Monday, August 22, 2011

Waste in Hospitals – Healthcare

By Al Norval,

I had an interesting case recently to observe firsthand the waste in some typical Healthcare processes.

My son enjoys playing rugby and plays on the school varsity team. I have to admit, it’s a sport I don’t understand as I never played it as I grew up. To me it’s players bashing each other back and forth trying to score a “touch” all with no pads and little stoppage in the action. In any case, the boys love it and that’s the main thing.

Like any parent, I went to the games to support the home team. At the last game of the season my son broke his thumb making a tackle. So, we iced it up and off we went to the local hospital’s Emergency Department. As we arrived I called my wife and said we’d be back home in about five hours. Surely, it can’t take that long to X-ray his thumb and set it in a cast. We’ll see I said.

As we entered the waiting area I noticed a short line up in front of the triage nurse. After a short wait it was our turn to answer the questions and fill out the forms after which we took our places in the appropriately named waiting room. Without getting into all the details, I’ll highlight the Value Added steps:
- Thumb examined by Emergency Department (ED) physician.

- Thumb X-rayed by ED technician

- X-rays read by physician

- Broken thumb set in a cast

Needless to say, there were many other steps in the process all of which were waste. Some were necessary steps and the waste was necessary such as the initial filling out of forms, answering questions and even having the thumb re X-rayed in the cast to ensure the bone had set properly. Others such as waiting for the X-ray to be taken and read, waiting for the physician to examine the thumb and answering the same questions several times were pure waste.

As I pondered this during one of our many waiting steps, I realized the key to improvement in Healthcare is no different than any other process. We need to divide the process steps into Value adding, necessary waste and pure waste. We then need to engage our team members in:

- Reducing the necessary waste, and

- Eliminating the pure waste

The overall measure of how much improvement we are making is through examining the Lead time of the process. As we eliminate waste, the Lead time of the process will go down.

How much Lead time did it take for my son’s broken thumb to set in a cast? Five hours...

How much of that time was value added? One hour...

Therefore the waste in the process was about four hours. Fertile ground for making improvements indeed.

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