A pioneering healthcare model applying large-scale production concepts: Principles and performance after more than 11,000 transplants at Hospital do Rim.

The kidney transplant program at Hospital do Rim (hrim) is a unique healthcare model that applies the same principles of repetition of processes used in industrial production. This model, devised by Frederick Taylor, is founded on principles of scientific management that involve planning, rational execution of work, and distribution of responsibilities. The expected result is increased efficiency, improvement of results and optimization of resources. This model, almost completely subsidized by the Unified Health System (SUS, in the Portuguese acronym), has been used at the hrim in more than 11,000 transplants over the last 18 years. The hrim model consists of eight interconnected modules: organ procurement organization, preparation for the transplant, admission for transplant, surgical procedure, post-operative period, outpatient clinic, support units, and coordination and quality control. The flow of medical activities enables organized and systematic care of all patients. The improvement of the activities in each module is constant, with full monitoring of various administrative, health care, and performance indicators. The continuous improvement in clinical results confirms the efficiency of the program. Between 1998 and 2015, an increase was noted in graft survival (77.4 vs. 90.4%, p<0.001) and patient survival (90.5 vs. 95.1%, p=0.001). The high productivity, efficiency, and progressive improvement of the results obtained with this model suggest that it could be applied to other therapeutic areas that require large-scale care, preserving the humanistic characteristic of providing health care activity.