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Appl Ergon. 2018 Sep;71:45-56. doi: 10.1016/j.apergo.2018.04.004.

The joint use of resilience engineering and lean production for work system design: A study in healthcare.

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DEPROT/UFRGS (Industrial Engineering and Transportation Department, Federal University of Rio Grande do Sul), Av. Osvaldo Aranha, 99, 5. Andar, Porto Alegre, RS, CEP 90035-190, Brazil. Electronic address:
DEPROT/UFRGS, Brazil. Electronic address:


Although lean production (LP) has been increasingly adopted in healthcare systems, its benefits often fall short of expectations. This might be partially due to the failure of lean to account for the complexity of healthcare. This paper discusses the joint use of principles of LP and resilience engineering (RE), which is an approach for system design inspired by complexity science. Thus, a framework for supporting the design of socio-technical systems, which combines insights from LP and RE, was developed and tested in a system involving a patient flow from an emergency department to an intensive care unit. Based on this empirical study, as well as on extant theory, eight design propositions that support the framework application were developed. Both the framework and its corresponding propositions can contribute to the design of socio-technical systems that are at the same time safe and efficient.


Design science research; Emergency department; Healthcare; Lean production; Resilience engineering

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