This chapter is the result of a project signed between the Universidade Federal Fluminense and the Ministry of Health in 2019 and executed in 2020. Its objective was to identify intersections of ideas between the national humanization policy (PNH) and the Lean methodology. The path used was to seek ideas in the Lean methodology similar to the ideas present in the principles of the PNH. These intersections are understood as opportunities for actions that consider both the reduction of waste and the strengthening of aspects of the humanization of health. The authors identified seven common ideas: focus on the customer, the importance of the collective as a space for transforming work, the importance given to the workplace, shared management of processes, user inclusion, transversality of both, acting in the way of thinking about work. The conclusion is that such coincidences exist and are opportunities to deepen the dissemination of the principles and guidelines of the PNH through the actions of the Lean methodology and vice versa.
TopIntroduction
Nations have been experiencing a difficult time due to the covid-19 pandemic since the beginning of 2020. By the beginning of March 2021, it had already caused more than 2,760,000 deaths worldwide and over 304,000 in Brazil, i.e., a country with over 12,330,000 infected cases. (John Hopkins University & Medicine, 2021). There are countries that are faced with a worse situation on account of scenarios in which they do not have a public health system to face such an imposed situation. This pandemic has evidenced how important it is for nations having strong health care systems to ensure the right and access to health care services for all individuals, as forecasted by the Unified Health System, SUS, which is the Brazilian healthcare system. An effective system is based on meeting the population's demand through quality services at the right time and in the right place.
Regarding healthcare in Brazil, Souza et al. (2019) consider that over time:
[...] improved performance of actions through the National Health Surveillance System, although control problems persist for large corporations, including the areas of food, tobacco and pesticides, whose practices involve risk factors related to the epidemic of chronic diseases. (p. 3)
According to these authors, the constitutional assurance of right to health has yielded positive results, nevertheless, the assertion of right “is far from being achieved” (p.3) by the population who frequently have “[…] emergency healthcare problems, gaps and errors in services, which is unacceptable in civilized societies.” (p.3)
In order to combat healthcare problems faced in the latest decades, several countries have been seeking solutions through Toyota’s manufacturing philosophy, a Japanese automobile company. It is known as Lean thinking, Lean methodology, Toyota Production System (TPS) or lean manufacturing which is customer-oriented and aimed at waste reduction.
In this context, it is aimed to discuss the alignment of concepts of Lean manufacturing and the National Humanization Policy adopted by SUS, otherwise known as HumanizaSus. For such a purpose, the text begins through a presentation of the National Humanization Policy (PNH) to expose the basic aspects of the Lean methodology in the following section. Then, it is discussed the identified alignments. These are understood as opportunities for introducing the HumanizaSus policy concepts into the Lean methodology, and vice versa.
TopAbout The National Humanization Policy (Nhp)
Among the fundamental rights established in the Federal Constitution of 1988, in the section of Social Rights, Art.6, health is enacted as the right of the Brazilian people, in addition to education, work, housing, leisure, security, social security, protection for motherhood, childhood and assistance to destitute citizens. In Art.196, the Brazilian Constitution stipulates that health is the right of all citizens and duty of the State, and that it must be ensured by social and economic policies aimed at “reducing the risk of diseases and other health predicaments, as well as universal and equal access to healthcare, practices and services for their promotion, protection and recovery.” (Constituição Federal, 1988, p.55).
According to Moura (2013), the Constitution of 1988 stipulated the basis for creating an organizational structure that would ensure healthcare for everyone, in addition to indicating how this structure should be devised, as well as a definition of its objectives, thus outlining the scope of the Unified Health System.
SUS was regulated by law 8,080 in 1990, and it states its duties and functions as a public health system. Its guiding principles are universality, equity and integrality of healthcare for the Brazilian population.
The first one, universality, is the principle that promotes the idea that all Brazilian citizens, with no distinction, are entitled to health actions and services. It is this principle that best expresses the democratic feeling that health is everybody’s right and the duty of the State. Before the creation of SUS, only workers with formal employment or individuals linked to the Social Security system were entitled to use public health services. In the same line of though, a free medication distribution program was launched for certain chronic diseases, which was based on the premise that access to health is a universal right and, therefore, the duty of the State.