Below are some examples of how each of the 8 Lean wastes in healthcare may appear. Reviewing this list will help you identify lean waste within your own workplace. From personal experience, I can tell you that it is important to prepare your mindset when first conducting a lean waste walk. Prepare yourself to ask “why” to anything that may look out of place or process steps that do not appear to be standard between staff members.
- Defects leading to rework: This lean waste has to do with any error or process step taken out of order that will require the staff to do more work in order to correct the issue. Examples include: changes to the schedule on the day of surgery that are not communicated to the patient, wrong site surgery, improperly filled medications at a pharmacy, distributing medication to the wrong patient (John Smith / Jon Smith)
- Overproduction: This lean waste can easily be remembered by thinking: right place – right time. Put simply, if the process is producing more than is necessary it is overproducing. Examples include: ordering unnecessary lab tests, ordering redundant diagnostic tests that may not provide much more information, and placing patients in the right setting (i.e.: telemetry utilization, seeking care in an ED vs care in a clinic)
- Waiting: Waiting is commonly found and identified in many different situations. For our purposes, we’ll defined it as any point in the process the customer must wait to receive/proceed to the next step in the process. Examples include: waiting in the ED to see a physician, waiting for a prescription to be filled, waiting for a room once admitted to the hospital, waiting to be discharged on the day of discharge
- Not the Best Use of Talent: This category of lean waste has to do with using the most appropriate level of staff to complete a task in a process. I wouldn’t anticipate that the chef would come directly to my table and take my order – they are busy cooking the food for other patrons at my restaurant of choice. Similarly, in healthcare, there are instances of tasks that are more appropriately carried out by support staff. For example, when preparing to receive a new patient into a hospital room, the housekeeping staff will clean and prepare the room according to a standard set-up. If one of the clinical staff is required to clean the room, this takes that clinician away from other patients and is not the best use of their talent and skills.
- Transportation: We can define this lean waste as the physical movement of any equipment, supplies or information in order to complete a task. Examples include: moving specialty beds between units, moving equipment to-from a patient care area, transporting paper charts, asking a patient to carry forward a form to the next stop in the process
- Inventory: I’ve seen this lean waste referred to in a couple of different ways. The obvious definition is inventory of supplies that are not needed. Another explanation of this waste is within the process where items moving through the value stream sit idle in queue for the next step. Examples include: medical supplies that are overstocked, expired supplies or medications, batched admissions or discharges processed at the end of a shift
- Motion: Where transportation has to do with equipment, motion has to do with the patient or staff member physically moving to complete the next step in the process. This lean waste can be observed and captured through the use of the spaghetti mapping technique. Examples include: the nurse having to walk to the station to chart in the medical record, the housekeeper who needs to go outside of their assigned work area to find a missing supply item
- Extraprocessing: This lean waste has to do with extra steps in the process that do not add value to the customer. In healthcare, this may present itself many different ways. Examples include: collecting unnecessary information from the patient, collecting that information more than once, ordering a panel of blood tests when only one result from the panel is really be needed