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      Process-based Management aimed at improving health care and financial results Translated title: Gestión basada en procesos visando a mejoría de los resultados asistenciales y financieros en Salud Translated title: Gestão baseada em processos visando à melhoria dos resultados assistenciais e financeiros em Saúde

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          ABSTRACT

          The limited resources allocated to the health area and the growing demands require leaders’ qualified and committed performance in hospital management. In this perspective, the objective of this study is to reflect on the management practices that can be applied to hospital facilities to achieve better care and financial results. Among them, process-based management proposes an approach for continuous process improvement to achieve desired results; the method Lean Six Sigma allows identifying and eliminating waste in production processes; the continuous improvement model combines practical knowledge with the knowledge of how the system to be improved works, through observations and changes that allow its results measurement; and cost management and value-based healthcare provides for care mapping, from beginning to end, to assess what actually adds value to patients. The contributions of implementing these practices are recognized worldwide; using them, processes can be increased, improving efficiency, reducing waste, adding value to the business, increasing its revenue, and resulting in savings that can be passed on to the consumer, by improving quality.

          RESUMO

          Os recursos limitados destinados à área da Saúde e as demandas crescentes requerem a atuação qualificada e compromissada dos líderes na gestão hospitalar. Nesta perspectiva, objetiva-se refletir sobre as práticas de gestão passíveis de serem aplicadas às instituições hospitalares visando o alcance de melhores resultados assistenciais e financeiros. Dentre elas, a gestão baseada em processos propõe uma abordagem para melhoria contínua dos processos a fim de alcançar os resultados desejados; o método Lean Six Sigma permite identificar e eliminar desperdícios nos processos produtivos; o modelo de melhoria contínua alia o conhecimento prático ao conhecimento do funcionamento do sistema a ser melhorado, por meio de observações e mudanças que permitam a mensuração de seus resultados; e a gestão de custos e a Saúde baseada em valor preveem que o cuidado seja mapeado, do início ao fim do processo, para avaliar o que, de fato, agrega valor aos pacientes. As contribuições da implementação dessas práticas são reconhecidas mundialmente; utilizando-as, os processos podem ser incrementados, aumentando a eficiência, reduzindo os desperdícios, agregando valor ao negócio, aumentando a sua receita e resultando em economias que podem ser repassadas ao consumidor, pela melhoria da qualidade.

          RESUMEN

          Los recursos limitados destinados al área de Salud y las crecientes demandas exigen la actuación calificada y comprometida de líderes en la gestión hospitalaria. En esta perspectiva, el objetivo es reflexionar sobre las prácticas de gestión que se pueden aplicar a las instituciones hospitalarias para lograr mejores resultados asistenciales y económicos. Entre ellos, la gestión basada en procesos propone un enfoque de mejora continua de procesos para lograr los resultados deseados; el método Lean Six Sigma permite identificar y eliminar los desperdicios en los procesos productivos; el modelo de mejoría continua combina el conocimiento práctico al conocimiento del funcionamiento del sistema que se reta mejorar, a través de observaciones y cambios que permitan la medición de sus resultados; y la gestión de costes y de salud atención médica basada en el valor establece que la atención sea mapeada, desde el principio hasta el final del proceso, para evaluar lo que efectivamente es lo que agrega valor a los pacientes. Las contribuciones de implementación de esas prácticas son reconocidas a nivel mundial; con ellas se pueden incrementar los procesos, aumentando la eficiencia, reduciendo los desperdicios, agregando valor al negocio, aumentando sus ingresos y generando ahorros que pueden transferirse al consumidor, al mejorar la calidad.

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          Systematic review of the application of the plan–do–study–act method to improve quality in healthcare

          Background Plan–do–study–act (PDSA) cycles provide a structure for iterative testing of changes to improve quality of systems. The method is widely accepted in healthcare improvement; however there is little overarching evaluation of how the method is applied. This paper proposes a theoretical framework for assessing the quality of application of PDSA cycles and explores the consistency with which the method has been applied in peer-reviewed literature against this framework. Methods NHS Evidence and Cochrane databases were searched by three independent reviewers. Empirical studies were included that reported application of the PDSA method in healthcare. Application of PDSA cycles was assessed against key features of the method, including documentation characteristics, use of iterative cycles, prediction-based testing of change, initial small-scale testing and use of data over time. Results 73 of 409 individual articles identified met the inclusion criteria. Of the 73 articles, 47 documented PDSA cycles in sufficient detail for full analysis against the whole framework. Many of these studies reported application of the PDSA method that failed to accord with primary features of the method. Less than 20% (14/73) fully documented the application of a sequence of iterative cycles. Furthermore, a lack of adherence to the notion of small-scale change is apparent and only 15% (7/47) reported the use of quantitative data at monthly or more frequent data intervals to inform progression of cycles. Discussion To progress the development of the science of improvement, a greater understanding of the use of improvement methods, including PDSA, is essential to draw reliable conclusions about their effectiveness. This would be supported by the development of systematic and rigorous standards for the application and reporting of PDSAs.
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            The promise of Lean in health care.

            An urgent need in American health care is improving quality and efficiency while controlling costs. One promising management approach implemented by some leading health care institutions is Lean, a quality improvement philosophy and set of principles originated by the Toyota Motor Company. Health care cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing. When well executed, Lean transforms how an organization works and creates an insatiable quest for improvement. In this article, we define Lean and present 6 principles that constitute the essential dynamic of Lean management: attitude of continuous improvement, value creation, unity of purpose, respect for front-line workers, visual tracking, and flexible regimentation. Health care case studies illustrate each principle. The goal of this article is to provide a template for health care leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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              Improving Operating Room Turnover Time in A New York City Academic Hospital via Lean

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                Author and article information

                Journal
                Rev Esc Enferm USP
                Rev Esc Enferm USP
                reeusp
                Revista da Escola de Enfermagem da USP
                Universidade de São Paulo, Escola de Enfermagem
                0080-6234
                1980-220X
                06 May 2022
                2022
                : 56
                : e20210333
                Affiliations
                [1 ]Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-graduação em Gerenciamento em Enfermagem, São Paulo, SP, Brazil.
                [2 ]Universidade de São Paulo, Escola de Enfermagem, Departamento de Orientação Profissional, São Paulo, SP, Brazil.
                Author notes
                Corresponding author: Fernanda Novaes Moreno Brancalion Av. Robert Koch, 60, Vila operária 86038350 – Londrina, PR, Brazil fernandamoreno035@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-0140-4707
                http://orcid.org/0000-0002-3582-2640
                Article
                00603
                10.1590/1980-220X-REEUSP-2021-0333en
                10081584
                35551576
                74bd1b34-4b4f-4321-ba33-e358566f822c

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 July 2021
                : 14 March 2022
                Page count
                Figures: 0, Tables: 0, References: 23
                Categories
                Theoretical Study

                health management,total quality management,value-based purchasing,hospital administration,health care costs,gestión en salud,gestión de la calidad total,compra basada en calidad,administración hospitalaria,costos de la atención en salud,gestão em saúde,gestão da qualidade total,aquisição baseada em valor,administração hospitalar,custos de cuidados de saúde

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