Here is an international reader question from somebody working in healthcare in the Middle East.
The reader writes:
I would like to thank you for your guidance. I have current and future state Value Stream Maps for a process, but I need your answer on these examples of Lean wastes in healthcare… Are these overproduction or overprocessing?
1) duplicate charging.
2) writing repetitive information in multiple documents
3) repeated registrationReally, I'm confused between many references.
In the Lean approach, people usually talk about seven or eight types of waste. These categories come originally from Toyota, but I think they generally translate well into healthcare and other settings.
Here is how I lay out the “eight wastes” in my book Lean Hospitals. This isn't the only framework out there. Some rearrange the first seven types of waste to spell TIMWOOD or the eight wastes might spell out DOWNTIME.
Sometimes, people tweak the names they use for the types of waste, but I see pros and cons to doing that. As with our discussion yesterday about Kaizen Card terminology, it's good to have language that your colleagues relate to, but I think there are benefits to us having common language in the “Lean community,”
As I wrote in the book:
“Having complete agreement on the exact terms is not crucial, as Toyota did not intend this list to be all inclusive or to be something that could not be changed. Consistent terminology does, however, help us communicate within our organization and across the industry.”
And the table:
| Table 3.3
The Eight Types of Waste |
||
| Type of Waste | Brief Description | Healthcare Example |
| Defects | Time spent doing something incorrectly, inspecting for errors, or fixing errors | Surgical case cart missing an item; wrong medicine or wrong dose administered to patient |
| Overproduction | Doing more than what is needed by the customer or doing it sooner than needed | Doing unnecessary diagnostic procedures; producing medications that are not used before the orders change or patient is discharged |
| Transportation | Unnecessary movement of the “product” (patients, specimens, materials) in a system | Poor layout, such as the catheter lab being located a long distance from the ED; patients moving from building to building to receive cancer treatment |
| Waiting | Waiting for the next event to occur or next work activity | Employees waiting for a patient, information, or work to do; patients waiting for an appointment, care or discharge |
| Inventory | Excess inventory cost through financial costs, storage and movement costs, spoilage, wastage | Expired supplies that must be disposed of, such as out-of-date medications |
| Motion | Unnecessary movement by employees in the system | Lab employees walking miles per day due to poor layout; walking to find missing supplies, equipment, or medications; unnecessary clicks in an EMR system |
| Overprocessing | Doing work that is not valued by the customer or caused by definitions of quality that are not aligned with patient needs | Entering data into a computer system that is never seen or used; Excessive warnings in an EMR system that physicians and nurses just click through |
| Human potential | Waste and loss due to not engaging employees, listening to their ideas, or supporting their careers | Employees get burned out and stop giving suggestions for improvement or quit their job |
As I say in the book, the types of waste are meant to help us find waste. Finding waste is a key step in improving the process. I've never found it to be a good use of time to debate if something is, for example, overprocessing or overproduction. That time would be better spent improving the process and reducing the waste where we can.
From the book, the same point:
“… it can be an academic exercise to categorize an activity as value or waste. Rather than arguing for hours about the classification, it is more important to ask if we can eliminate that step or find a better way. Looking for waste is meant to be a way that leads to improvement by challenging existing practices.B
Back to the scenarios from the reader… all of these clearly seem like waste, so maybe we don't have to spend time debating if something is “value added” or “non value added” (or waste).
duplicate charging
Is this a defect in the process? Is it wasted motion? Overprocessing? Is it the overproduction of charges?
The key is working to improve the process to reduce or eliminate that duplication.
writing repetitive information in multiple documents
Is that wasted motion? Overprocessing? Overproduction of information?
There seems like a clear opportunity to eliminate that duplication (or so I'd hope)
repeated registration
Is that overprocessing or overproduction?
No matter… what do we have to do to reduce that duplication? I've seen patients have to stand in line to register in multiple parts of a hospital in the same date. It's frustrating and a waste of time resources.
This might be the type of situation where we call this “required waste” in the short term. We can't stop doing the multiple registrations tomorrow, perhaps. But, maybe we can reduce this waste over time. Does it require a new IT system?
What do you think? Do you spend time debating the categories of waste?
It's not always as clear as the recycling and rubbish bins, is it? Well, I find myself confused when faced with five or six different types of bins…
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