CREATING VALUE IN THE STROKE GREEN PATHWAY: CONTRIBUTION OF LEAN METHODOLOGY AND CLINICAL SUPERVISION IN NURSING
DOI:
https://doi.org/10.63176/wqm05p95Keywords:
Stroke, Lean Methodology, Clinical Supervision in Nursing, Value-Based Health Care, Integrated Care, Stroke Green PathwayAbstract
Introduction: Creating value in healthcare constitutes a paradigm oriented towards achieving clinically, functionally, and experientially relevant outcomes for the individual, simultaneously promoting efficiency and sustainability. Value-Based Healthcare (VBHC), the Lean Healthcare methodology, and integrated care are complementary frameworks for reorganizing care processes. The Stroke Green Pathway (VV AVC), as a highly complex and time-dependent process, represents a particularly relevant context for the application of these frameworks. In this context, clinical nursing supervision can play a transversal role in the implementation, monitoring, and continuous improvement of practices.
Objetives: To critically analyze the contribution of Lean methodology and clinical supervision in nursing to the creation of value in healthcare throughout the different phases of the Stroke Green Pathway, integrating the principles of Value-Based Health Care and the values of integrated care, and to propose a conceptual model explaining this articulation.
Methods: A theoretical-reflective study with a qualitative approach was developed, supported by a narrative literature review and an integrative conceptual analysis. The bibliographic search was conducted between January and March 2026 in the PubMed, Scopus, CINAHL, and SciELO databases, complemented by consultation of institutional documents, standards, technical reports, and reference literature. Descriptors related to Value-Based Health Care, Lean Healthcare, clinical supervision, integrated care, and stroke were used, combined using the Boolean operators AND and OR. Publications between 2000 and 2025, in Portuguese, English, and Spanish, were considered. The analysis was organized according to the different phases of the stroke care pathway and categories related to efficiency, variability, safety, integration of care, clinical outcomes, patient experience, continuity, and sustainability.
Results: Conceptual analysis showed that value creation in stroke care results from the interaction between operational efficiency, clinical quality, care integration, and professional development. Lean methodology contributes to waste reduction, workflow optimization, decreased variability, and improved critical times in the care pathway. Clinical nursing supervision emerges as a transversal mechanism for implementation, monitoring, and continuous improvement, favoring consistency of practices, competency development, and safety of care. The values of integrated care, namely collaboration, coordination, transparency, trust, shared responsibility, and empowerment, underpin continuity of care and person-centered care. The integration of these frameworks resulted in a conceptual model of value creation applicable to the stroke care pathway.
Conclusions: Value creation in stroke management should be understood as a multidimensional process resulting from the articulation between value-based clinical practice, Lean methodology, and integrated care. Clinical nursing supervision plays a structuring role in translating these frameworks into practice, contributing to more efficient, safe, coordinated, and person-centered processes. The proposed conceptual model constitutes a contribution to the organization and improvement of care, although it lacks empirical validation in real clinical contexts.
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