Productivity challenges in healthcare management
Health care is a highly complex system, in which clinical, administrative and financial decisions intertwine in real time. Each component, from care teams to supply chains, from regulatory processes to financing models, influences the performance of the whole. When one of these links falls out of adjustment, the entire system loses coherence: productivity falls, costs rise and quality weakens.
The current scenario exposes this lack of attunement. Rising costs, litigation, regulatory instability and misaligned payment models reveal a management that still operates in silos, reacting to crises instead of learning from them. The result is an “orchestra out of time”, in which each part acts in isolation and value to the patient is dispersed in the noise of the system.
Restoring harmony requires more than cost control or digitalization. It requires a form of management based on learning, stability and purpose – a way of thinking and acting that integrates productivity, quality and safety as parts of the same challenge. This is where lean management becomes essential.
Financial pressure and structural imbalance
In 2025, the health care sector was marked by persistent financial pressure that threatens the stability of the entire value chain. Rising costs of medicines and supplies have created severe strains on distributors, clinics and hospitals. Distributors, a critical link between the pharmaceutical industry and health care institutions, face squeezed margins and growing defaults. They pay the industry in about 42 days but receive payment from hospitals after approximately 75 days, which puts pressure on working capital and reduces liquidity.
In hospitals, the situation is similar. Energy, maintenance and staff costs are growing faster than revenues. Management starts operating in the short term, seeking immediate financial balance, often at the expense of cuts in investments in quality and innovation. When the economic flow becomes unpredictable, attention tends to shift from the patient to institutional survival.
Fiscal insecurity and systemic impact
In addition to cost pressure, the sector faces an unstable fiscal environment. The agreement that maintains the ICMS exemption for medical devices was renewed until the end of 2026, avoiding, for now, an estimated average increase of 20% in the costs of these products. Studies indicate that, if this exemption were ended, there would be a significant impact on the SUS and on supplementary health care, including about 29% of oncological surgeries and more than 17 million hemodialysis sessions per year.
This uncertainty compromises long-term planning and inhibits investment. Manufacturers and providers reduce inventories and postpone equipment purchases, raising the risk of shortages and of delays in elective procedures. Countries that treat health care as a strategic sector maintain predictable fiscal policies. Preserving this balance is essential to guarantee access to cutting-edge treatments and technologies, as well as to maintain the competitiveness of the national productive sector.
The expansion of litigation
Health care litigation is growing rapidly. Brazil has already exceeded 570,000 lawsuits related to the sector, a number greater than the total number of doctors in the country. Between 2023 and 2024, medical malpractice lawsuits increased by more than 500%, and lawsuits against health plans doubled. Although many of these lawsuits represent the legitimate pursuit of rights, their side effects are profound.
Each court decision outside the plan shifts resources, disrupts flows and puts pressure on teams. Hospitals and health plan operators are forced to pay for high-cost medicines and procedures, often without consolidated clinical evidence. This unpredictability creates a management environment under constant tension. Financial directors, physicians and care teams need to balance legal compliance, clinical safety and economic viability. This picture reinforces the importance of management systems capable of anticipating, learning and reacting based on data and methods – not just on emergencies.
Payment models in crisis
The way the health care system pays for work is one of the oldest and most persistent roots of instability. The predominant model still pays for volume, not value. This logic fragments care, encourages redundancies and shifts teams' focus from the patient to the production of procedures.
In recent years, initiatives have emerged to transition to value-based models, focused on clinical outcomes and patient experiences. However, progress has been slow. Integrated data on costs and outcomes is lacking, and information systems between health plan operators and hospitals remain poorly interoperable. The absence of reliable metrics and the lack of trust among the players block progress.
In practice, managers still move between two models. On one side, payment by volume, predictable but limited in efficiency. On the other, payment for value, more promising but complex to implement. Advancing in this transition requires organizational maturity: understanding costs precisely, measuring outcomes consistently and developing leaders and teams capable of improving processes and reducing variability.
It is worth stressing that the effective functioning of value-based payment is related to the need to reorganize care flows, in the sense of creating centers focused on certain areas and specialties, generating a combination of greater scale, flow and value. Otherwise, there may be a great deal of idle capacity in the system that will not be paid for, and a very high fixed cost.
Lean management offers this foundation. By creating visibility into the work, connecting clinical and economic outcomes and eliminating waste, lean establishes the conditions for payment centered on real value. Without this managerial support, any new model remains fragile. When the system learns to measure what matters and to act on causes, the change of model ceases to be rhetoric and becomes a consequence.
In this context, it is important to understand the challenge of establishing “product families” as specialties and redistributing operations, developing specialized hospitals focused on regionalization. Even so, high-complexity centers that are unviable from an economic standpoint will have to continue to exist, since many of them are necessary or even indispensable because of the distances involved in access and the urgency of performing certain procedures.
Quality and safety: the true core of productivity
Productivity in health care is not about reducing costs, but about increasing value. Value means offering safe, effective and accessible care, with rational use of resources and time. The pursuit of efficiency must go hand in hand with the pursuit of quality and safety, because both depend on the same conditions: reliable processes, evidence-based decisions, and professionals trained to solve problems at the source.
Studies indicate that process failures, rework and avoidable incidents account for up to a quarter of hospital costs. In daily life, this translates into prolonged hospital stays, repeated tests and medication errors – symptoms of unstable systems. Each failure consumes resources, time and trust.
Lean thinking helps tackle these causes in a practical way. It teaches us to see care as a continuous flow that crosses functional and professional boundaries. By reducing variability and making problems visible, the hospital gains predictability. And predictability is the foundation of safety.
Patient safety is not a program or a seal, it is a result. It emerges when work is well designed, when people understand the purpose of what they do, and when each incident is treated as an opportunity for learning. This requires close leadership, stable teams and a disciplined method of improvement.
When quality and safety become the center of productivity, a virtuous cycle forms: fewer failures, lower cost, higher team morale and better care. Lean practice does not treat these elements as separate goals, but as parts of the same system. Productivity is only sustainable when quality and safety are too.
Lean management as the foundation of sustainability
Lean management is a system of continuous learning that aligns purpose, processes and people around value for the patient. Its strength lies in transforming complex problems into structured opportunities for improvement. It all starts with the right direction: you need to understand what problem you are trying to solve and why. When the purpose is clear, the collective effort is oriented toward what is essential.
The focus is on the real work. Improving productivity means eliminating the barriers that prevent value from flowing: waiting, rework, duplication and decisions not based on data. Stable processes reduce variability, prevent failures and strengthen safety. No process evolves without the development of people. Lean practice develops professionals and leaders capable of observing, testing and learning. Learning ceases to be an event and becomes a way of operating.
A good management system connects this learning to the institutional purpose. Short meetings, visual management and cycles of reflection make problems visible and solvable. Governance becomes an instrument of learning, not of control. When this model matures, a culture of collaboration and intellectual curiosity emerges. Productivity ceases to be a response to pressure and becomes the natural consequence of organizations that learn and stay focused on what matters: value for the patient.
Leadership and continuous learning
Leadership is the link that turns principles into practice. Lean leaders do not control, they teach. They create the conditions for teams to think scientifically about the work and solve problems at the source. The leader's role is to develop people's capability to improve the system. The leader does not give answers, but asks questions that stimulate reasoning and reflection. Each problem is treated as an opportunity for learning, not as a failure to be punished.
This leadership is expressed through presence. Being in the gemba, observing the real work, understanding the context and supporting teams are part of the daily routine. By aligning purpose and operations, the leader turns management into collective learning. When leadership is exercised through method and example, learning becomes systemic. Each team gains autonomy to identify causes, test solutions and share knowledge. The culture of continuous improvement takes root, sustaining quality, safety and productivity as parts of the same commitment to the patient.
Lean leadership is not a position, it is an organizational competence. It is what maintains coherence between purpose and execution, ensuring that each decision moves in the right direction: generating real value for the patient.
Tuning the health care orchestra
Productivity, quality and safety are dimensions of the same system. When they strengthen each other, they form the foundation of a health care model capable of sustaining value, trust and purpose over time. More than an improvement method, lean management represents a way of thinking about and practicing management. It makes it possible to see the health care system as an integrated flow of value creation, in which every decision, process and professional contributes to the same goal: providing care with efficiency, safety and respect.
The future of health care will be determined less by technology and more by the maturity with which institutions learn and improve their own work. Organizations that combine lean thinking and practice build resilience, improve clinical outcomes and consolidate a culture in which learning and caring are dimensions of the same act. Ultimately, lean is a practice of lucidity in the face of complexity. It helps align efforts, eliminate noise and maintain the clarity needed for care to remain, at the same time, the purpose and the result of all the work.
