Aplicação da filosofia Lean em uma clínica odontológica do SUS

Abstract

Today, public health institutions face the constant pressure of meeting the needs of the population, while trying to manage the limitations of financial and human resources. In dentistry, the last national survey, in 2010, showed that 75% of the adult population between 35 and 44 years old needed dental treatments in Brazil. Faced with epidemiological challenges, financial difficulties, and the need to improve processes to expand access to public clinics, the question arises about how to improve these services. The need to review the current processes, aiming at improvements, increased access and more efficient management, justifies the realization of this research. In this context, the Lean philosophy emerges as a way to identify opportunities for improvement in processes, avoiding waste and guiding practices according to the needs of the population. This study aimed to evaluate the impact of the implementation of Lean in an unified healthcare Unified Healthcare System (UHS), system dental clinic. To achieve this goal, a qualitative research was carried out using the action research methodology, integrating theory and practice. Focus groups were also conducted with users and workers before and after the implementation of Lean, seeking to identify the value of the customer, their needs and perceptions of change. The results of the research highlight the impacts and positive results of the implementation, showing that Lean can and should be applied in dental clinics, with potential for other areas of health. The expansion of access occurred through new forms of scheduling, both at the reception of the gerenal practitioner and by application. With expanded access, the number of appointments has also increased, with an additional average of 87 patients seen per month. This represents more than a thousand patients annually, without financial or human resources investments. This approach can be optimized by implementing actions to control absenteeism, such as overbooking, confirming appointments, and using idle spaces. The research also reveals a similarity between Lean and Public Service Logic, a theory that allows us to understand the value of a public service based on the needs of users. Some challenges were identified, such as the lack of knowledge about Lean among health professionals. Additionally, the research describes contributions to theory and practice, detailing the entire implementation process and serving as a benchmark for future implementations. In the city of Curitiba, if applied in all dental clinics of the general Practitioner, this approach could result in an increase of 50% in the current supply, which would mean savings in the expansion investment of almost 12 million per year.