Eight Wastes

Healthcare Wastes Explained

In a healthcare context, value is a combination of what is valued by patients within a care pathway and the achievement of appropriate health outcomes (linked to providing evidence-based care). Any activity that does not contribute to this value can be classified as waste.

The concepts of value and waste are central to the Lean methodology that has been adapted from its manufacturing origins and applied successfully to the context of healthcare improvement in a number of organizations. The eight wastes approach can help to achieve improvement in healthcare services by enabling staff to examine their own workplace and eliminate activities that do not add value, ie wasteful activities.

This approach can improve the patient experience and release time that frontline staff can reinvest in service provision. Considering the eight wastes can be a useful exercise within any service improvement effort and will play a significant part if a wider Lean methodology is being implemented.

Waste is a symptom rather than the root cause of a problem. Waste indicates where problems are within the system or organization. You can use the eight wastes approach if you are embarking on a project to ensure that resources are being used to optimal efficiency.

These are the eight wastes:

1. Transport: waste transport refers to the excess movement of the product, patient/service user, or medical records, supplies, and equipment through the process. Some amount of transportation will be necessary depending on the hospital or clinic layouts – but ask yourself, “Have we optimized or minimized transportation?”

2. Inventory: wasteful inventory is usually excessive inventory – defined as having more of a particular item than is needed to perform the process. Excess inventories tie up resources – hospital cash is used to pay for these materials that sit in store cupboards. Often we spend additional money to store these items – shelving, etc. As inventories grow so the space required to store them increases – and this may mean that material has to be stored remotely from the point of use – this, in turn, can lead to additional transportation waste.

3. Motion: while transportation considers the movement of the product or patient/service user, the waste of motion refers to employees. Service re-design should aim to reduce or eliminate the extra motion that poor system design often creates. A system with optimal motion reduces employee fatigue and frees up valuable time to focus on the value add activities within our processes. Often in a healthcare environment, the wasted motion is walking and is very rarely a value add activity. 

4. Waiting: waiting refers to those points in the process where nothing is happening – no value is being added. Patient/service user waiting rooms is one obvious example – often due to poor flow or schedules. Racks of histology specimens waiting for the diagnosis, or surgical instruments waiting to be sterilized are other examples.

5. Over-production: this is waste where an excess of a product or service is being created without there being any need for them. Examples may include patient/service user meals, IT reporting, or pharmacy medications for patients/service users who have already been discharged.

6. Over-processing: doing unnecessary work or work to a higher quality than the client requires.

7. Defects: any work activities not done 'right the first time'.

8. Skills: not using people to the best of their abilities. One example could be bed managers acting as porters, but can also be created through not engaging employees or listening to their ideas.

What next?

Once you have succeeded in eliminating waste, your next step should be waste prevention. Ensure you design new services without inherently wasteful steps. Eliminating waste is not the only way to become a Lean organization, but it is a valuable learning experience, which brings all the team together to understand problems that they are then encouraged to solve.

References

NHS. (2021). Lean -Ohno’s eight wastes Online library of Quality, Service Improvement and Redesign tools. https://improvement.nhs.uk/documents/2125/lean-ohnos-eight-wastes.pdf

University Health Network [UHN]. (2016). The 8 wastes in health care. Www.youtube.com. https://www.youtube.com/watch?v=7mA1L_a_FX4