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.

In this work, a novel optimisation-simulation based on the Recursive Optimisation-Simulation Approach (ROSA) methodology is developed to provide effective decision-support for integrated production planning and scheduling. The proposed iterative approach optimises production plans while satisfying complex scheduling constraints, such as robots' allocation in collaborative tasks. The plans are determined through a two-level MILP model and are iteratively evaluated by a detailed discrete-event simulation model to guarantee capacity-feasible solutions at the scheduling level. Through an industrial case study of a multistage assembly line design collaboratively operated by humans and mobile shared robots, near-optimal solutions comprise lot-sizing decisions, the release schedule of production orders, the allocation of tasks to humans or robots, and the number of robots per period. Moreover, by addressing a set of propositions to assess the methodology, the results highlight the advantages of the hybrid approach to converge into optimised operational decisions and analyse the process dynamics.

Emergency departments in hospitals are having many difficulties in achieving the performance levels required by health regulators and society. The waiting times as well as the total throughput time are examples of performance indicators that emergency departments need to improve in order to provide a better service to the community. To achieve improvement of performance, the present paper shows a methodology to assist the design process of an emergency department using simulation techniques. In this study, the emergency department of a hospital located in the northern region of Portugal was considered to test the proposed simulation technique. The emergency department initial state was assessed, in terms of patient flow, as well as the human resources needed at every stage of the service. In order to understand in depth the process that a patient goes through during an emergency episode, a comprehensive study was performed on the hospital database. This allowed the analytical description of an emergency episode, which was further used as an input to the simulation model. After developing the simulation model with the information obtained by the hospital’s database, a validation stage was performed. Finally, in order to achieve an optimized design for the emergency department several variant scenarios were considered and evaluated. This methodology proved to be very useful in determining an optimized operation for complex, and non-linear systems.

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.

The adoption of healthcare technologies has grown significantly, with real-time location systems (RTLSs) gaining particular attention. Despite decades of research, gaps persist in understanding the current state of the field and its future directions. This scoping review, conducted by PRISMA guidelines, identified 1718 articles retrieved from six databases, from which 83 were included. The findings reveal a dominance of U.S.-based case studies and a lack of systematic literature reviews. While RFID is the most commonly used technology, alternative solutions are emerging, though few studies explore their combined use. The emergency department is the most studied setting, focusing on patient flow. However, case study quality varies, which affects replicability, and literature reviews often fail to justify technological choices adequately. RTLS benefits include improved efficiency, enhanced patient safety, and cost reduction, but challenges such as precision issues and signal interference persist. RTLS also serves as a foundation for digital twins, integrating AI and Industry 4.0 technologies for more sustainable healthcare operations. Technological advancements may shift perceptions of RTLS challenges and benefits, highlighting the need for analysis by technology type and release date. Additionally, current MeSH terms fail to adequately cover healthcare technologies, resulting in the exclusion of relevant studies.