8 Wastes of Lean Last Revised: 8/8/2017

Waste Any activity that consumes resources but creates no value for the customer. An activity that is unneeded, unwanted, or involves excess effort. Not all waste is avoidable. Think of activities that are required to allow the value-added steps to occur or are required by regulations. We want o find the pure waste where we can and cut it out of our processes. How does waste affect us? Can be seen in comments like: I had a bad/frustrating day. I felt like nothing went right. I felt like I only dealt with problems and couldn’t do any actual work. Necessary Waste = things like, quality control testing, steps required by regulatory bodies like IDPH or DNV, registration (in the eyes of the patient), etc. Last Revised: 8/8/2017

When identifying waste, Lean breaks them down into 8 categories: Defects =Fixing mistakes due to incorrect information, QC in lab to prevent errors Overproduction = Filling out discharge paperwork, then discharge is pushed back a day Waiting = waiting to go to X-ray Non-Utilized Talent = Employee good at computers not recruited to help co-workers, Knows blood pressure cuffs are missing but doesn’t say, Ideas not harvested Transportation = movement from one nursing unit to another (ortho to rehab) Inventory = Stocking 2 cases of glucola when we do <1 GTT on inpatients per month Motion = Looking for pillows Extra processing = Faxing paperwork to Miller that is thrown away, Towel-folding and unfolding between laundry & floors Last Revised: 8/8/2017

8 Wastes We recently had a Lean project group look at the processes involved in managing patient beds throughout the inpatient tower. The scope included movement of extra beds when census was low or high and movement of beds when they needed repair. To look at the workflows, we put together a multi-disciplinary team made up of: Housekeeping, Maintenance, Materials Management, Nursing, and Wound Care. Let’s look at each type of waste as it appeared in this project. Last Revised: 8/8/2017

Defects: efforts caused by rework, scrap, and incorrect information Bed moved downstairs for repair when it was an easy, on-the- floor fix Unsure if bed has been cleaned, have to clean it again Unsure what’s broken, have to spend extra time “diagnosing” the problem Have to repeatedly fix wheels because size makes them easy to damage entering/leaving elevators Using the Bed Management Project to illustrate the various wastes Last Revised: 8/8/2017

Overproduction: production that is more than needed or before it is needed Cleaning empty second bed in a room when patient/visitors are likely to dirty it Cleaning beds on a unit with low census when other departments need beds cleaned now Moving a second bed to a room in expectation of an admit that never comes Last Revised: 8/8/2017

Waiting: wasted time waiting for the next step in a process Beds waiting on parts Any point in the process where a department’s other work means beds have to wait Housekeeping day shift plans for 2 admits/discharges a day Both Housekeeping & Maintenance staff getting pulled for other “STAT” duties Last Revised: 8/8/2017

Non-Utilized Talent: underutilizing people’s talents, skills, & knowledge Could train more Maintenance staff on bed maintenance Could better prioritize Maintenance duties to allow staff with special skills to focus on those What fixes can nursing staff try before reporting a bed as broken? Not involving front line staff in working on the bed process (before now) Not involving staff in working on the bed process (before now) Last Revised: 8/8/2017

Transportation: unnecessary movement of products & materials Moving unused, doubled beds downstairs or to the hallway, and then back again when census is higher Moving specialty equipment – SCD pumps, etc. – with beds downstairs Last Revised: 8/8/2017

Inventory: excess products and materials not being processed Bed storage space crowded with other things – medical records, broken chairs, etc. Holding on to un-fixable beds Older beds “undesirable” to floors Last Revised: 8/8/2017

Motion: unnecessary movements by people (e.g. walking) Walking around looking for beds when census is high Going up & down to store beds/remove beds from storage Looking for parts/equipment, like wheelchair footrests or SCD pumps Looking for parts? (like wheelchair footrests) Last Revised: 8/8/2017

Extra-Processing: more work or higher quality than is required by the customer Our staff getting pulled to work in non-RMG offices Going through several fixes when the problem is actually something small Cleaning a non-isolation room like it was an isolation room Last Revised: 8/8/2017

Waste Walk Go to the Gemba, or place where the actual work is done, and observe work in progress. Look for evidence of any of the 8 wastes in action. Involve front-line staff – they know the issues because they see them every day. Last Revised: 8/8/2017

We see the waste – now what? Once waste has been identified, develop plans to minimize or eliminate it. Get to the root cause. Look at the processes, not the people. Be willing to rethink anything. Use PDCA (Plan-Do-Check-Act) to test out ideas so that you don’t jump to solutions without confirming that they work. Last Revised: 8/8/2017

Sara Meyer Lean Educator smeyer@rhc.net (815)935-7256 x6392 If you have any questions or would like to learn more about Lean at Riverside, feel free to contact me: Sara Meyer Lean Educator smeyer@rhc.net (815)935-7256 x6392 Any questions? Last Revised: 8/8/2017