Feelin’ Lean – The 8 Wastes found in Healthcare

First of all, I feel like the moderately cheesy title deserves a brief explanation.  When I worked in Lean departments in various hospitals, I heard no shortage of greetings phrased as “Lean” puns (i.e. “how you leaning?”), including the one above.  The one I chose felt like the best of the bunch as a title for an ongoing blog series, so there it is.

As discussed in an earlier SOAP notes blog, What is Lean and What’s it Doing in Healthcare?, Lean is a methodology that’s gaining popularity in the healthcare sector after being used for decades in industries such as manufacturing.  In this post, we’ll dive a little deeper into some of that methodology, starting with a primary Lean staple – waste.

There are actually numerous ways waste is described in Lean, depending on the group or person doing the explaining.  The one I am most familiar with is outlined and well explained in this Process Excellence Network post.  The acronym for the 8 Wastes is DOWNTIME, and it stands for:

  1. Defects
  2. Overproduction
  3. Waiting
  4. Not Utilizing Talent
  5. Transportation
  6. Inventory Excess
  7. Motion Waste
  8. Excess Processing

You might be thinking, “Great, but how do these related to healthcare?”  Here’s a few examples (with help from this document from the Montana Hospital Association):

Defects – These are some of the more obvious examples of waste in healthcare.  Medication errors, surgical errors, and billing errors are the most common defects in  healthcare.

Overproduction – Nurses are familiar with duplicate charting, which is a prime example of overproduction.

Waiting – Anyone and everyone who has ever been to a hospital is familiar with this type of waste.  Nurses waiting for a doctor to round and write a discharge order, doctors waiting for lab results so they can write discharge orders, patients and families waiting for a discharge so they can go home, etc.

Not Utilizing Talent – One example for nurses is when too much time is spent on on tasks that aren’t patient care.  It also applies more generally, when supervisors don’t utilize staff to their full potential.

Transportation – As a nurse, have you ever had to walk to another nursing station or department to find the supplies you need?  That’s transportation waste.

Inventory Excess – Costco has normalized having lots of extra stuff, but the truth is, it’s waste.  Overstocking say, surgical instruments, is not only wasteful as far as space, but also cost.  Most surgical equipment has an expiration date, which is easy to overlook if there is more than needed.

Motion Waste – Can’t find those lab results because they weren’t appropriately put into the patient’s chart?  Or having to spend 20 minutes searching for a catheter because they aren’t where they’re supposed to be?  These are great examples of motion waste.

Excess Processing – Having to make a phone call to clarify orders is a good example of excess processing.  As a patient, having to fill out the same information across nine different documents is a waste due to excess processing.

This is just the tip of the iceberg in terms of waste in healthcare.  I’m sure all of you clinicians out there can think of countless examples experienced on a daily basis.  And it’s even easier if you’ve ever been a patient.  The important thing is that too often, the daily grind of healthcare can mask inefficiencies as just “the way it’s done.”  Learning how to spot waste is the first step in reducing it, which is a topic for another day!




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