Talking about waste can be…..problematic in health care. In almost all health and social care systems, staff are very busy, and often feel they are going the extra mile to help deliver care to their patients or clients. Give this, the idea that there might be waste in the system can feel hurtful and unfair.
In my last post, on value, I concluded that, for a process to have value, it has to be of benefit to the patient, be done right first time, and has to transform the product in some way. Tapping and colleagues, in their book ‘Value Stream Mapping’, suggest that waste is ‘anything that adds costs or time without adding value’.
This can include a wide range of activities and barriers. Wastes are often divided in to seven or eight categories. Commonly described categories are defects, waiting, over-production, over-processing, motion, transportation and inventory, with some authors adding in the category of ‘loss of human potential’.
It is often useful in practice to add a division in to absolute waste, and waste that is currently required. This is sometimes described as ‘necessary non-value added activities’. Examples of clear cut waste often include steps left over from previous processes, which have not been removed, and can be stopped immediately with no impact on patient care (for example continuing to keep a spreadsheet or stand alone database after an electronic patient record has been introduced, and which can produce the same data).
Currently necessary activities are often related to the layout of a hospital, or to problems that are difficult to resolve. For example, an x-ray department may be some distance from an out-patient department. The journey from one to the other adds no value to the process, but cannot be currently avoided because of the hospital layout. I saw a recent example of the same category, in a service that needed to keep electronic copies of video clips of ultrasound scans. There was storage space on the system, but repeated attempts had failed to find a way to copy the clips automatically to the storage system from the scan system. Instead, staff had to copy the scans to disc, record them on paper sheets, and archive the discs in a cupboard. There was no added value, and it took considerable staff time, but it was currently necessary, at least until the problems in the communication between the two systems can be resolved.
I am going to devote a series of posts to discuss types of waste – please feel free to comment on the posts as I progress.
Image courtesy of scottchan at freedigitalphotos.net.