Table 5.

List of proposals.

Proposals	Muda
Establish a communication protocol with the Public Health system to ensure that every new patient brings a medical history file (in paper or electronic format), thus a more efficient approach will be adopted (some tests might not be necessary, avoiding duplicity and improving patient experience).	Delay Transportation Overprocessing Movement Overproduction
Reduce the number of activities and the number of participants. Ex. 1. Portable X-Ray equipment would help patients to be transferred from emergency area directly to floor, as X-Ray test could be carried out at that moment. Ex. 2. Transfer of patient to operating area to be done in a way that only one hospital porter is required to dress/undress with safety protection equipment.	All 8 types of muda
Avoid duplication of tasks (for instance, printing X-Ray in paper and saving it electronically).	Delay Overproduction
Reduce distances by locating some areas in a different place. Ex. After surgery doctor speaking to patients in a meeting room.	Delay Transportation
Review and maintenance of electronic equipment and IT systems with the aim of detecting potential causes for malfunctioning.	Delay Overprocessing
Automate some steps: When starting the process, some actions could be automatically initiated as tests (blood test, X-Ray) and medical consultations (calls to geriatrics or cardiologist).	Delay Overprocessing
Implement a system to measure the quality of the delivered service (patient satisfaction, patient experience, etc.).	Overprocessing Defects
Implement poka-yokes in operating processes within the operating room: marking leg, surgery checklist to be displayed in operating area, screen or board with main steps identifying critical activities with symbols.	Overprocessing Defects Overproduction
Implementation of 5s techniques in operating processes within the operating room.	All 8 types of muda
Clinical process standardization (for surgery, doctors and nurses). Administrative and data input process standardization. Training of personnel according to the abovementioned new standardized processes.	All 8 types of muda
Implementation of communication practices between doctors and nurses based on documentation of orders and instructions (it could be in the computer system or in patient´s logbooks) with the aim of minimizing errors due to misunderstandings or wrong interpretations.	Transportation Overprocessing Defects Overproduction
Implementation of an adequate inventory management system (EOQ, FIFO, etc.).	Inventory
Implementation of tools to record and share best practices within the hospital and among different hospitals within the group. Further data analysis to understand the variability of data.	All 8 types of muda