Dengue na atenção primária em saúde: uso do mapa de fluxo de valor da filosofia lean healthcare

Abstract

Introduction: Primary Health Care (PHC) plays a central role in the organization of care within Brazil’s Unified Health System, particularly in the management of infectious and neglected diseases. However, PHC services still face challenges related to fragmented workflows, inefficiencies, and operational waste. In this context, Lean Healthcare emerges as a promising approach to reorganize care processes, focusing on waste reduction and value generation for users. Objective: To analyze and redesign the care flow for patients with suspected dengue in a Primary Health Care Unit in the Federal District, using Value Stream Mapping (VSM) as a Lean Healthcare tool. Method: This qualitative intervention study was conducted in a Primary Health Care setting with the participation of a multidisciplinary health team. Data collection was carried out through participatory workshops, during which the current care flow was mapped, bottlenecks and inefficiencies were identified, and a future-state care flow was collaboratively developed. The analysis was guided by Lean Healthcare principles and Clinical Governance, aligned with national dengue management guidelines. Results: The current-state VSM revealed weaknesses such as long waiting times, communication failures, task duplication, lack of standardization, incompatibility among information systems, and irregular supply of materials. The future-state VSM incorporated improvements including reorganization of triage, clearer definition of professional roles, enhanced integration among nursing, medical, and laboratory services, and strengthened coordination between surveillance and care. These changes were characterized by low implementation cost and high potential impact. Final considerations: Lean Healthcare proved to be feasible and effective in PHC, contributing to the reorganization of dengue care flows, improved service responsiveness, and strengthened clinical governance. The participatory use of VSM supported collaborative work processes and sustainable improvements, particularly in socially vulnerable territories. The findings highlight the relevance of expanding Lean Healthcare applications in non-hospital settings to strengthen PHC and health care networks.