A quality improvement initiative in hospital-based speech-language pathology: development and evaluation of a Lean–Agile management model
Carina Escudero, Cirley Novais Valente Junior, Gisele Chagas de Medeiros, Fernanda Chiarion Sassi, Ana Paula Ritto, Claudia Regina Furquim de AndradeAbstract
Background
Hospital-based speech-language pathology (SLP) plays a strategic role in the care of critically ill patients, particularly in dysphagia management. However, high service demand and limited resources highlight the need for structured management approaches. This quality improvement (QI) study describes the implementation of a Lean–Agile management model and the establishment of a baseline of clinical care indicators to support dysphagia management in a high-complexity hospital setting.
Methods
This QI initiative used a retrospective descriptive design and was conducted in a high-complexity quaternary public hospital in São Paulo, Brazil. The model comprised four phases: process mapping and value chain construction; clinical demand management using a Kanban-inspired prioritization system; continuous monitoring through predefined process and outcome indicators; and evaluation through retrospective analysis of 1312 adult intensive care unit (ICU) patients receiving dysphagia management between January 2024 and June 2025. Oral intake status was classified using the Functional Oral Intake Scale (FOIS). Descriptive statistics were used, and proportions are reported with 95% confidence intervals (CIs) (Wilson method).
Results
The mean daily service coverage rate was 73%, corresponding to 33 patients seen per day out of a mean daily active demand of 45 patients across 100 ICU beds. The overall prevalence of dysphagia (FOIS 1–5) was 88.95% (95% CI: 87.1%–90.5%), and dependence on an alternative feeding route at initial assessment (FOIS 1–3) was observed in 54.65% (95% CI: 51.9%–57.3%) of patients. The favourable swallowing outcome rate was 80.55% (95% CI: 77.8%–83.0%; N = 869), and the alternative feeding route weaning rate was 77.28% (95% CI: 73.4%–80.8%; N = 493). Unfavourable outcomes were predominantly attributable to poor functional prognosis (52.05%) and clinical severity (30.41%), whereas process-related failures accounted for only 0.5% of the total sample.
Conclusion
The Lean–Agile management model provided a structured approach to organizing SLP services in a high-complexity ICU setting and enabled the establishment of a baseline of dysphagia care indicators. Most unfavourable outcomes were attributable to patients’ underlying clinical conditions rather than service-related factors. These findings may inform service planning and quality monitoring in similar hospital contexts, pending multicentre evaluation.