Society is experiencing a transient epoch in which old problems coexist with new ones. The new shape of the demographic pyramid, with growing aging populations and a decrease in birth rate, increased prevalence of chronic disease, the persistence of infection diseases, the need for more technology and resources and the increment of healthcare cost are concerns for decision makers in many countries (Martens and Huynen, 2003). In spite of the rapid evolution of the healthcare management in the last thirty years, this situation has resulted in some gaps in research, such as new techniques that support hospital planning, including forecasting the length of stays and other aspects of hospital performance and new ways of staffing with regard to the number and type of nurses in hospitals (Edwards and Harrison, 1999). Such tools are necessary to help create healthcare systems that are safe, effective, patient-centered, timely, efficient and equitable through the use of techniques that measure and optimize system performance to meet performance goals (Reid et al., 2005). The identification of organizational models based on factory and network focused concepts that provide a real integrated care system are essential to respond to population demands and at the same time deliver this change in a sustainable way (Karakusevic, 2010). In Brazil, there was an 8.34% decline in the number of hospitals from 1999 to 2005, while the population increased by 12.34%. There was an increase of 16.3% in hospital admissions between 2002 and 2004, and a decline in hospital beds of 18.6% from 1992 to 2005 (IBGE, 2006). Public hospitals absorb 30–۵۰% of government budgetary allocations in the health sector in both developed and developing countries (Barasa et al., 2015). In 2008, the aging population (over 65 years old) was 6.6%, with a tendency of growth. Between 2000 and 2005 hospital expenditures rose 87.7% (IBGE, 2008), while the rate of inflation was 39.8%. The majority of the Brazilian population (75.5%) receives healthcare via the public system, with most coming from low-income families, while high income families are likely to use the private sector (IBGE, 2006). In addition to the many strategies that could be undertaken at a national level, managerial improvements at organizational level can cope with these issues.