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Operational Excellence 5.0 and the sustainable development goals: lessons from Lean health care and palliative care in Brazil

GABRIEL CIMADA DA SILVA et al.

International Journal of Lean Six Sigma2026https://doi.org/10.1108/ijlss-10-2025-0285article
AJG 1ABDC B
Weight
0.50

Abstract

Purpose This study aims to evaluate how the integration of palliative care (PC) and lean health care can drive Operational Excellence 5.0 in a Brazilian public hospital, with a focus on the sustainable development goals (SDGs). Design/methodology/approach A mixed-methods study was conducted through qualitative documentary analysis of the Palliative Care Committee and established clinical protocols, combined with quantitative evaluation of hospital indicators using statistical tests and interrupted time series (ITS). Findings Average length of stay (LOS) decreased in ICU/intermediate units (7.1–5.5 days; p = 0.0055) and in wards (5.6–5.0 days; p = 0.0088). Despite a 26.9% increase in medical visits, the total number of hospital deaths remained statistically stable (ITSp = 0.3033), with redistribution across sectors: deaths decreased in intermediate units (9.3–6.7 deaths/month; p = 0.0091) and increased in wards (10.5–17.5 deaths/month). ITS analysis with Newey–West correction identified an immediate reduction of 0.97 day in ward LOS (p = 0.0185), followed by a sustained monthly decrease of 0.135 day (p = 0.0017). Research limitations/implications The use of aggregated data without individual adjustment limits generalizability. Future multicenter studies should also include outcomes focused on patient quality of life. Practical implications Lean standardization and multiprofessional training demonstrated potential to optimize critical resources and reduce waste in the Brazilian Unified Health System (SUS). Social implications The model expands access, reduces inequalities and promotes dignity at the end of life, aligning with SDGs 3, 10 and 12. Originality/value This study provides novel evidence in Brazil showing how lean health care and PC, in synergy, can generate efficiency, sustainability and humanization.

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https://doi.org/https://doi.org/10.1108/ijlss-10-2025-0285

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@article{gabriel2026,
  title        = {{Operational Excellence 5.0 and the sustainable development goals: lessons from Lean health care and palliative care in Brazil}},
  author       = {GABRIEL CIMADA DA SILVA et al.},
  journal      = {International Journal of Lean Six Sigma},
  year         = {2026},
  doi          = {https://doi.org/https://doi.org/10.1108/ijlss-10-2025-0285},
}

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Evidence weight

0.50

Balanced mode · F 0.40 / M 0.15 / V 0.05 / R 0.40

F · citation impact0.50 × 0.4 = 0.20
M · momentum0.50 × 0.15 = 0.07
V · venue signal0.50 × 0.05 = 0.03
R · text relevance †0.50 × 0.4 = 0.20

† Text relevance is estimated at 0.50 on the detail page — for your query’s actual relevance score, open this paper from a search result.