Rui M. Lima, Erik Teixeira Lopes, Derek Chaves Lopes, Bruno S. Gonçalves and Pedro G. Cunha
This work aims to integrate the concepts generated by a systematic literature review on patient flows in emergency departments (ED) to serve as a basis for developing a generic…
Abstract
Purpose
This work aims to integrate the concepts generated by a systematic literature review on patient flows in emergency departments (ED) to serve as a basis for developing a generic process model for ED.
Design/methodology/approach
A systematic literature review was conducted using PRISMA guidelines, considering Lean Healthcare interventions describing ED patients’ flows. The initial search found 141 articles and 18 were included in the systematic analysis. The literature analysis served as the basis for developing a generic process model for ED.
Findings
ED processes have been represented using different notations, such as value stream mapping and workflows. The main alternatives for starting events are arrival by ambulance or walk-in. The Manchester Triage Scale (MTS) was the most common protocol referred to in the literature. The most common end events are admission to a hospital, transfer to other facilities or admission to an ambulatory care system. The literature analysis allowed the development of a generic process model for emergency departments. Nevertheless, considering that several factors influence the process of an emergency department, such as pathologies, infrastructure, available teams and local regulations, modelling alternatives and challenges in each step of the process should be analysed according to the local context.
Originality/value
A generic business process model was developed using BPMN that can be used by practitioners and researchers to reduce the effort in the initial stages of design or improvement projects. Moreover, it’s a first step toward the development of generalizable and replicable solutions for emergency departments.
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Denise Luciana Rieg, Rui M.M. Lima, Diana Mesquita, Fernando Cezar Leandro Scramim and Octavio Mattasoglio Neto
The purpose of this paper is to implement and evaluate active learning strategies to support engineering students in the development of research competences, contributing to the…
Abstract
Purpose
The purpose of this paper is to implement and evaluate active learning strategies to support engineering students in the development of research competences, contributing to the growing need for a closer relationship between research and teaching.
Design/methodology/approach
This study was developed using an action research approach. The data were collected through observations, questionnaire and focus group in order to evaluate the active learning strategies used in the context of the study, based on students' perceptions.
Findings
The results show that the implementation of active learning strategies, such as research-based learning and think-pair-share enhance the development of research competences, namely critical thinking and written communication. Additionally, this approach enables students to develop further their capstone projects, using the standards demanded in research process.
Research limitations/implications
The study was based mainly on teacher's observation and the participants are undergraduate engineering students enrolled in the course “Scientific Methodology” during 1 academic year.
Practical implications
Two levels of implications can be identified in this study: (1) for teachers' practice, who can adapt the step-by-step descriptions of the implemented approaches and (2) for research, contributing to the discussion about how to explore the teaching-research relationship in undergraduate courses.
Originality/value
The course of “Scientific Methodology” is part of the curricular structure of most undergraduate engineering programs offered by Brazilian Higher Education Institutions, and this study is a contribution for the improvement of knowledge on how this course may be conducted in an effective and engaging way.
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Najla Alemsan, Guilherme Tortorella, Carlos Manuel Taboada Rodriguez, Hadi Balouei Jamkhaneh and Rui M. Lima
The importance of a lean health-care supply chain is increasingly discussed. However, it is still not very clear how lean practices relate to resilience capabilities, as there are…
Abstract
Purpose
The importance of a lean health-care supply chain is increasingly discussed. However, it is still not very clear how lean practices relate to resilience capabilities, as there are synergies and divergences between them. This study aims at identifying the relationship between lean practices and resilience capabilities in the health-care supply chain.
Design/methodology/approach
This study conducted a scoping review based on five databases, which allowed the content analysis of 44 articles. Such analysis allowed the verification of trends and volume of studies on this topic. Further, the descriptive numerical and thematic analyses enabled the proposition of a conceptual framework, relating the adoption of lean practices to the development of resilience capabilities according to the tiers of the health-care supply chain in different value streams.
Findings
Three research directions were derived from this scoping review: empirical validation of the contribution of lean practices to resilience capabilities in the health-care supply chain; systemic implementation of lean practices across tier levels of the health-care supply chain; and complementary approaches to lean implementation toward a more resilient health-care supply chain.
Practical implications
The understanding of these relationships provides health-care managers arguments to prioritize the application of lean practices to improve desired resilience capabilities in the entire health-care supply chain.
Originality/value
To the best of the authors’ knowledge, there is no similar study in the literature.
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Flavia V. Barbosa, José C.F. Teixeira, Senhorinha F.C.F. Teixeira, Rui A.M.M. Lima, Delfim F. Soares and Diana M.D. Pinho
The aim of this paper is to characterize the rheological properties of the flux media exposed to different levels of solicitation and to determine its influence on the rheology of…
Abstract
Purpose
The aim of this paper is to characterize the rheological properties of the flux media exposed to different levels of solicitation and to determine its influence on the rheology of the solder paste. The data obtained experimentally are fundamental for the development of numerical models that allow the simulation of the printing process of printed circuit boards (PCB).
Design/methodology/approach
Rheological tests were performed using the Malvern rheometer Bohlin CVO. These experiments consist of the analysis of the viscosity, yield stress, thixotropy, elastic and viscous properties through oscillatory tests and the capacity to recover using a creep-recovery experiment. The results obtained from this rheological analysis are compared with the rheological properties of the solder paste F620.
Findings
The results have shown that the flux is viscoelastic in nature and shear thinning. The viscosity does not decrease with increasing solicitations, except in the case where the flow is withdrawn directly from the bottle. Even if the solder paste shows a thixotropic behavior, this is not the case of the flux, meaning that this property is given by the metal particles. Furthermore, the oscillatory tests proved that the flux presents a dominant solid-like behavior, higher than the solder paste, meaning that the cohesive/tacky behavior of the solder paste is given by the flux.
Research limitations/implications
To complement this work, printing tests are required.
Originality/value
This work demonstrates the importance of the rheological characterization of the flux in order to understand its influence in the solder paste performance during the stencil printing process.
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Thiago A. Souza, Guilherme Luís Roehe Vaccaro and Rui M. Lima
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…
Abstract
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.
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Rui M. Lima, José Dinis-Carvalho, Thiago A. Souza, Elisa Vieira and Bruno Gonçalves
Even though the implementation of lean in health care environments is relatively recent, it has been receiving a lot of attention in recent years. Partly because of the fact that…
Abstract
Purpose
Even though the implementation of lean in health care environments is relatively recent, it has been receiving a lot of attention in recent years. Partly because of the fact that it is a recent field of practise 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 study aims to review the implementation of lean tools and techniques applied to hospital organizational areas in a five-year period, between 2014 and 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.
Design/methodology/approach
As starting point for this systematic literature review (SLR), a set of selected pre-existing review publications was used to support the current study and as the ground base for the expansion of the studies about lean health care. The current study contemplated 114 articles from a five-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 production organization methods, 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 the cultural change of hospitals through structural changes, following new visions and strategic objectives, supported by real models of continuous structural and sustained improvement.
Originality/value
The current study develops a new perspective of the articles published under the thematic of lean health care, published in a recent period of five 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 health care, exposing the current trends, improvements and also the main gaps.
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Social movement research often focusses on phases of success and large protest events. By contrast, taking an interest in the question of how organizational change occurs within…
Abstract
Social movement research often focusses on phases of success and large protest events. By contrast, taking an interest in the question of how organizational change occurs within social movements, this study points out the importance of phases of low protest activity. The organizational structure of the Portuguese anti-austerity protests provides a thought-provoking case, as large protests organized by civil society actors other than the trade unions were a novelty in 2011. Furthermore, there are long periods of absence of large protests, and the organizational structure of the protests has undergone significant changes. Based on fieldwork in Portugal between September 2011 and March 2013, I differentiate between four phases in the organization of protests against austerity. I argue that it is mainly times of low degrees of activism – times that are rarely taken into account by social movement research – that lead to radical changes in the organizational structure of a social movement. The impact of the following factors on the direction of change is analyzed: (a) strategic choice; (b) values and normative commitments; (c) (potential) alliances and participants; (d) inspiration from other cases of social movement activism; and (e) learning processes, the history of social movements and the impact of memory.
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Ana Pinto de Moura, Luís M. Cunha, M. Castro‐Cunha and Rui Costa Lima
The purpose of this paper is to explore women's perceptions about the benefits and risks of fish consumption, while exploring differences on their views about wild and farmed…
Abstract
Purpose
The purpose of this paper is to explore women's perceptions about the benefits and risks of fish consumption, while exploring differences on their views about wild and farmed fish, considering light fish consumers.
Design/methodology/approach
The methodology adopted is exploratory, using focus group technique, segregating women by education level (higher education versus lower education). A focus group guide was designed, taking into account the following dimensions: attitudes towards fish consumption and perceptions towards farmed fish relative to wild fish, also considering risk perceptions related to farmed versus wild fish.
Findings
This study has shown that fish consumers enjoy the taste of fish and they are strongly convinced that eating fish is healthy. The main reason for their low fish consumption is related to perceive lacking of convenience. Women with higher education levels expressed additional knowledge considering different aquaculture systems and women with lower education levels were convinced that both wild and farmed fish offer benefits and present disadvantages.
Originality/value
The paper shows that attitudes of light fish users are partially similar to heavy fish users considering farmed fish production, with the search for convenience being driven by either perceived lack of time or perceived lack of cookery skills to prepare fish‐based meals.
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Muhammad Hussam Khaliq, Rui Gomes, Célio Fernandes, João Nóbrega, Olga Sousa Carneiro and Luis Lima Ferrás
This work aims to provide additional insights regarding the practicability of using conventional materials in the fused filament fabrication (FFF) process.
Abstract
Purpose
This work aims to provide additional insights regarding the practicability of using conventional materials in the fused filament fabrication (FFF) process.
Design/methodology/approach
Two different acrylonitryle butadiene styrene (ABS) grades are studied and compared, aiming to check to what extent the regular ABS developed for conventional polymer processing, with a different rheology than the one provided for the FFF process, can also be used in this process (FFF).
Findings
The rheological results show that a general-purpose ABS (ABS-GP) melt is much more viscous and elastic than ABS-FFF. It is clear that using ABS-GP as feedstock material in the FFF process results in poor coalescence and adhesion between the extruded filaments, which has a detrimental effect on the mechanical properties of the printed specimens. Despite its lower performance, ABS-GP can be a good choice if the objective is to produce an aesthetical prototype. If the objective is to produce a functional prototype or a final part, its mechanical performance requirements will dictate the choice.
Originality/value
This work provides insightful information regarding the use of high viscosity materials on the 3D printing process.
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Barbara de Lima Voss, David Bernard Carter and Bruno Meirelles Salotti
We present a critical literature review debating Brazilian research on social and environmental accounting (SEA). The aim of this study is to understand the role of politics in…
Abstract
We present a critical literature review debating Brazilian research on social and environmental accounting (SEA). The aim of this study is to understand the role of politics in the construction of hegemonies in SEA research in Brazil. In particular, we examine the role of hegemony in relation to the co-option of SEA literature and sustainability in the Brazilian context by the logic of development for economic growth in emerging economies. The methodological approach adopts a post-structural perspective that reflects Laclau and Mouffe’s discourse theory. The study employs a hermeneutical, rhetorical approach to understand and classify 352 Brazilian research articles on SEA. We employ Brown and Fraser’s (2006) categorizations of SEA literature to help in our analysis: the business case, the stakeholder–accountability approach, and the critical case. We argue that the business case is prominent in Brazilian studies. Second-stage analysis suggests that the major themes under discussion include measurement, consulting, and descriptive approach. We argue that these themes illustrate the degree of influence of the hegemonic politics relevant to emerging economics, as these themes predominantly concern economic growth and a capitalist context. This paper discusses trends and practices in the Brazilian literature on SEA and argues that the focus means that SEA avoids critical debates of the role of capitalist logics in an emerging economy concerning sustainability. We urge the Brazilian academy to understand the implications of its reifying agenda and engage, counter-hegemonically, in a social and political agenda beyond the hegemonic support of a particular set of capitalist interests.