WASTE REDUCTION USING THE THOR 2 HYBRID METHOD: DECISION MAKING IN THE CONTEXT OF LEAN HEALTHCARE

Drei, Samuel Martins; Santos, Marcos dos; Gomes, Carlos Francisco Simões; Angulo-Meza, Lidia

doi:10.1590/0101-7438.2023.043.00278889

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ARTICLES • Pesqui. Oper. 44 • 2024 • https://doi.org/10.1590/0101-7438.2023.043.00278889 copy

WASTE REDUCTION USING THE THOR 2 HYBRID METHOD: DECISION MAKING IN THE CONTEXT OF LEAN HEALTHCARE

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The purpose of this paper is to prioritize which waste should be treated by Lean Healthcare in a medical clinic of a middle-sized Brazilian hospital, using the multicriteria decision support method THOR 2. It focusses on structuring the problem, establishing alternatives through the study hospital and Lean interventions already made in it, and determining the criteria and parameters of THOR 2 with the help of Value Focus Thinking (VFT) and the hospital directors. THOR 2 was able to identify, taking into account its preference relationships in S2, that establishing a Kanban within the hospital’s medical clinic is the preferred and the main contribution and novelty to the literature is the way that multicriteria methods can help in Lean Healthcare decision making. As conclusions, it was possible to establish a prioritization order, maintaining the concept of continuous improvement, arising from Lean Healthcare, while respecting the limits and restrictions of the hospital.

Keywords:
THOR 2; Value Focus Thinking (VFT); Lean Healthcare in public hospitals

Waste	Lean tool	Code
D₁	Standard Work Procedure: Establish the stretcher bearer’s Genba, that is, a place he must return to, after the end of a process; preferably a hospital room, close to the reception.	A₁
D₂	Standard Work Procedure: Establish that at each new admission, the current capacity of the medical clinic is recorded for the main related wards of the hospital.	A₂
D₃	Kanban: Signpost the medical clinic rooms with signs, like the ones that already exist in the rooms.	A₃
D₄	Checklist: Establish a necessary checklist to be followed, every time a patient with a contagious disease is admitted to the medical clinic.	A₄
D₅	Standard Work Procedure: Establish that the time of entry of the patient is recorded at each admission.	A₅

Alternatives	C1	C2	C3	C4	C5
A1	5	1	0	621	30
A2	1	4	0	1008	102
A3	4	3	335	1036	96
A4	2	4	0	1067	90
A5	3	4	0	1144	88
Weights (DM1)	0,25	0,15	0,35	0,15	0,1
Weights (DM2)	0,1	0,3	0,3	0,2	0,1
Weights (DM3)	0,25	0,1	0,25	0,3	0,1

Parameters	C1	C2	C3	C4	C5
p	1	1	500	400	30
q	0,5	0,5	300	50	10
D	4,5	4	1000	1500	50

Result S1						Result S2						Result S3
A1	0	0,5	0,5	0,5	0,5	A1	0	0,5	0,5	0,5	0,5	A1	0	0,5	0,5	0,5	0,5
A2	0,5	0	0,5	0,5	0,5	A2	0,5	0	0	0,5	0	A2	0,5	0	0	0,507	0
A3	0,5	0,5	0	0,5	0,5	A3	0,5	0,513	0	0,513	0,5	A3	0,5	0,735	0	0,735	0,566
A4	0,5	0,5	0,5	0	0,5	A4	0,5	0,5	0	0	0	A4	0,5	0,912	0	0	0
A5	0,5	0,5	0,5	0,5	0	A5	0,5	0,509	0	0,502	0	A5	0,5	0,908	0	1,0	0
A1	2,0					A1	2,0					A1	2,0
A2	2,0					A2	1,0					A2	1,007
A3	2,0					A3	2,027					A3	2,536
A4	2,0					A4	1,0					A4	1,412
A5	2,0					A5	1,511					A5	2,408
A1=A2=A3=A4=A5 - Original						A3≥A1≥A5≥A2=A4 - Original						A3≥A5≥A1≥A4≥A2 - Original

Type	Criteria	Result	Elimination
S1	C1	A4=A5≥A3≥A2≥A1 - Without criteria	C2 and C5
	C2	A1=A2=A3=A4=A5 - Without criteria
	C3	A3≥A5≥A4≥A2≥A1 - Without criteria
	C4	A1≥A3≥A5≥A4≥A2 - Without criteria
	C5	A1=A2=A3=A4=A5 - Without criteria
	A1=A2=A3=A4=A5 - Original
S2	C1	A5≥A1=A2=A4≥A3 - Without criteria	None
	C2	A5≥A1≥A4≥A3≥A2 - Without criteria
	C3	A3≥A1≥A5≥A4≥A2 - Without criteria
	C4	A3≥A1≥A2=A4=A5 - Without criteria
	C5	A1≥A3≥A5≥A4≥A2 - Without criteria
	A3≥A1≥A5≥A2=A4 - Original
S3	C1	A5≥A4≥A2≥A1≥A3 - Without criteria	C3
	C2	A5≥A4≥A1≥A3≥A2 - Without criteria
	C3	A3≥A5≥A1≥A4≥A2 - Without criteria
	C4	A3≥A5≥A4≥A1≥A2 - Without criteria
	C5	A1≥A5≥A3≥A4≥A2 - Without criteria
	A3≥A5≥A1≥A4≥A2 - Original

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