Waste walk exercise in hospitals

Waste is universal and is in every process and in every industry, but when the same waste is seen on the hospital floors, then it has a much bigger impact than the usual ones. It’s very unfair of the system when the clinical professionals, have to invest the majority of their time doing a non-clinical job in a hospital. Wasteful processes in the system often forces healthcare professionals to extended working hours, overruns and fatigue. The chaotic work environment significantly increases the chance of harm to the patients too. With these kinds of uncertainty and risk associated with the healthcare industry, the health leaders often face challenge to find solutions for implementing cost-effective programs for the operational efficiency and to reduce the burden on everyone.  

Waste is a huge issue in the modern healthcare system and there is an estimated 30-60% of the wasteful activities happening in hospitals that are of absolutely no value to the providers, the patients and the system as a whole. In an industry where we are so much concerned about the manpower crunch, cost, affordability and patient safety, somewhere we underestimate the benefits of eliminating waste from our operational processes and the impact it can have on the entire system. Let’s explore the waste walk exercise quickly, try to understand its simplicity and see how can it help boost operational efficiency across the care facility.  

What is a Waste?  

Anything that does not add value is considered as a waste. It could be any step or action in a process that consumes resources but creates no value to the customers. Taiichi Ohno, the founder of the Toyota Production System, identified the seven (7) wastes. Another waste was added at a later date and we call these the 8th Waste. Let's look into the simple healthcare examples of each:  

• Waiting - Patient waits to see the doctor  
• Defects – Re-test, wrong medications  
• Motion - Ergonomic issues  
• Transportation - Excessive transfer of patients   
• Inventory - Storing excessive medication  
• Over production - Unnecessary diagnostic procedures  
• Over processing - Collecting unnecessary information  
• Unused human potential - Lack of employee involvement, restricting employee’s authority and responsibility to make routine decisions  

What is a waste walk?    

Waste Walks are designed to identify opportunities for reducing waste in the operational processes. It's very usual to become set in our ways of carrying out processes, confined by the routines and the long-standing operating procedures that we are following for a long time but sadly it may not be the most efficient ones. Often there is a chance of bias to make out those waste as you are continuously in the same place & seeing the same process over a period of time and things just looks fine to you. In such scenarios a "Waste Walk" can provide a new way of rethinking your processes and potentially help you become more productive and profitable over a period of time. Taking a “Waste Walk” is one of the ways to make the waste visible again. It's a simple & structured exercise to increase awareness about waste with an intent of identifying rapid, no or low-cost improvements. It's a walk around, looking at the processes or physical spaces for things that don't add any value to the stakeholders.  

Please note that a Waste Walk is different from a Gemba Walk, though both are key Lean tools. A waste walk is more of a planned visit to the areas where the work is being performed, to observe what’s happening and to specifically track and look for the wasteful activities.  

Why to take waste walk?  

Hospitals can turn to waste elimination techniques to help them not just achieve their long-term cost affordability and but also to build a sustainable business for the future. Waste elimination can become a key tool and a strategic differentiator to remain competitive, however, the most challenging issue is not the identification of waste, but the empowerment of the teams and the individuals on the hospital floors and their desire to tackle waste effectively. In a Waste Walk we look for:   

• Disorganised work place  
• Unnecessary process steps  
• Waits and delays  
• Recurrent reworks  
• Excess inventories  
• Wasted motion or transportation  

How to waste walk?  

Wasteful activities are abundant on the hospital floors, from bad layouts to inefficient utilization of spaces to lots of redundant paperworks to unorganised workplace and many more. With the waste walk exercise we can make waste visible again. The waste walk is one of the best ways to train the hospital staffs on revealing wasteful activities and discovering new improvement opportunities right on the floors. In a waste walk exercise, either a team or an individual (who are experienced and seasoned in waste identification), heads to the hospital floors and walk through the process to discover where the problems are, they gather and sort the information into some expression that compares defects to location, team, product and other variables. They look for the inventories, bottlenecks and constrained process areas. Encouragement of ideas is vital to the success and morale of the team. It's imperative for the management and the senior leaders to promote creativity and be supportive. After the walk concludes, the next phase is debriefing and generating actions from the waste walk. This will let you create and execute the action plans, then prioritise on those problems with the simplest solutions and/or the highest impact.   

In the coming sections, let’s have a look at the basics of waste walk exercise, the strategy, how to go for it and what comes next, with quick self-explanatory pointers.  

Basics of waste walk 

1. Review your current processes (procedures and work instructions) and answer the following questions:  

• Are there processes that seem to take a longer time?  
• Are there processes that seem to consume a lot of resources?  
• Are there processes with recurring errors or rework?  
• Are there processes which are carried out inconsistently, either by the same person or by more than one person?  
• Are there processes that are complicated or clumsy?  

2. Review your service measures, what are they telling you?  

3. Review the customer's feedback (if any), what are they telling you?  

4. Talk to your hospital staffs/co-workers, take their inputs.  

5. Where are things not working? When you think they should be working? 

Waste walk strategy  

The waste walks can be initiated by the experienced employees who are seasoned in waste identification. It can be a great way to train new employees to develop a Lean mindset while learning to see opportunities to remove waste from the system. Let's see how it works: 

1. Identify your problem statement  
2. Gather a team  
3. Identify and classify the waste  
4. Map the "AS-IS" process - the current state 
5. Identify the gaps/ Carry out Root Cause Analysis  
6. Set improvement goals  
7. Identify solutions & take corrective actions  
8. Map the "TO-BE" process - the future state 
9. Implementation and follow-up  

How to go for it ? Let's look at the steps: 

1. Pick a dedicated team and the areas to focus on:  

• Schedule team meetings to discuss the waste walk event.  
• Discuss the agendas, agree on the route & assign observation areas.   
• Review the various forms of wastes and distribute the waste walk work sheets among the team members.  

2. Start your waste walk and look for examples of each type of waste in the process, the physical space and the way of working.   

Respect for people  

3. A 30 to 45 minutes of observation is required in each area to understand the process & look for wastes.  

4. One rule to follow is respect for people, get permission from the process owners while observing, as you are not there to demean anyone or pinpoint the way they are working. Just carry out a non-disturbing observation in the most natural setting.  

Identify wastes  

5. As you observe the process in the walk around, enumerate every waste based on the classification in the waste walk worksheet (example given above). 

6. End the walk when all the team members have successfully identified the wastes with examples in the processes they are reviewing.  

7. Return to the team and discuss the observations. Individually, have each team member describe their points. Brainstorm action plans to eliminate the wastes that have been identified.  

Repeat the activities 

8. Carry out the exercise once per week with your team over the next three weeks. Give a little twist to the walk timings and change the days to get a better picture of what is really happening on the hospital floors. Vary the flow or processes you are observing.  

9. On the fourth week, bring the team together and review the information and the inputs that are collected over the last three weeks.  

So what's next? 

The next step will be to decide about the solutions to implement, out of the many suggestions made by the team members. The best way to do this, is to follow Impact ease matrix. It's a matrix based on the impact of solutions to the ease of implementation of those solutions. It guides you about solutions which are easy to implement with the most impact on the process efficiency.   

Steps to create the matrix 

• Retrieve suggested solutions from the shared ideas.  
• Make an empty diagram with the horizontal axis of efforts required to implement the solution and the vertical axis of the impact of the solution and divide it into four quadrants (refer above matrix) 
• Assess effort and impact for each of the solutions. Place the solutions in the diagram according to the assessments you have made. Use a number, a symbol, color, or label to identify each possible solution.  
• Solutions falling into the upper left-hand quadrant will yield the best return on investments and should be considered first, as those solutions are the quick wins.  

A quick recap 

1. Report the wastes you identified.  
2. Enumerate the causes of those wastes?  
3. Evaluate the impact of those wastes on your customers, patients, employees & the business?  
4. Discuss the bottlenecks in the process flow.  
5. Brainstorm the ideas and the action plans for eliminating or reducing the identified wastes?  
6. Implement the solutions based on the matrix.  
7. Evaluate the outcomes.  

Finally... 

Leaders in the care facility must build a collaborative environment whereby everyone is involved in the process of developing strategies for waste elimination from the system. Has your hospital tried waste walks anytime? Were you involved in any such exercise? Do you get engaged in the process improvement programs in your care facility? What do you think are the biggest barriers to such steps? Do you think waste walk still makes sense when most of the processes are getting automated and replaced with technology? What about the hospitals, which are not so tech enabled? Looking forward to your experiences:)