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The subject of innovation in public service has been gaining attention in Brazilian scientific practice and production. This paper aims to identify national studies on innovation in public administration and increase the level of knowledge about the subject, as well as to inspire new research and promote advances in theoretical and practical knowledge about innovation in the public sector.

The present study has a descriptive purpose, quantitative nature and was performed through a bibliometric study based on the protocol proposed by Cronin et al. (2008). Documentary data were collected from scientific articles, and quantitative techniques for descriptive statistics were used to analyze the results. Were selected Brazilian scientific journals classified with Qualis equal to or higher than B1, in the area of Public Administration and Business, Accounting and Tourism, in the quadrennium 2013-2016; a total of 164 journals searched.

The results herein indicate a research gap that should be filled by more theoretical studies. Also, they point to the need for multimethod research studies that promote the evaluation of product and process innovation, especially related to the phases of invention and implementation.

Few studies have covered public administration and, especially, innovation reviews; none of these studies focused on innovation in the Brazilian public sector, as proposed by this research; the period of analysis and coverage of journals used as search criteria also differ from other reviews in the area of innovation and public sector.

Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.

A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.

Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.

The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.