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improvement
The Seven Wastes in Health Care
Senior Value Engineer Luca Boi applies the Lean concept of waste to health care and explains how learning to see the “Seven Wastes” can help focus your efforts.
Luca Boi
Apr. 10, 2019 5 minutes

Learning objectives

After completion, you will be able to:

(1) define waste in health care

(2) differentiate between value-added and non-value added activities

(3) identify the seven wastes in health care

Download slides: PPT

How to spot common problems

H

ealth care is complex. Many areas need improvement and it is difficult to know where to begin. The Seven Wastes is a classification system that helps identify common problems found in every industry. When you know what to look for, you know where to begin.

What is waste in health care?

Waste in health care is any activity that doesn’t add value to patient care. Value is determined by our patients. The terms value-added and non-value added are commonly used to help identify waste:

Value-added (VA) refers to any work activity that contributes in a meaningful way to the patient’s care provision (like a visit with a clinician) or information about that care (like test results).

A step is value-added if it adds to the patient's care provision or information about that care.

Non-value added (NVA) refers to any work activity that doesn’t contribute to the patient’s care—in other words, waste. NVA doesn’t mean “not necessary.” Not all of the work required to run a health system is perceived by patients as valuable. For example, federal laws require that we document certain things in the electronic health record. These efforts may not be perceived as valuable to patients, but they are important for running a health system.

Icon The Seven Wastes Common Health Care Examples
Defects/mistakes: Time and material spent doing something wrong and, later, fixing it.
  • Duplicate MRNs
  • Correct labs not ordered
  • Misdiagnosis
  • Hospital-acquired conditions
Waiting: When patients or their information sits in a queue. Some definitions include employee wait time.
  • Emergency department wait time
  • Lab processing
  • Clinic wait rooms
  • Clinic exam rooms
Transportation: Moving patients or materials between work centers.
  • Moving patients from department to department
  • Moving information through email or electronic medical record (EMR)
  • Moving meals from cafeteria to unit floor
Overproduction: Producing more than is needed. Producing too soon.
  • Delaying discharge
  • Keeping urinary catheter in too long
  • Making a meal the patient doesn't eat
Overprocessing: Doing more work than needed.
  • Asking patients to fill out duplicate paperwork
  • Performing a surgery when a non-invasive intervention will suffice
  • Ordering and completing unnecessary tests, diagnostics and therapies
Inventory can expire, get damaged, and become obsolete. Also applies to stored information.
  • Drawing and keeping blood samples (rainbow draws)
  • Keeping too much bedside equipment
  • Preprinting forms
Motion: Unnecessary movement within a work station.
  • Navigating through the EMR
  • Hunting and gathering materials and equipment
  • Walking—from the health unit coordinator (HUC) station to the med room to the patient room

Download the 1-page overview of this table here.

Conclusion

Before you begin improving any process reflect on the Seven Wastes to help prioritize and plan wisely. Developing the ability to spot these challenges early is an essential improvement skill. It creates value for you, your team, and your patients.

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Resources

Contributor

Luca Boi

Senior Consultant, Process Improvement, Analytics, Planning, Strategy and Improvement, Brigham and Women's Hospital
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