Eight Forms of Waste Healthcare Example

Waste Category Definition Health Care Examples

DEFECTS


Correction or rework because of defects, low
quality, or errors

Requisition form incomplete/inaccurate/illegible.
Order entry error. Incorrect bill.
Incorrect name. Wrong site surgery.
OVERPRODUCTION


Producing more, sooner, or faster than required
by the next process. Any health care service
that does not add value to the patient.

Antibiotics for respiratory infections.
Unused printed results/reports.
Unnecessary labs/visit. Over ordered medications
WAITING


People, machine, and information idle time.

Patient in waiting room. Waiting for meetings.
Wait for lab results. Waiting for patient bed.
Waiting for OR cleaning.
NON-UTILIZATION
OF TALENT


Underutilized ability of people. Mismatch of
skills and task.

Nurses refilling Rx or making appointments.
Doctors doing simple patient education.
Not getting improvement ideas from frontline
workers.
TRANSPORTATION
(MATERIALS)


Material movement.

Unnecessary patient or material movement.
Multiple patient/paperwork transfers.
Temporary locations for supplies.
INVENTORY


Information, material, or patient in queue or
stock.

Patient waiting in exam room.
Excess stored supplies. Bed assignments.
Ordering in bulk. Specimens awaiting analysis.
MOTION (PEOPLE)


Unnecessary staff movement (travel,
searching, walking).

Walking to and from copier/office/exam room.
Searching for misplaced form/equipment/chart.
Crossing room for reagents.
EXTRA PROCESSING


Redundant or unnecessary processing.

Reentry of patient demographics.
Repeat collection of data. Multiple consent forms.
Bed moves.

Munson Healthcare Management Engineering/Decision Support 9/13/2011
Lean Resources

1. Advanced Lean Thinking: Proven Methods to Reduce Waste and Improve Quality in Health Care. J oint
Commission Resources. 2008.

2. Doing More with Less: Lean Thinking and Patient Safety in Health Care. J oint Commission Resources.
2006.

3. Environment of Care Management Plans. J oint Commission Resources. 2010.

4. Getting the Right Thing Done: A Leaders Guide to Planning and Execution. Dennis, Pascal. 2006.

5. Getting Things Done: The Art of Stress-Free Productivity. Allen, David. 2001.

6. Going Lean: Busting Barriers to Patient Flow. Smith, Amy. 2008.

7. Kaizen Event Fieldbook: Foundation, Framework, and Standard Work for Effective Events. Hamel,
Mark. 2010.

8. The Lean Company: Making the Right Choices. J ordan, J ames. 2001.

9. Lean for Dummies. Williams, Bruce. 2007.

10. Lean Guide to Transforming Healthcare: How to Implement Lean Practices in Hospitals, Medical
Offices, Clinics and Other Healthcare Organizations. Zidel, Tom. 2006.

11. Lean Hospitals: Improving Quality, Patient Safety and Employee Engagement. Graban, Mark. 2009.

12. Lean in the OR. Leone, Gerard. 2010.

13. Lean Library Management: Eleven Strategies for Reducing Costs and Improving Customer Services.
Huber, J ohn. 2011.

14. Lean Production Simplified: A Plain-Language Guide to the Worlds Most Powerful Production System.
Dennis, Pascal. 2007.

15. Lean Six Sigma for the Medical Practice: Improving Profitability by Improving Processes. Cohen,
Frank. 2010.

16. Lean Thinking: Banish Waste and Create Wealth in Your Corporation. Womack, J ames. 2003.

17. Lean Transformation: How to Change Your Business into a Lean Enterprise. Henderson,
Bruce. 1999.

18. Managing Patient Flow in Hospitals: Strategies and Solutions. Litvak, Eugene. 2010.

19. Mastering Patient Flow: Using Lean Thinking to Improve Your Practice Operations. Woodcock,
Elizabeth. 2007.

20. Six Sigma and Minitab: A Complete Toolbox Guide for All Six Sigma Practitioners. Brook, Quentin.
2006.

21. Six Sigma Book for Healthcare: Improving Outcomes by Reducing Errors. Barry, Robert. 2002.

22. The Six Sigma Memory J ogger II: A Pocket Guide of Tools for Six Sigma Improvement Teams.
Brassard, Michael. 2002.

FORMULATING THE QUESTION
FINDING THE APPROPRIATE RESOURCE

STRUCTURE QUESTION USING THE PICO METHODOLOGY

P=Population/ Patient - Who is the patient/customer that you are trying to find out information for? What are the
most important characteristics of the patient? This may include the primary problem, disease, or co-existing conditions.
Sometimes the sex, age or race of a patient might be relevant to the diagnosis or treatment of a disease.

I=Intervention - Which main intervention, prognostic factor, or exposure are you considering? What do you want to do
for the patient? Prescribe a drug? Order a test? Order surgery? What factor may influence the prognosis of the patient?
Age? Co-existing problems? What was the patient exposed to? Asbestos? Cigarette smoke?

C=Comparison - What is the main alternative to compare with the intervention? Are you trying to decide between two
drugs, a drug and no medication or placebo, or two diagnostic tests? Your question does not always need a specific
comparison.

O=Outcome - What are you trying to do for the patient? Relieve or eliminate the symptoms? Reduce the number of
adverse events? Improve function or test scores? What can you hope to accomplish measure, improve or affect?



* Prioritization of resources will change depending on customer group (i.e.: nurse or nursing question use CINAHL as
first choice).
EBM Questions will usually fall
into these categories:
Laylevel/ Consumer Health Clinical*
Therapy/Treatment MedlinePlus, Mayo Clinic, Patient Ed
Webpage, Librarian
Medline/PubMed, CI NAHL, Cochrane
Diagnosis MedlinePlus, Mayo Clinic, Patient Ed
Webpage
Medline/PubMed, CI NAHL, Cochrane
Prognosis MedlinePlus, Books, I nternet Medline/PubMed, CI NAHL, Cochrane
Etiology MedlinePlus, Books Medline/PubMed, CI NAHL, Cochrane
Harm Reference Books, Lexicomp,
MedlinePlus, Natural Standards
Medline/PubMed, CI NAHL, Cochrane
Topic Specific Questions Laylevel/ Consumer Health Clinical
Drug I nformation Medline Plus, Lexicomp, Natural
Standards
Lexicomp, Medline/Pubmed
Guidelines/Consensus Statements National Guidelines Clearinghouse,
Medline, MDC Guidelines, Association
Websites, Reference Books
National Guidelines Clearinghouse,
Medline, MDC Guidelines, Association
Websites, Reference Books
Healthcare Administration Business
Models, Leadership, Planning,
Strategy, Forecasting/Trends
Health Business Elite, Google Health Business Elite, CI NAHL,
Medline/PubMed, Google
National/Regional Organizations Organization websites, MedlinePlus Organization websites, MedlinePlus
Statistics Stat Resource Intranet Page, National
Organizations, Google
Stat Resource Intranet Page, National
Organizations, Google
Support Group Information Support Group Binder, Munson website,
Google
Support Group Binder, Munson
website, Google, CHL
Test Results Reference Books, Lab Tests Online
website
Reference Books, Lab Tests Online
website
Reference I nterview Grid by Customer Group
1. Determine customer group by viewing Munson ID. Customer must have a Munson ID to use the HSL.
2. Determine if question is Ready Reference, a request for a literature search, or a document delivery request.
3. If request is for literature search or document delivery, follow the outline below.
*Primary Allied Health Professions: Audiology, Cardiovascular Tech, Clinical Psychology, Dietitics, EMT, Medical Assistants, Med Lab Tech, OT, Paramedic,
Pharmacy Tech, Pharmacy, PT, Radiologic Tech, Respiratory Therapy, SLP, Surgical Tech, Social Work, Sonography, Ultrasound.
Administrator,
Physician, Resident,
Medical Student
Nurse,
*Allied Health, Employee,
Volunteer
Employees who are
Students

All Students/ All Other
Not Employee

1. What is the purpose of
your request?

Determine if request is for
research or document
delivery.
1. What is the purpose of
your request?

Determine if request is for
research or document
delivery.
1. What is the purpose of
your request?

Determine if request is for
research or document
delivery.
1. What is the purpose of
your request?

Determine if request is for
personal use or for school.

If document delivery
request continue with next
question.
If document delivery request
continue with next question.
If document delivery request
continue with next question.
If request is for personal
use refer to CHL.
OR OR OR OR
If clinical research request,
obtain research request
form and continue with
next question.
If clinical research request,
obtain research request form
and continue with next
question.
If clinical research request,
obtain research request form
and continue with next
question.
If request is to support
school, refer customer to
home school library. Direct
to home library webpage
for services such as
database access and
document delivery.
OR OR OR We are able to provide
supplemental library
services for all students.
Students should be utilizing
their home library for
search services and
document delivery if their
request does not support
patient care or a hospital
project. This is part of
what their tuition covers.
Most students are not
aware of their home library
services and need
education in this area. This
is particularly true for those
students pursuing online
degrees.

*Does not include Medical
Students.
If consumer health
request, provide basic
information and refer to
CHL for additional
resources.
If consumer health
request, provide basic
information and refer to CHL
for additional resources.
If consumer health
request, provide basic
information and refer to CHL
for additional resources.
If not Consumer Request If not Consumer Request If not Consumer Request
2. How will this information
be used to support patient
care?


2. How will this information
be used to support patient
care?


2. How will this information
be used to support patient
care?
OR OR If supports patient care fill
out research request/DD
form. Provide full services.
3. How will this information
be used to support a
hospital project?
3. How will this information
be used to support a hospital
project?
If doesnt support patient
care go to next question.
Fill out research request/DD
form.
Fill out research request/DD
form.
3. How will this information
be used to support a hospital
project?
Provide full services. Provide full services. If information supports
hospital project fill out
research request/DD form.
Provide full services.
If information request does
not support patient care or a
hospital project, refer to
home library for support. Can
direct them to home library
webpage and services offered
such as database access and
document delivery.


Article Request Owned by Library

Verify if employee if not refer to CHL/Kiosk/Home Library


Article Request/Not Owned by Library

Verify if employee if not refer to CHL/Kiosk/Home Library


Print/Electronic Book or Multi Media Request Owned & Not Owned

Verify if employee if not refer to CHL/Kiosk/Home Library