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1. Introduction
Due to the large volumes of resources consumed, healthcare organizations are under constant pressure to reduce costs, waiting times, errors, while improving services and patient safety (Aherne and Whelton, 2010; Waring and Bishop, 2010). Specifically in terms of costs, healthcare processes related to material and information flows are the most expensive ones, corresponding from 30 to 40 percent of the total expenditures (Aronsson et al., 2011; Johnson, 2015). In turn, Poulin (2003) and Schwarting et al. (2011) emphasize that approximately 50 percent of the total expenditures related to a hospital supply chain could be eliminated using supply chain management practices. In this sense, adopting methods that support healthcare supply chain improvements is extremely important, especially in public healthcare organizations.
Among the existing improvement approaches in healthcare management, the adaptation of concepts from manufacturing has been widely accepted, such as the implementation of lean production (LP) practices and principles (Brandao De Souza, 2009). Such adaptation has been denoted as “Lean Healthcare” (LH) and refers to the integration of lean practices and principles into the healthcare context (Sloan et al., 2014; Graban, 2016). LH implementation enables practitioners and personnel to continuously improve their work (Spear, 2005), prioritizing patients by identifying what is value for them, eliminating waste and reducing time to perform processes (Womack et al., 2005; Toussaint et al., 2012). According to Radnor et al. (2012), the benefits of implementing LH practices comprehend reduction of waiting time, improvement in service level, elimination of duplicated processes, greater organization of the work environment, improvement in relationship with other departments, and employee motivation.
Several studies on LH implementation are found in the literature (e.g. Spear, 2005; Kim et al., 2006; Fillingham, 2007; Brandao De Souza, 2009; Mazzocato et al., 2010; Filser et al., 2017). In general, they indicate that, although the maturity level of lean implementation in healthcare organizations is considered initial, there is a significant increase in the number of publications in this area. However, few studies address the implementation of lean practices in the context of healthcare supply chain, as well as methods that evaluate their implementation (Machado et al., 2014; Böhme et al., 2014; Hasle et al., 2016). Further, the fact that many of...