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Purpose Although there are general methodologies for lean implementation in manufacturing companies, a specific methodology for the implementation of lean healthcare in hospitals has not been addressed by the literature. Addressing this gap, the purpose of this paper is to develop a practice-driven methodology for implementing lean in hospital operations. Design/methodology/approach Three case studies were conducted to collect evidence on the lean implementation process in Brazilian hospitals. From empirical evidence and literature, the implementation methodology was proposed and submitted to critical assessment by experts from the field. Findings The process of lean implementation was very similar in all cases, triggered by strategic planning and operationalized by continuous improvement projects. On the other hand, in all cases, the lean implementation teams had to deal with employees’ resistance. These findings were valuable inputs to the development of the implementation methodology. After refinement, it was proposed a feasible, useful and user-friendly methodology. Research limitations/implications The proposed methodology was raised from the practice through case study research. However, the proposed methodology was not fully applied, and the associated performance measures were not elaborated in this paper. Therefore, more case studies and applications will be necessary to generalize the findings. Practical implications The methodology provides practical guidelines that support lean implementation in hospital operations. Although it demands adaptations for each specific hospital setting, this initial step may encourage hospital managers to start the lean journey. Originality/value This study addressed the gap in the literature regarding the lack of methodologies for implementing lean healthcare in hospital operations. The methodology synthesizes the knowledge, principles and tools of lean thinking that can be applied in hospital operations.

Resumo: Geralmente, a implementação do Lean Manufacturing (LM) se inicia com o Mapeamento do Fluxo de Valor (MFV). O objetivo deste trabalho é apresentar a aplicação do MFV, associado à simulação, a fim de analisar os impactos da adoção do LM no desempenho de uma empresa calçadista. Então, realizou-se um MFV do estado atual e, por meio da implantação de elementos da abordagem lean, pôde-se construir o MFV do estado futuro. Diferentes cenários foram simulados para a implementação do estado futuro e tiveram seus resultados comparados. As etapas produtivas simuladas foram o transfer, o corte e a montagem, visto que se considerou que entre esses processos poderia ser estabelecido um fluxo unitário do produto. Após a simulação, o cenário que apresentou melhores resultados proporcionou um aumento de produtividade de 19% em relação ao estado atual, além de melhoria em todas as outras variáveis que foram comparadas. A aplicação da simulação como um elemento adicional do MFV ajudou a identificar as vantagens da abordagem conjunta, uma vez que a mesma possibilita testar diferentes alternativas e definir melhor o estado futuro e suas estratégias de implementação. Palavras-chave: Lean Manufacturing. Mapeamento do Fluxo de Valor. Simulação.Abstract: The development of the Value Stream Mapping (VSM) is generally the first step for implementation of Lean Manufacturing (LM). The aim of this paper is to present an application of VSM with simulation in order to analyze the impacts of the LM adoption in the performance of a footwear plant. Therefore, a VSM was designed for the current state and, through the implementation of lean elements, a future state could be designed. Different scenarios were simulated for the future state implementation and the results were compared each other. Transfer, cutting and assembly sections were chosen to be simulated, because it was considered that would be possible to establish a onepiece flow between those processes. After the simulation, the scenario that presented the best results provided a 19% productivity increase over the current state, as well as improvement in all other process variables. The application of simulation as an additional element of VSM has helped to identify the advantages of the joint approach, since it enables to test different alternatives and better define the future state and its implementation strategies.

This study aimed to analyze the process of implementing lean healthcare in three Brazilian hospitals that have played a pioneering role in the implementation of this system. We adopted the case study approach and collected data through interviews, document analysis, and observation. The results showed that the processes of implementation of lean healthcare in the hospitals shared many similarities in terms of the flow of patients, materials, or information. Finally, it was possible to obtain some guidelines for the application of lean principles and techniques in order to facilitate the implementation of lean healthcare in hospital operations.KEYWORDS | Lean production, lean healthcare, service operations, healthcare operations, case studies. RESUMO Este artigo tem como principal objetivo analisar como ocorreu o processo de implementação do lean healthcare em três hospitais brasileiros que exerceram um papel pioneiro na aplicação desse sistema. Foi utilizada a abordagem metodológica do estudo de caso, adotando como técnicas de coleta de dados entrevistas, análise documental e observação. Os resultados evidenciaram que os processos de implementação da produção enxuta nos três hospitais tiveram muitas semelhanças, seja nos fluxos de pacientes, materiais ou informações. Por meio da pesquisa, foi possível extrair diretrizes quanto à aplicação das técnicas e dos princípios enxutos de modo a fornecer suporte às operações hospitalares na implementação da produção enxuta. PALAVRAS-CHAVE |

ResumoA visão baseada em recursos destaca o papel dos recursos empresariais para a eficácia das estratégias e para a construção de uma vantagem competitiva sustentável. Com base nesses conceitos, este artigo tem por objetivo verificar se os recursos estratégicos de duas empresas do setor hoteleiro de um município do estado de Mato Grosso do Sul estão contribuindo para as estratégias realizadas por essas organizações e, consequentemente, para sua vantagem competitiva. Para alcançar esse objetivo, foi adotado o método do estudo de caso, utilizando como técnica principal de coleta de dados a entrevista semiestruturada com perguntas abertas e fechadas dirigidas aos gerentes das empresas. Os resultados demonstraram um padrão comum entre as empresas pesquisadas, que apresentaram estratégias e recursos semelhantes. A avaliação dos recursos estratégicos permitiu entender a sua contribuição e a relação deles com as estratégias identificadas para os dois hotéis.

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We have investigated the polarized emission from a n-type GaAs/ AlGaAs resonant tunneling diode under magnetic field. The GaAs contact layer emission shows a large constant negative circular polarization. A similar result is observed for the quantum well, but only when electrons are injected from the substrate, while for inverted biases, the polarization tends to become positive for small voltages and large laser excitation intensities. We believe that the quantum well polarization may be associated to the partial thermalization of minority carriers on the well subbands and is thus critically dependent on the bias-controlled density of carriers accumulated in the well.