BPMN como ferramenta de análise e melhoria contínua: um estudo de caso SGQ na Unimed João Pessoa

Abstract

Process modeling is a strategic tool for identifying flaws and optimizing operational flows. This study aimed to analyze how modeling using BPMN notation can contribute to improving the Nonconformity (NC) handling process within Unimed João Pessoa's Quality Management System. The methodology was based on the PDCA cycle, with stages of diagnosis, interviews, root cause analysis, action plan, execution, verification, and standardization. The results revealed that the current monitoring model had weaknesses, such as limitations in billing channels and a lack of validation of responses. To mitigate these issues, three improvements were implemented: changing the processing deadlines, adding a response analysis field to the system, and a new billing rule with multiple channels. These actions resulted in an average 21% reduction in duplicate NCs and an increase in on-time processing from approximately 53% to 74%, in July/2025. The study reinforces the usefulness of process modeling as a practical and theoretical tool, contributing to quality and standardization in organizational environments, especially in the healthcare sector.