The 7 Wastes of Lean in Healthcare

Although the Lean business improvement methodology was initially developed to

improve the quality and productivity of automotive factories, it has been used with great
success in industries and settings of all types, including software development,
government, retail, and other service settings.

Healthcare organizations, in particular, have found that the approach can be used to
reduce costs and improve quality and patient satisfaction at the same time.

One of the core principles of Lean is the elimination of waste, which is defined as
anything that doesnt add value to the customer. Practitioners target eight specific types
of waste (there were originally seven - more on that later). They are as common in
healthcare as they are in manufacturing.

Defects/Mistakes
While defects in manufacturing are expensive and troublesome, in healthcare they can
be deadly. They may include:

Misdiagnosis
Administration of incorrect medications
Hospital acquired conditions
Incorrect IDC codes

The waste includes the time spent creating a defect, reworking these defects, and
inspecting these defects. Even though we consider inspection to be waste, we can't
eliminate inspection altogether until we have a perfect defect-free process. Even Toyota
still has final inspection in the year 2016... but they consider it to be waste that they'd
hope to eliminate some day.
Waiting
In manufacturing, waiting occurs when parts can't flow or when team members cant
perform their tasks due to problems, such as a lack of inventory or equipment failure.
Waiting in healthcare is a problem for both patients and providers.

Patients in waiting rooms (or exam rooms)

Staff members with uneven workloads waiting for their next task
Emergency department patients and physicians waiting for test results
ED patients waiting to be admitted to the hospital
Patients waiting to be discharged once medically ready.

Transportation
The waste of transportation occurs when materials are moved around inefficiently. In
healthcare it occurs when:

Patients are moved from department to department or room to room

Medication is moved from the pharmacy to where it is needed
Supplies are moved from storage to the floor

Some of this transportation is considered "necessary" waste to be minimized, even if it

can't be completely eliminated.

Overproduction
Overproduction in manufacturing results in excess "work in process" or unsold inventory
of "finished goods." It is more difficult to spot in healthcare, but it occurs when providers
do more than is needed by the customer at this moment. It includes:

Unnecessary diagnostic tests

Uneaten meals
 Ordering medications that the patient doesnt need
Peak staffing during non-peak hours

Over-processing
Over-processing means doing more work, making it more complex or more expensive
than is necessary. It takes the form of:

Ordering complex diagnostic imagery (MRI) when a simpler method would suffice
(X-ray)
o To reduce the cost and time related to MRI scanning alternative methods
such as optical imaging can be made use of which manipulates light and
produces images with high resolution
Unnecessary paperwork
o Use Computers
Surgical intervention in lieu of an equally effective medical alternative
Follow-up appointments that dont improve patient outcomes
o Only Mandatory appointments need the hospital visits
Treatment by specialists that could be done by primary providers

Inventory
Manufacturers have largely moved to a just-in-time approach to inventory in order to
reduce costs related to storage, movement, spoilage and wastage. Healthcare
organizations look to do the same as it relates to:

Medication that may expire

Overstocked consumables
Pre-printed forms
Excess bedside equipment
Motion
Motion refers to unnecessary movement of people within a facility or campus. This
happens when:

Office or hospital layout is not consistent with workflow

Supplies are not stored where needed
Equipment is not conveniently located

The first step in combating the wastes of Lean is recognizing them within your
organization. For most, examining each of these specific frequent contributors to waste
leads to the discovery of multiple opportunities for improvement. We can also strive to
eliminate wasted motion (including clicks) in software systems.
Human Potential
Some early sources in the Lean literature refer to 7 wastes of Lean. In recent years,
though, most publications have started referring to an eighth type of waste - failing
to utilize people's talent or human potential. Examples include:

Not listening to employees

Pressuring people to hide and cover up problems
People habitually working below their level of licensure

Defects
Company: Thai rubber gloves manufacturing company
Problem: To reduce/eliminate quality defects (i.e. holes/stains) on gloves, which clearly
comprise both an impact on customers expectations and important savings for the
organisational study.
Solution:
1) In order to overcome this problem, the company used principles and tools of one
of the most effective quality management and improvement methodologies, Six
Sigma. In particular, the DMAIC (Define-Measure-Analyse-Improve-Control)
 problem-solving and improvement model of Six Sigma was followed. Under the
umbrella of this model, several statistical and quality improvement tools such as
fishbone diagram, Pareto chart, Design of Experiments (DOE) and two-way
analysis of variance (ANOVA) were used.
2) A project charter was created clearly defining the focus area on gloves solely on
Medium (M) size.
3) Before the Percentage defect for Leaking was 19.51. After the improvement the
percentage defect reduced to 8.38%.

The muda of overproduction is caused by producing more than is necessary or

required.

Managing Overproduction in Agile Software Development

Waste #2: Over production:

Providing more than what is being asked for

Possible reasons

Gold-plating by the development team

Wrong prioritization of product features

Lack of understanding of the product vision

How can you eliminate it?

The product backlog should map it to the product vision

While prioritizing the stories for a sprint, the product owner and the development team

have to come to a common agreement on the stories for that sprint, and they must stick

to that list.

Right from the release planning, the product features have to be carefully prioritized.
The keys to prioritizing these stories are value, cost, and risk