One of the first principles taught in Lean training is defining and demonstrating how to see Waste, or non-value-added effort.  Learning Lean in a healthcare setting taught me to identify waste not only at work, but everywhere I go.  It drives my husband crazy because I continuously point out waste and improvement opportunities wherever we go, including restaurants, airports, retail shops, and – I hate to admit it – even in our home. Most recently, we visited a sub sandwich restaurant, where I observed a Lean sandwich making process.

If you’re not familiar with Which Wich, upon entering the restaurant you find a wall lined with categorized paper bags correlating with a sandwich on a menu board.  To select a sandwich, you pull a bag and then use a pen to mark options to customize exactly what you want.  Next, an associate reviews your bag, identifies any defects, rings you up and places the bag on an overhead wire.  The bag is moved down the line as the sandwich is being made and customized.  At the end of the line, the sandwich is placed in the bag and another associate calls out your name when your order is ready.


My daughter and her friends choosing their sandwich at Which Wich.



Which Wich Sandwich Bag

This single piece flow operation adheres to an IDEAL process:

DEFECT FREE—exactly what the customer wants (customer fills in circles on bag as to what he/she would like)

ONE-BY-ONE—customized to each individual customer (fresh sandwich, not made in advance, and configured on the assembly line)

ON DEMAND—exactly as requested (single piece flow – not batched)

IMMEDIATE RESPONSE—problems or changes (associate at register reviews for clarity and immediately identifies missing information)

NO WASTE (no confusion as to what is available – items are listed on the bag, no overproduction of sandwiches –limited transportation/motion – bag that is written on for order is the bag you receive your sandwich in, and no excess processing – sandwich is made right the first time)

SAFE—customers and staff (staff feel competent and comfortable with their process to safely provide their customer with a safe product)

These principles can easily be applied in a Lean Healthcare setting.  As you are looking to improve a process, ask yourself the following questions:

  • Does the process provide the patient with exactly what he/she wants or needs (DEFECT FREE)?
  • Is the process customized ONE-BY-ONE to each individual patient?
  • Is the process ON DEMAND, exactly as the patient requested it?
  • Is there a way to identify a problem or change in the process IMMEDIATELY?
  • Can you identify any WASTE in the process?
  • Is the process SAFE for patients, staff, and clinicians?

EinbeckNicole_resizeToday’s blog was written by Nicole Einbeck, lean design consultant with HPP.

Nicole works primarily in healthcare lean led design and facility consulting services, involving improving workflow and documenting new standards. 

For nearly two decades, Nicole has worked across the healthcare field, including human resources, risk management, occupational health, employee health, safety and wellness, and process improvement. She spent five years assisting in the Lean transformation at Monroe Clinic in Monroe, Wisconsin, where she also served as the Clinic’s move project manager and process improvement specialist. 

Nicole holds a Bachelor’s degree in Health Promotion/Wellness and Psychology from the University of Wisconsin, Stevens Point.

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