International Journal of Lean Six SigmaLean office in health organization in the Brazilian ArmyIris Bento da Silva Everton Cesar Seraphim Oswaldo Luiz Agostinho Orlando Fontes Lima JuniorGilmar Ferreira Batalha

Article information:To cite this document:Iris Bento da Silva Everton Cesar Seraphim Oswaldo Luiz Agostinho Orlando Fontes LimaJunior Gilmar Ferreira Batalha , (2015),"Lean office in health organization in the Brazilian Army",International Journal of Lean Six Sigma, Vol. 6 Iss 1 pp. 2 - 16Permanent link to this document:http://dx.doi.org/10.1108/IJLSS-09-2013-0053

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Lean office in healthorganization in the

Brazilian ArmyIris Bento da Silva

Engineering School of São Carlos, University of São Paulo,São Carlos, Brazil

Everton Cesar Seraphim and Oswaldo Luiz AgostinhoFaculty of Mechanical Engineering, State University of Campinas,

Campinas, Brazil

Orlando Fontes Lima JuniorFaculty of Civil Engineering, State University of Campinas,

Campinas, Brazil, and

Gilmar Ferreira BatalhaDepartment of Mechatronics & Mechanical System Engineering,

University of São Paulo, São Paulo, Brazil

AbstractPurpose – The purpose of this paper is to present management techniques in the healthcare sectorthrough lean office.Design/methodology/approach – A case study approach is adopted, with data collected in theBrazilian military organization.Findings – The findings identify several ways to apply lean concepts outside manufacturing. Fromthis, a future lean office health state design will be proposed.Research limitations/implications – The lean office health proposal has to be tested in otherorganizations to confirm this case study. While this may limit the generalization of the findings, thereis value in demonstrating the benefits modern lean office techniques can bring to the developing worldhealthcare.Practical implications – The paper shows that lean office health techniques can provide benefits tohealthcare in developing countries’ hospitals and others.Originality/value – The value of the paper arises from providing a detailed analysis of a healthcarelean office in the developing world. There have been only a small number of other studies published inthe literature about lean office health.

Keywords Lean health, Lean office, Lean production

Paper type Case study

1. IntroductionMilitary organizations have functional peculiarities, the result of their verticalmanagement structure and their relationship with the federal administration. Thestructure of the Army is favorable about the command, direction and discipline. In

The current issue and full text archive of this journal is available on Emerald Insight at:www.emeraldinsight.com/2040-4166.htm

IJLSS6,1

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Received 12 September 2013Revised 6 May 2014Accepted 31 May 2014

International Journal of Lean SixSigmaVol. 6 No. 1, 2015pp. 2-16© Emerald Group Publishing Limited2040-4166DOI 10.1108/IJLSS-09-2013-0053

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contrast, in a second moment, when it comes to changing an organizational culture thatworks with people in the Army and civilians, the change process becomes more difficult.

The situation worsens when differences arise between the staff of the Army that ledthe team of civil health. This was the difficulty at the Campinas Medical Centre inmanaging their processes, both in support (back office) and customer-focused (frontoffice).

Another aspect that does not facilitate the functioning of the Medical Centre isthat each operation (doctor, dentist, etc.) is held in different locations, hinderingcommunication, decision-making and advances in most cases.

Thus, the concepts of lean office proposed by Tapping and Shuker (2003) can providegood results for military health organizations. This concept improves workflow andeliminates waste (problems) in existing administrative areas.

Based on these points, the development of this work was directed by the followingresearch question:

RQ1. Can you reduce the lead time in administrative proceedings applying the leanoffice?

Thus, this paper presents an application of lean office at the institutional level in the areaof service delivery, particularly in healthcare in military organizations (Medical Centre).

This paper is structured as follows. Initially, Section 2 presents the literature reviewon lean office. Section 3 presents the methodology adopted. Section 4 presents a casestudy of the lean office approach implementation in the administration, which in turn isanalyzed, and discussions are presented in Section 5; the conclusions are in Section 6.

2. Lean practices2.1 PrinciplesLean principles gained notoriety in the 1980s with the release of the results of a researchproject led by MIT (Massachusetts Institute of Technology), which studied themanagement practices and improvement programs adopted by leading companies inthe automotive supply chain and found that the adoption of these principles greatlycontributed to their competitiveness (Womack et al., 2007).

Lean thinking is supported on the TPS (Toyota Production System) (Liker, 2004;Shamah, 2013). It concerns the elimination of waste in the production process thatdoes not add value to the customer, besides reducing cost and improvingproductivity.

Thus, for the administrative processes to become leaner, companies have started todiscuss this possibility. The transfer of this methodology from the industrial area to theoffice is not so simple, and yet, there are few reports of actual experiences of leanapproach use in the management of services.

When the material waste and physical transformation processes involved areidentified in the operations area, they seem easy to apply (Hines and Taylor, 2000;Murgau et al., 2006; Found and Harrison, 2012; Laureani and Antony, 2012). However, inadministrative areas, most of the activities are related to information, thus it is moredifficult to look for losses in these processes.

The application of lean principles in this case is called lean office. What is importantfor this research is to evaluate the added value to the customer, which is not a simpletask, in the case of office (McManus, 2003; Chen and Cox, 2012).

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2.2 WasteIn the office (service areas), wastes are approximately 99 per cent (1 per cent is addedvalue), caused by the loss of values in their processes (Hines and Taylor, 2000). Thus,this study describes these losses, and then proposes procedures to reduce them.

The so-called seven wastes, according to Womack and Jones (1996), are classicallyidentified in manufacturing, and they can also be found in the office (Table I).

The waste called overproduction can generate more paper information thannecessary (paper or excessive bureaucratization). Stock waste can be exemplified asoverproduced reports that remain filed in computers. Another type of waste may beincorrectly recorded data (Lareau, 2002).

Lean transformation for offices recommends certain planning and action tools.

2.3 ToolsRother and Sook (2003) advocate the application of value stream mapping (VSM), whichis a planning tool that facilitates the visualization of information flows. VSM tries toportray the service system in a comprehensive way and aims to build maps that

Table I.The seven wastes inmanufacturing andin the office (adaptedfrom Lareau, 2002)

Waste Manufacturing Office

Processing novalue

Unnecessary Strategy: Is the value lost by implementing processesthat meet short-term goals, but that does not addvalue to our stakeholdersAlignment of goals: Is the energy expended bypeople working with unfocused goalsStrategic management: When there is muchdifference between the company’s organizationalstructureStandardization: The energy expended because of ajob not being done the best way possible, in such away that each group wants to accomplish it yourwayInadequate procedures or systems. Lack ofstandardization of documents

Overproduction Producing too muchand early

Information beyond what is necessary. Box emailcharged

Inventory Excess work-in-process Buffer overloadedDefect Problem of quality Five-s: Resistance to change leads the organization

fail to reach the discipline. This fact is linked tonon-compliance with procedures, system failuresoccurringMistakes in the documentation. Incorrectdetermination of the service times

Transportation Excessive movement ofpeople or parts

Excessive use of systems in communications.Unrelated database

Movement Disorganization of theworking environment

Excessive movement of people. No cell layout

Delay Machine maintenanceor setup

Approval signature for all documents, photocopywait, hold on the phone. Excess meetings.Disorganized files. Lack of training

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represent the same page as the flow of information (Tapping and Shuker, 2003;Danielsson, 2013; Habidin et al., 2014).

The Five-S (5S) tool is an important practice to motivate change, to establishdiscipline and also to standardize. For this, each of the “esses” considered promotes afundamental attitude toward work rationalization. This application, combined with asuitable physical arrangement, results in better visual control and execution of tasks ina lean way (Fabrizio and Tapping, 2006).

Continuous flow allows information to flow between the process steps, removingbottlenecks (restrictions, limitations, does not flow), with no stops (hold on phone), noinventory information (file in the computer) and without people moving between steps(Tapping and Shuker, 2003).

Standardized work is the best combination of features, such as employees andequipment, to ensure that a task is always performed in the same way. This meansdiscussing, establishing, documenting and standardizing, through a procedure, the bestresult with the best method.

It is noteworthy that authors such as Lewis (2000), Meir and Forrester (2002), Shahand Ward (2003) and Bhasin (2013) developed research on implementing lean practices.These articles report the importance of teamwork and cultural changes.

The method usually indicated for lean implementation is Kaizen workshops alignedwith VSM (Chen and Cox, 2012), which must be followed up daily through visualcontrols (Laraia et al., 1999; Martin and Osterling, 2007).

2.4 Lean office stepsTo achieve this state, Tapping and Shuker (2003) propose eight steps, shown in Table II.

Administrative systems should support value streams in customer relations, theequation of demand and supply (George, 2003). These systems must also plan thestrategic people management (training in lean tools and concepts, group problem-solving and suggestion programs, among others).

The application of lean principles in the service area is one of the main challenges(LaGanga, 2011). Reducing the times of the activities and available resources, reducingfailures and increasing the value-added operations are the main objectives ofimplementing programs in lean offices (Tapping and Shuker, 2003).

Table II.Eight steps to reach

the lean office(adapted Tappingand Shuker, 2003)

Steps Description

1. Involvement Everyone should have a good understanding of the lean concept2. Commitment There must be commitment from everyone and teamwork should be

encouraged3. Choose the stream The flow must be chosen to value the process more representative in

the organization4. Mapping the current state Provides a clear view of Muda (wastes) and it shows the current status

of the analyzed process5. Tools Choose the main tools that help you to reach the state lean6. Mapping the future state The proposed improvements should be incorporated into the map,

considering consumer demand, reducing lead time and waste disposal7. Kaizen plan To establish processes, timelines and responsible for the improvements8. Kaizen implementation Implementing the proposals with monitoring in the management

through visual control

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Thus, according to Ehrlich (2002), lean techniques improve the quality of services, whilereducing waste and costs.

3. MethodologyThe purpose of this article is the application of lean office. Thus, this research seeks theimplementation of waste reduction and lead time in administrative proceedings, at theMedical Centre of Campinas. The methodology used is classified in one exploratory casestudy (Saunders et al., 2003).

In addition, the work also provides a description of the evidence of implementing it ina special case, in the services within a medical center. To meet this purpose, the methodadopted was the case study, according to Yin (2009). This method usually involves theinvestigation of a case and seeks to create relationships and understandings about theobject of study.

Thus, we selected Medical Centre of Campinas. It is therefore an organizationalexperience in the health service area, which includes attributes that qualify it as a case(Yin, 2009). The case study was developed in the Campinas city, state of São Paulo,Brazil. The study organization is a military organization belonging to the BrazilianArmy.

To collect more specific data, the lean office case study design was selected in asample in the reception area of the Medical Centre and was correlated (biunivocally)with 17 areas related to service. This is not a random sample, but a purposive sampledesign. The case study was studied by means of a questionnaire and also theparticipation of one of the authors, who belongs to the Brazilian Army.

4. Case study4.1 The Brazilian Army health systemThe Army health system is deployed at three levels: primary, secondary and tertiary(Table III).

At the primary level is the military organization itself, i.e. the Army medical andcivilian contractors. In this case, the first medical procedures, sanitary control andscreening of cases that need treatment are performed.

The second level is the responsibility of the Medical Centre, which is installed inplaces of greatest military concentration. Here are held the first medical inspections andminor surgeries. Finally, the third level is the closest military hospitals that performsurgeries.

The system is subsidized by the Army and has monthly contributions with apercentage of the military salaries, nominated Army Health Fund (AHF).

Table III.Military healthorganizations

Level Military Civilian

PrimaryHealth Military organization itself Civilian health organizations

SecondaryMedical Centre Installed in places of greatest concentration

TertiaryMilitary hospital Hospitalization surgical treatments Freelancer health professionals

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4.2 Organizational structure of the Campinas Military GarrisonFigure 1 presents the structure of the Campinas Military Garrison. It contains theMedical Centre in Campinas, the Preparatory School of Cadets and the MilitaryOrganization Operational Brigade headquartered in the city.

The Medical Centre is also responsible for the medical care to the entire body of Armypersonnel, reserve and retired military and all their dependents residing in the Campinascity and surroundings, as well as to all the beneficiaries of the Brazilian AHF. Thisuniverse reaches a total of approximately 6,000 users. In particular character, the Navyand Air Force and their dependents are also served.

The physical structure has a built area of approximately 600 m2, which is intendedfor medical, dental, laboratory and nursing in outpatient integrated by the HealthDivision, and the entire administration of the health system, Army medical inspectionscoordinated by the Medical Centre.

In the activity of the Health Division, the Medical Centre has doctors serving in theareas of clinical medicine, cardiology, obstetrics and gynecology, pediatrics, surgery,orthopedics, pulmonology and dermatology. It also has an emergency treatment andobservation room, an area for the service medical records and statistics; a clinicallaboratory working in the fields of hematology, biochemistry and parasitology; anddental offices with expertise in the areas of dentistry, periodontics, endodontics, oralsurgery and dental prosthetics. These activities are performed at business hours (officeshifts). There is a medical and dental care emergency regime that works continuously innight shifts.

The AHF division performs administration and customer service, through sectionscontract and accreditation; audit medical bills, payment and reimbursement ofexpenses; prostheses acquisition; screening section and routing guides, which hasuninterrupted operation in night shifts.

The AHF is a health system that ensures the provision of health care to its users,provided by it or hired in the private health system. For this purpose, any holder of theAHF contributes monthly with a percentage of their salaries. Whenever it is necessaryto use the system, the beneficiary will pay 20 per cent of all the costs incurred, which are

Figure 1.Organization of theCampinas Military

Garrison (Campinascity, state of São

Paulo, Brazil)

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compensated by the AHF, by deducting monthly, up to 10 per cent of their salaries.Thus, every beneficiary of the AHF is co-responsible for their expenses. The costs ofeach beneficiary are deployed in the system through the registration section of themanagement unit, electronically.

Finally, the structure of the Medical Centre has a team of 30 officials – captain, major(90 per cent for direct care and support to 10 per cent) and 23 graduates (soldiers, forexample) to perform administrative support.

4.3 Corporate systems supporting the Medical CentreCorporate systems to support the Army health agencies are tools of informationtechnology made available to enable management tasks at all levels. Table IV presentsall the activities of the Medical Centre managed by real-time electronic systems. Thesesystems manage, for example, the care provided by the Military Health Organization, inthis case the Medical Centre, involving costs of materials and medicines which areindemnified by the user, in the same ratio of 20 per cent.

In addition, Table V shows the following systems, which manage the activities of theAHF specifically.

Besides, the activities of the AHF are also administered by the system forwardingrecord (SFR). This system controls the health fund, third-party contracts, the issue ofmedical guides, the debit account (Army and users) and payments (Table VI).

Table IV.Integrated corporatesystems support

Integrated system Description

Resource management This system manages all the activities of the Medical Centre via electronicsystems in real time

Planning This system manages the distribution of resources in according the budgetPayment control This system manages payments

Table V.Army Health Fundsystems support

System Description

Contracts This system prepares the analysis to authorize contract with Freelancer andCivilian Health Organization

Medical inspection This system controls the medical inspections. It also makes the programmingof consultations and prepares the necessary documentation

Medical supplies This system allows inventory management of equipment and medicinesHealth activities This system manages the activities of the Health Division

Table VI.Description of SFR

Description

1. Beginning of the month: Review of the balance of the AHF2. Ascertain: The need to use Health Organization3. Check: Third-party agreements (limits)4. Prepare: Medical guide5. User: After medical consultation, request invoice6. Release: Payment of third party7. Shutdown: System upgrade

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4.4 Mapping the flow of current valueThe actual application of the lean office concept in the Medical Centre occurredprimarily with the involvement of its entire staff. To coordinate these activities, a hiredmultidisciplinary management group was established (the name of group is G5). Thisgroup held a series of meetings in the form of lectures on lean concepts, involving thereception staff, doctors, dentists and management staff, among others. Next, the groupidentified the commitment of those involved in better serving users of the MedicalCentre.

Then the G5 group identifies the first flow to value analysis (Figure 2). The addedvalue of area 15 (Issuing guide) and SFR has greater impact, but the improvement inthese sectors will be made by the IT area.

By the other side, the area that most closely relates to others and also has greatimportance in this case is the reception (number 1 area). Thus, we focus on this area.

4.5 Dysfunctions of the organizational structure of the Medical CentreThe Medical Centre is managed by a military level (sub-command), which in turndepends on the brigade command structure. This form often provides somedisagreements in decision-making (Table VII).

The doctor (fully dedicated) works in office hours. The evening activities areperformed by professionals from the Military Garrison (or freelancer). This form of workis not standardized, providing conflict.

In addition, information systems have changed recently and still require furtherintegration.

Figure 2.Current value stream

mapping

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4.6 Complementing lean thinking into the Medical CentreAfter verifying the existence of the problem (waste), through current VSM, i.e., wesought to study it in a complete way. This development was made by future VSM.

At this moment, it is very important to define the goals outlined for the futureperformance of the service process, to identify measures, to choose the tools to solve theproblems, to define and to implement the action plans and to keep Kaizen management in sight.

The multidisciplinary working group (G5), by analyzing the VSM of the MedicalCentre, defined the following objective, together with stakeholders:

• O1: Raising users’ satisfaction in health care by 80 per cent;

To achieve the objective O1 is applied:(1) Responsibility functional matrix (Table VIII) and, in parallel.(2) Lean techniques, such as:

• future VSM;• continuous flow;

Table VII.Dysfunctions in theorganizationalactivities

Activities Medical Centre Brigade command Dysfunctions Opportunities (tools)

Management Subcommand Command Disagreement indecision-making

VSM continuous flow;lead time reduction;motivation

Doctors Fixed Variable Turnover Standardized work;responsibilityfunctional matrix;motivation teamwork

Standardization Level average Action plan isvery difficult

5S (discipline andstandardized)re-layout

Table VIII.Responsibilityfunctional matrix

S/C 1 2 3 4 5 6 11 12 13 14 15 16 17

1 X 1 2 3 4 5 10 11 12 13 14 15 162 17 X 18 19 20 21 26 27 28 29 30 31 323 33 34 X 35 36 37 42 43 44 45 46 47 484 49 50 51 X 52 53 58 59 60 61 62 63 645 65 66 67 68 X 69 74 75 76 77 78 79 806 81 82 83 84 85 X 90 91 92 93 94 95 96

13 193 194 195 196 197 198 203 204 X 205 206 207 20814 209 210 211 212 213 214 219 220 221 X 222 223 22415 225 226 227 228 229 230 235 236 237 238 X 239 24016 241 242 243 244 245 246 251 252 253 254 255 X 25617 257 258 259 260 261 262 267 268 269 270 271 272 X

Notes: S/C: Supplier/Customer (internal and external); 1: Reception; 2: Dentist; 3: Laboratory;4: Secretary; 5: Contract; 6: Nursing; 7: Board; 8: Leader; 9: Medical Ethics Committee; 10: Warehouse;11: Army Health Fund; 12: Patient (Customer); 13: Brigade; 14: Clean shop; 15: Issuing guide;16: Medical; 17: Staff on attendance

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• time reduction;• Five-S; and• standardized work.

The matrix presented in Table VIII is the relationship between the 17 areas (S: Supplierand/or C: Customer, simultaneously – biunivocal) belonging to the Medical Centre. Theupper part of the matrix (right and above the diagonal) is the ratio of input to outputareas and bottom of the matrix (left and below the diagonal) is the feedback from onearea to another. The matrix has 272 relationships and feedbacks.

The matrix is a multifunctional analysis, i.e. for each area, inputs and outputs as wellas their proper functions are analyzed (Figure 3).

In Table VIII and IX are examples of analysis arising from the relationship betweenareas. The first example is the relationship (number 1) (2nd line and 3rd column ofmatrix) of (number 1 area) reception with (number 2 area) dentist. The resulting data(input and output) about this relationship highlight that it does not present conflicts.

In the second example (Table VIII and IX), the biunivocal relationship (number 2)(2nd line and 4th column of matrix) between the (number 1 area) reception with (number

Figure 3.Relationship between

areas

Table IX.Customer

relationshipmanagement

(S) SupplierRelationship Input and output Dysfunctions (conflicts)(C) Customer

(S) Reception (number 1 area) 01 1. Receiving patients(personal and telephone)

Without relevant conflicts

2. Miscellaneous Information3. Schedules

(C) Dentist (number 2 area) 4. Opening and referralsrecords

(S) Reception (number 1 area) 02 1. Receiving patients(personal and telephone)

1. Standby time attendanceis high

2. Miscellaneous Information 2. Results of laboratorytests without certification

3. Schedules 3. Improper location forstoring and displayingmaterials

4. Delivery of test(C) Laboratory of ClinicalAnalysis (number 3 area)

5. Delivery and receipt ofmaterials

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3 area) laboratory presents in a communication failure resulting in longer patient care(Figure 4). The feedback about this is presented in relationship (number 33) (4th line and1st column of matrix). Moreover, it presents the lack of standardization of work.

The problem was presented to the Chief of the Medical Centre, responsible for theMilitary Family Project, which precisely aims, among other things, at the continuousimprovement in processes.A partnership was established with a company (Julius Consulting – Brazil)specializing in strategic management of people, which began its work by diagnosingproblems.

In this diagnosis, the choice was to analyze the dysfunctions in the form of theresponsibility functional matrix. It sought to identify the root causes in which for a givenservice, this matrix shows the interaction between the supplier and customer flow of asystemic process, evaluating the inputs, outputs and feedbacks.

At the end of the work, with the responsibility functional matrix defined and agreedupon, the process was standardized, with the relationships between the areas of theorganization clearly defined, facilitating and enabling the application of different toolsfor eliminating the waste (problems) detected.

The group’s actions (G5) with the new model seek toward improving efficacy(product/service) and efficiency (resources) that must be shared between internalcustomers and suppliers. At this step, the commitment of health personnel and elementsof the Military Garrison, necessary for the proper conduction of the work, with the corebusiness of the Medical Centre, were very important.

4.7 Future VSMFigure 5 shows the results of the future VSM. The calculation of added value movedfrom 1.7 to 8.2 per cent.

The elimination of activities that do not have added value to the service allowedoutpatient care and prostheses were improved, resulting in a reduced time forscheduling appointments.

5. Discussions of the results5.1 Future VSMThe time reduced in the process went from 18 days to 4 days (Figure 5).

This reduction was, for example, through the analysis of time in the processes:dentistry and clinical laboratory, where dysfunctions were eliminated. After the main

Figure 4.Relationship(number 2) betweenreception(number 1 area) andlaboratory(number 3 area) ofmatrix

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activities were standardized, using the responsibility matrix, it was possible to performthe same balancing by eliminating bottlenecks (restrictions, limitations, does not flow)encountered.

5.2 Support of corporate systemsAfter the integration of information systems, it became possible to get better reception inthe Medical Centre. As an example, the transfer of funds and requests for services havechanged to online. In relation to consumables, they were available in 60-90 days, butmodified monthly without inventory increasing.

5.3 MotivationThe problem motivation has always been a major obstacle, such as some types ofproblems caused by the medical and dental field. This problem is now solved byreducing turnover. This question was monitored through a climate survey with usersand as a result, showed that personal satisfaction increased from 30 to 70 per cent.Surveys of general satisfaction through suggestion and questionnaires for user box,held after each service, showed a very marked improvement from 40 to 85 per cent.

5.4 RankingAnother aspect to be reported was increased scores from the Medical Centre in thebalanced scorecard of the Army, especially in the health record system. In this analysis,the Medical Centre ranked second (position) among 21 centers throughout Brazil, eightmonths after the implementation of improvements.

Figure 5.Future value stream

mapping

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6. ConclusionsAfter the assessment of the problems at the Medical Centre, you can apply the conceptsof lean office. When apply the VSM, the area of lowest value was the reception (number 1area – supplier, in the matrix and VSM). However, this fact was also related to otherareas.

Before the adoption of lean thinking, the Medical Centre followed processes thatfavored customer dissatisfaction with them. The result, for example, showed that the(particularly laboratory and dental prostheses) medical guides were made withoutplanning, which caused inappropriate financial outlay and longer processing time.

The new methodology used in the Medical Centre made use of the lean officeprinciples and now has a strong partnership with their health organizations, in such away that problems were minimized.

The same occurs in the indoor environment, the relationship of those responsible forvarious processes. Thus, users also have a clearer view of the real possibilities and,therefore, their level of anxiety was reduced.

The results arising from an action plan began with the standardized work tool, whichreceived all the information from the responsibility matrix and led them to success. Thiswas only possible through the involvement and commitment of the whole clinical andsupport staff whose satisfaction increased.

In turn, the VSM can streamline activities, especially dental care, prosthetics andscheduling appointments. These results caused the Medical Centre to reach the toppositions among all of the Brazilian Army.

Finally, the responsibility functional matrix analysis through the inputs and outputsof the processes of the 17 areas combined with lean office (VSM and tools), organizingthe reception (number 1 area) and others, improving communication, standardizingactivities and reducing the times, providing greater user satisfaction.

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the call center”, International Journal of Operations & Production Management, Vol. 29No. 1, pp. 54-76.

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About the authorsIris Bento da Silva holds a mechanical engineering degree from the University of São Paulo (USP),a MSc and PhD in mechanical engineering from the State University of Campinas (UNICAMP) anda postdoctoral degree from UNICAMP, Brazil. His industrial experience includes working inBrazil as a positional executive in the auto parts manufacturing for about 30 years at EatonCorporation. He is a founding member of the Brazilian Academy of Quality. Nowadays, he is anAssistant Professor in mechanical engineering at the University of São Paulo (USP) in theEngineering School of São Carlos. His research interests include Lean Six Sigma in operations andmanufacturing engineering. Iris Bento da Silva is the corresponding author and can be contactedat: ibs@sc.usp.br

Everton Cesar Seraphim was a member of the 11th Light Infantry Brigade of the BrazilianArmy. He is pursuing his MSc at the State University of Campinas.

Oswaldo Luiz Agostinho holds a mechanical engineering degree from the University of SãoPaulo (USP), a MSc in mechanical engineering from the State University of Campinas (UNICAMP)and a PhD in mechanical engineering from the University of São Paulo (USP). He is an AssociateProfessor in mechanical engineering at the University of Campinas (UNICAMP), Brazil. Hisresearch lines are competitiveness strategies linked to competitiveness, technology managementfor competitiveness, flexibility and integration productive systems, planning process.

Orlando Fontes Lima Junior holds Naval Engineering, MSc and PhD degrees in transportengineering from the School of Engineering of the of University of São Paulo (USP) and apostdoctoral degree from UNICAMP. He undertook sabbatical studies at BournemouthUniversity, UK. He has 26 years of experience in the transports, logistics and service sector. Hewas the Mayor of UNICAMP for four years and a consultant in logistics. He is an AssociateProfessor in transports and logistics, and the Coordinator of LALT. His research works relate todevelopment of methodologies for evaluation of logistic services in freight villages, logistics in theservice sector, logistics in organ transplantation and logistics platform.

Gilmar Ferreira Batalha holds a Mechanical Engineering degree from the University ofBrasilia, a MSc in mechanical engineering from the Federal University of Santa Catarina and aPhD in mechanical engineering and habilitation in manufacturing processes from the School ofEngineering of the University of Sao Paulo, where he has been a Professor since 1989. He haspostdoctoral research experience at the Friedrich Alexander University Erlangen–Nuremberg,Germany. He was a Visiting Professor at Ecole Centrale de Lille, France and at the Faculty ofMechanical Engineering of the Silesian University of Technology, Gliwice, Poland. He is a deputymember of the editorial board of the Archives of Materials Science and Engineering. He is amember of the World Academy of Achievements in Materials and Manufacturing Engineering.He is a deputy member of the Manufacturing Engineering Steering Committee at the BrazilianSociety of Mechanical Sciences and Engineering. His research topics are concentrated onfabrication and manufacturing processes. He coordinates the Laboratory of ManufacturingEngineering of the EPUSP, and is responsible for several international and national cooperationagreements for student and researcher exchange as well as for consultancy with the industry.

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