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Introduction
Business process management (BPM) is derived from the combination of two approaches to improving performance, Six Sigma and business process reengineering, resulting in an integrated business performance management system focused on managing business processes from end-to-end (Hammer, 2010). This is a new way of viewing business operations, unlike the traditional view of functional structures based on the orchestration of activities in business functions (Paim et al., 2008). BPM emerged from process orientation, in which organizations began to focus their business processes on the customer instead of emphasizing functional and hierarchic structures (Reijers, 2006).
These organizational goals can be achieved with the aid of managing processes focused on delivering customer value (Maddern et al., 2013). In this context, the lean method, which is also focused on value, is approached in BPM as one of the different knowledge sets, mainly applied to the transformation of processes aimed at reducing waste (Association of Business Process Management Professionals (ABPMP) – Brasil, 2013). Thus, it is a supporting technique that includes a set of useful tools for improving processes and consequently the delivery of greater value to customers.
Improving organizational efficiency requires a constant focus on improving key processes and knowledge management (Bitkowska, 2015). Lean principles are currently known worldwide, and applications reach well beyond the production of goods to include service and healthcare delivery (Brandão de Souza, 2009). Initiatives to improve business processes are often confused with BPM, but they relate to specific improvements and culminate in a set of improvements to be implemented. However, the use of these approaches does not imply that the organization is committed to the practice of BPM (ABPMP, 2013).
Lean has been widely applied in the health sector independently of BPM. This application is sporadic and targeted at solving specific problems (Mazzocato et al., 2010). Thus, the overall strategic vision addressed by BPM has been suppressed by the current use of the lean approach in healthcare, contrary to that proposed by Womack and Jones (2003). Improving the management of business processes is a growing concern and a critical success factor for healthcare organizations (Rebuge and Ferreira, 2012) that are looking for methods to streamline processes to deliver high-quality services while reducing costs (Yarmohammadian et al., 2014). These organizations...