários, com também a nível do desenvolvimento e concretização da Formação em Contexto de Trabalho e da Prova de Aptidão Profissional, verificando-se parcerias consolidadas.The focus of this research, which integrates the Master of Education dissertation in Education Sciences, in the specialized area of Pedagogical Supervision and Teachers‟ Evaluation, presented to the Faculdade de Educação e Psicologia da Universidade Católica Portuguesa the Curricular Development in Modular Structure, its specificity and potentialities. Thus, this research aimed to inquire, in the vocational schools within its scope, if and in what way this modular system is being implemented / developing, how the schools‟ leaderships regard it, how both teaching and learning are being processed. This study has been supported by a theoretical framework related to areas such as curriculum and curricular development, with a specific timeframe (from the 1930‟s to the 1990‟s), to understand the theories substantiating the said curricular practice, and whether this organizational model corresponds to a better adaptation to the new emerging school: the “school for the masses”, a school for all. In its empirical component, this research has followed a method of qualitative approach, based not only on interviews made to relevant participants, but also in-class observation and documental analysis. The resulting data was observed with the appropriate instruments, described and justified in the study, therefore proving the conclusions sustained, holding the objectivity proper to a descriptive study. This research was developed in two private vocational schools in Porto, and the data was gathered using the semi-structured interviews to their pedagogical directors, course coordinators, teachers and students, in-class observation of four subjects and documental analysis of the two schools‟ educational projects. The study showed that after twenty-five years, the modular structure is still being implemented in vocational schools, albeit with inefficiencies, and although its structural principles are known by the participants, few are applied. The modular structure is used with contradictions, as there is acceptance to traditional reasoning, but also a mixture of teaching practices. Regarding the evaluation, the “test mode” is the predominant element, which indicates a divergence concerning the purpose of the curricular model. The setup of teaching and learning spaces is a traditional one, although practices outside the classroom were also observed. Both schools showed openness towards the community, not only because of the activities included in modules, as well as those integrated in community programmes, but also because of the development and accomplishment of the Professional Training Program as well as the Final Evaluation of the Professional Project, in which consolidated partnerships were observed