8 Wastes in Lean Healthcare

The 8 Wastes in Healthcare and how you can remove them by Lean Healthcare application. See now.

8 Wastes in Healthcare – Summary

This course was facilitated by Mark Graban and webinar format during this presentation Mark introduces the different types of waste.

He’s encountered within the healthcare world as well as how to counter these situations Mark delivers his message by sharing powerful real-world stories.

He’s learned practice and taught lean and continuous improvement methodologies and settings including manufacturing Healthcare and startup.

Mark Graban – Curriculum

Mark as the author of the book lean hospitals and is co-author of a second book titled Healthcare Kaizen.

Mark earned a BS in industrial engineering from Northwestern University and also graduated from MIT where he earned an MS in mechanical engineering and an MBA from MIT Sloan’s leaders for Global operations program.

Finally marks created a dedicated landing page with notes and information related to this presentation will link to this page in the resources section or you can go directly to the website by typing this URL into your browser.

Reducing Waste in Healthcare

I want to talk today about the types of waste in healthcare.

It’s all about reducing waste and like reducing waste is a good start reducing.

The eight types of waste is a good start.

We’re also going to talk about value and what that means to patients and the healthcare setting when I first decided to do the webinar.

I originally was going to try to do eight stories about eight different types of waste but as I start have pulled together different stories and I realize it’s hard to find a story that’s just about one type of waste.

The 8 wastes are all interconnected one type of waste leads to another they’re both presents at the same time and sometimes of waste your certainly worse than others.

So I’m going to tell some stories for my own work some stories that you may have heard of out there in the healthcare land telling us stories in the context of lean.

And so when we talk about waste when we identify problems in the lean methodology, it’s honestly not always very uplifting the problems are the reality of the current state.

It’s not always pretty but it is what it is now people listening and attending they might be either just interested in lean Health Care.

Maybe you want to come in from the outside and I would say please please come on in.

There’s a lot of waste to reducing Healthcare.

You might be new to lean as a healthcare professional.

You might been in a hospital that’s been using lean for a while.

I’m hoping either way that this webinar is a good introduction or reminder.

Lean is Safety for Patients and Healthcare Workers

I think we need to fix the things that really matter most in healthcare, I think as Lean Community, we need to help our leaders understand that Lean needs to be first about safety for patients and for healthcare workers and quality and access and waiting times.

With that cost is a happy end result.

I think we all need to maybe try a little harder myself included the pushback if we’re just being asked to cut costs.

If we focus on first things first, we’ll find that we really going to reach the potential of what lean can do in healthcare across a lot of different dimensions.

Billion Dollars Wasted around the world

So we say this number here seven hundred and sixty-five billion dollars.

Well, that number, of course, represents the amount of wasted Health Care spending in the United States in 2009 according to a recent Institute of medicine report and I’ll have a link to that report in the notes that are going to be distributed after the presentation.

We’re burning money seven hundred sixty-five billion dollars a year and almost every country around the world, even though nobody spends as much as the U.S.

Everybody is struggling with the idea that we’re spending too much.

Have enough of a budget we need to reduce the waste in health care spending now put this big number and contest let’s look at an even bigger number of our total us Healthcare spending again 2009 2.5 trillion dollars.

That’s 18% of GDP.

We’re now spending close to 3 trillion dollars and the next highest major country to the U.S. is spending about 12% of GDP.

So again, this is a problem around the world.

We need system redesign and we need Continuous Improvement.

Now, if you look at the breakdown in the IOM report of that seven hundred and sixty-five billion dollars what are the contributors to either setting that money on fire or flushing it down the toilet regardless of how?

I want to look at this.

With my weird pie chart here.

We look at some of the big contributors.

We see things like fraud Miss preventive opportunities, excessive administrative costs.

I think the two buckets of waste that are maybe most clearly addressable with Lean include the category of what the IOM calls inefficiently delivered services of a hundred and thirty billion dollars a year.

This means quality problems.

This means inefficiencies in the delivery of care that patients should be receiving then there’s this even bigger category or bucket that they call.

Necessary Services 210 billion dollars of waste in Lean we would probably call this over-processing or overproduction providing care that doesn’t provide any value.

That doesn’t help the patient will talk about a few examples of those today.

Lean Approach vs Traditional Approach

There are opportunities in healthcare to save money by reducing these different types of waste which is a different approach than I think kind of the traditional approach of cost-cutting that we see in healthcare which often leads to because labor is 60 or 70 percent of Cost for a health system cost-cutting often just directly means layoffs.

Now the good news with Lean is that it gives us a fighting chance to improve and redesign process has to look at things in a new way to improve the way care is delivered and take the waste out of the system instead of just slashing headcount.

Cost of Quality vs Human Cost

And I think we need to focus on not just the financial cost of poor quality and efficiently deliver services and think of some of the human cost is well.

The picture you see here is a little patient Malia Jeffers and her story unfortunate.

I think really illustrates the pain and harm that comes from the waste of waiting.

Malia’s Story – Cost of the Waiting Waste

Now Malia was two years old her parents brought her to the emergency department in the Sacramento hospital.

She had a fever she was kind of turning purple.

She was weak and while in the waiting room as she was waiting and waiting Malia grew sicker and weaker now her parents repeatedly asked even begged Hospital workers to treat their daughter.

And the hospital said well, no, she’s not a highest priority right now and they were continuing to wait.

Well, it was five hours before Malia was first seen by a doctor according to court documents because they were lawsuits and eventually a ten million dollar settlement and emphasize the 10 million dollar number not to say.

Well that’s 10 million dollars of costs.

We should reduce that’s the settlement from the harm that occurred to Malia because she wasn’t seeing promptly because the patient flow was not what it could be in the emergency department and we see thankfully lots of emergency departments around the world using lean.

Redesign and improve patient flow so that nobody has to wait five hours.

So unfortunately in the case of Malia if she got worse and worse, she was flown to a children’s hospital and the doctors there found.

She had streptococcus a bacteria that invaded her bloodstream and organs and they had to amputate parts of both hands and both of her feet, but she’s now walking on Prosthetics as a four-year-old girl, which shows the very best of what healthcare can accomplish now in the sand aftermath of this tragedy the hospital says they’ve added new policies and procedures and audits.

They’ve assigned a nurse to the ER Lobby 24/7 to assess patients as they’re waiting that we’ll wait a minute.

Are they really addressing the root?

Cause and fixing the system to reduce this type of waiting a new story said the hospital didn’t want to comment on any possible disciplinary procedures that might have taken place which unfortunately I mean, I hope it’s not the case sounds like the old habit of blaming individuals for what are systemic problems and we look at the waste of waiting time.

This is just not there’s not just a matter of efficiency.

In fact, we look at trade-offs one reason.

High Utilization and Waste of Waiting

There’s a lot of waiting is because the focus is placed on the high utilization of people of rooms of beds.

If you look at the book on The Improvement by Jody Crane and Chuck Noon, they talked about the need to not focus on a hundred percent utilization.

Whether it’s 400 hours or MRI machines or for ERS when we have a hundred percent utilization basic industrial engineering and queuing theory tells us we are going to have long waiting times.

So maybe we need to rethink the idea of it’s really obvious when we see a healthcare professional who’s waiting or who’s not doing anything but sometimes for good flow and for an efficient system, we need resources that are wasted so that we don’t have the waste of long waiting times and patient harm that sadly occurs as a result.


So the six words you see here.

  • No waiting
  • No waste
  • Zero harm

The harm in waiting or types of wastes subsets of waste waiting can lead to harm but the lean approach is both patient and staff focused.

We don’t want patients waiting.

We certainly don’t want to harm them.

We don’t want staff members running around ragged all day long firefighting jumping through hoops dealing with waste.

We certainly don’t blame staff for the waste. It’s not their fault.

They’re doing the best they can and what’s often a broken system.

So by eliminating the waste better-taking care and providing better systems for the staff that allows them to take better care of our patients.