What is Waste in Lean Healthcare?

The waste of transportation isn’t about you driving a car or jumping on a bus. It’s more about some of the unnecessary A to B journey’s you make during your working day. Think about this as you having to move a person, product or material needlessly from one point to another.

Example of the waste of Transportation: Imagine you are a nurse on a ward and you need to take a patient to theatre for their procedure. Having waited for a porter to arrive you accompany the patient to theatre. The journey may involve walking along multiple corridors and perhaps even taking a lift. You arrive at theatre only to find that the patient isn’t having their procedure and has been cancelled. The only thing left to do is to go back to the ward.

Your entire journey can be categorised under the waste of transportation. Why? There was no benefit to either patient, yourself or indeed the porter. The one universal reality is that everyone’s time was ‘wasted’ and staff capacity was consumed.

The waste of inventory is where you have unnecessarily too much or too little of something. Why is this wasteful? If you have too much of something you have to store it, keep it dry, clean and secure. All this consumes resources and costs i.e. someone has to fetch and carry the items and it impacts on cash flow too as you have to pay for heating.

Example of the waste of Inventory: The easiest way for you to think of the waste of inventory is to think about the last time you needed to replace a printer cartridge. You probably went to the stationary cabinet and found all the types of cartridges except for the one that you needed – this is the waste of too much inventory. After searching for a while it might be that you didn’t find what you need – this is the waste of too little inventory. The net effect is that you have now wasted time looking for something that you couldn’t find, which has ultimately impacted upon your productivity and capacity.

In a healthcare setting you will find that ‘inventory’ can take multiple guises sometimes dependent upon your role;
– Surgeon: Too many patients on the theatre list
– Admin clerk: Too many patients arrive on your day case ward requiring admitting for their surgery
– Ward Nurse: Not enough patient labels for attaching to patient observation sheets

The waste of motion is different from the waste of transportation as this time the unnecessary movement is related to yourself.
Example of the waste of Motion: You go to pharmacy to check if an inpatient’s medications are ready so they can be discharged off your ward. You walk from your ward all the way to the pharmacy to find out that the medications are still not ready. Your ‘trip’ has been a wasted journey and can be categorised as a waste of your motion.

In manufacturing, particularly on assembly lines, a great deal of attention is put on the movement of assembly cell team members. Lean Engineers observe each Operator’s movement down to every twist and turn. Together with the observations Engineers time the entire assembly process right down to the second. What they’re looking for is ‘waste’ which includes the waste of motion. Included in these observations are opportunities to improve safety and ergonomics to prevent stress on joints by repeating a process potentially hundreds of times a day.

The waste of waiting is known as the ‘Mother of all wastes‘. It is the one waste that invariably occurs due to one or more of the other wastes. Where ever you hear the word ‘waiting’ you can be assured that you have come across the waste of waiting.

The waste of Waiting includes waiting for; material, stock, decisions, information, emails and so on. Example of the waste of Waiting: patients waiting in waiting rooms, patients/staff waiting for medications and waiting for porters to take patients to theatre.

The best way for you to think about the waste of over-production is when you produce too much of something i.e. more than what is actually required. At first glance you might think that ‘batching‘ is efficient in terms of time and resources. Actually, what you’ll find is that batch production ‘masks’ many of the other wastes e.g. transportation, inventory, defects/rejects. If you’ve made a batch of 100 products and one is defective then there is a risk that the remaining 99 are also defective. For most businesses there is now additional cost, time and resources required to manage the excess products that were unnecessarily created.

If you consider the waste of over-production from a healthcare perspective you might think about Outpatients departments and clinic bookings. Booking teams will typically be instructed to fill every available slot (to keep utilisation high) and additionally over-book to allow for DNAs (did not attends). An appointments clerk may end up booking a clinic to 120% capacity. Not great if every patient turns up for their appointment. Theatre booking staff follow similar practices.

The waste of over-processing is when a process is ‘over-engineered’ or in other words, is doing more work, adding more components, or having more steps in a product or service than what is required by the customer. Essentially, over-processing tends to lead to more complexity. If you think about the process of theatre utilisation i.e. confirming a list of patients for a given theatre session, you would think it is relatively straightforward. It isn’t. Usually this is because of the variables relating to patients not being fit for theatre, DNAs and so on.

In an attempt to compensate processes are ‘refined’ to such an extent that they are unusable by the people working within the process. The net affect is complexity in the overall process.

The waste of defects or rejects is where a product or service has failed or requires rework to make it functional. Defects and rejects consume finite capacity, time and resources. All this comes at a cost. These costs are typically passed on to the customer or service user. The net impact being that products or services end up costing more.

This category of waste can be seen in both clinical and non-clinical processes.

The waste of skills under-utilisation is where you have teams who are not actively encouraged to contribute to process improvement. Your teams are the experts in their processes as they use them over and over again every single day. They will have an in-depth knowledge and familiarity with what they do and are well positioned to identify improvement opportunities.

Typically this waste rears its head when two things happen;

1. When team members are not given the right skills to support them with effective process improvement. For example not getting the training to better understand the ‘science’ of improvement and acquiring the tools to deliver change.
2. When the culture of the organisation is such that managers ‘do the thinking’ and ‘workers do what they are told’.