These days, everyone in healthcare is affected by the high cost of resources.  Even organizations with little exposure to Lean healthcare principles seek to be good stewards of supplies and labor in an effort to keep costs down.

When we consider the wastes identified in Lean healthcare, we evoke the mnemonic DOWNTIME (standing for Defects, Overproduction, Waiting, Not Clear (confusion), Transport, Inventory, Motion and Excess Processing).  Many organizations have wisely spent a great deal of time and effort on reducing waste in each of these categories – eliminating re-work, decreasing stock on hand, optimizing staff efficiency, and so on.

Over-utilization of resources is an indicator of waste which no reasonable provider can afford to ignore. Another, less obvious, indicator of waste is the under-utilization of resources.

LeanHealthcare_8wastesNext time you use a Lean healthcare tool, like value stream mapping or A3 problem solving, purposely seek out the waste of resource under-utilization.  Some examples you may find:

  1. Staff functioning below their licensure or training level
    Using more resources (skill and hourly pay rate) to achieve something that could be done with fewer resources exhibits the waste of excess processing. Obvious examples are RNs transporting patients or pharmacists pulling medications.  Review your internal policies and procedures and ensure they do not inhibit the full use of non-licensed technicians.  Good places to start are those areas which already have highly trained technicians in place.  OR Techs, Pharm Techs, EMTs, Med Techs, CNAs and Cath Techs may be able to take on additional tasks previously reserved for licensed providers.
  2. Empty rooms or open space
    Empty rooms could exhibit the waste of waiting. In many facilities space is a premium commodity.  There never seems to be enough – whether for offices, storage, or program expansion.  Yet how much existing space is actually underutilized because it serves functions that only occupy a room 30 to 50 percent of the time?  Private offices, on-call rooms, OP clinics are prime examples of areas that may only actually be used for a fraction of the day.  Consider creative ways to multi-purpose under-utilized spaces.  Could your clinic exam rooms or OR-prep spaces be used as overflow areas for busy evening ED hours?
  3. Partially implemented information systems
    Partially implemented technology drives the waste of excess processing because it takes more effort for staff to complete tasks than it would if the IT tools are fully utilized. Today’s IT systems are becoming increasingly robust and multi-functional.  Everyone has an EMR, but who can boast that theirs is fully implemented?  Many engage the applications needed to fix problems or meet regulatory requirements while allowing other efficiency driving capabilities to run idle in the background.   Do you have physicians who still use transcription?  Have you employed kiosks for registration?  Can your patients schedule an appointment on-line?  Along with your EMR, review best of breed products in surgery, supply chain, or ambulatory care as well.

With these few examples in mind, next time you are tempted to focus solely on how to cut back or minimize resources perhaps you will surprise your team by asking, “What could we use more?”


Today’s blog was written by Karen Kendall, RN, healthcare planner with HPP. Karen is a registered nurse with more than 30 years of healthcare experience in clinical and leadership roles.

Before joining HPP, Karen led multi-disciplinary teams through operational and space planning and work redesign efforts which resulted in in significantly improved efficiency, patient satisfaction and employee engagement. She has extensive experience in campus master planning, equipment planning, and way-finding. She has also served in clinical and leadership roles in a variety of areas including invasive cardiovascular services, surgical services, and pediatrics.

Karen holds a Bachelor of Science in Nursing degree as well as a Master of Healthcare Administration degree from Duke University.

Photo by NEC/cc by

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