As noted in the previous posts, the idea of ‘waste’ is abhorrent to some people. They see busy, over-worked staff, doing their best to deliver good quality services. The suggestion that they are producing waste is distressing and blaming, they argue.
When this criticism arises in the course of discussing Lean, I explain that the problem is the system, not the people working in the system. Identifying waste is not a criticism of staff, but rather a way of enabling staff to deliver the service they want to provide. Some people accept this, but others look askance – ‘that’s just rhetoric’, they argue: ‘it’s going to come back to blaming us and trying to make us work even harder’.
The best way to counter this is by letting people experience the approach for themselves: nothing else is as persuasive as direct personal experience. Providing examples can also be valuable, and that’s the purpose of this post, which deals with two types of waste – waiting and motion.
Much of the experience of people using services is direct experience of waiting. When you map out care journeys, it is common to find that a very small percentage of time, when considered from the point of view of the service user, is adding value.
Examples of waiting are:
- waiting to receive an appointment
- waiting at a clinic for the staff member to be ready to see you
- waiting within a clinic process for the next person to see you
- waiting for test results
- waiting for a prescription to be ready
- waiting for transport – and so on
Staff experience much the same thing – waits for patients to emerge from a previous treatment, waits for test results, waits for rooms to be free, waits for equipment, etc.
Waiting is so ubiquitous in health and social care, that we often stop thinking about it. So far, I have not come across a service in which waiting cannot be reduced, usually by changes to the system. I discussed an example of decreasing waiting by improving flow in an example from a pre-operative assessment service in a previous post.
‘Motion’ is usually taken to describe movement by staff. As Mark Graban comments in his book, Lean Hospitals, ‘the aim is not to have static staff who never move, but rather to reduce or eliminate unnecessary motion and walking‘.
Examples of wasted motion include:
A clinic where staff spent time looking for a tonometer, a device to measure pressure inside the eye. There were several tonometers, but fewer devices than there were treatment rooms. A device had been borrowed for use on a ward, and a second device had broken. Staff sought to save the cost of new devices by managing with fewer. During observations, it was common to see staff leaving a treatment room and knocking on several other doors before they located a tonometer they could borrow, and returned to their room, to the patient who had been waiting.
It was clear that the cost of the staff time spent looking for devices over the course of a year greatly exceeded the cost of the replacement tonometers, and in this case, additional equipment was purchased. This example also proved to include over-processing, and I will pick that up in the relevant section. Keeping the devices in the correct place for immediate use was resolved by the use of 5S.
A service where the printer was located in a different corridor. The administrative staff had to walk 150 feet (about 46m) each way to retrieve their print outs. As this included material for patients, this also produced waiting. Over the course of a day, the administrative staff could make the journey over 20 times, meaning total walking of over 1.8km. A neighbouring service located an unused printer which was relocated to the area in which the administrative staff worked, eliminating the walk.
Preparation for a procedure. A service repeated the same procedure up to ten times in the course of a specific clinic. Preparing the equipment and supplies for the procedures took an average of 11 minutes. A queue often developed at this part of the clinic visit, resulting in waiting for patients, and additional stress for staff. Much of the time was spent locating supplies from a main storage room. There would have been several ways of tackling this problem, including external setup where preparation happens in parallel to the treatment process, and moving supplies to the treatment room. In practice, if proved to be most effective to have dedicated sterile packs made up for the procedure, and so reducing motion, waiting for patients and stress on staff.
Do you have examples of wastes in these categories? How have you addressed them?
Photo courtesy of Stuart Miles at freedigitalphotos.net