In a process, waste is:

“Any human activity which absorbs resources but creates no value”

Value can only be defined by the patient (or by ‘the customer’ of a process) and it is only meaningful when expressed in terms of a specific service (or product) which meets the patient’s (or ‘customer’s’) needs at a specific time, and at a specific cost.

You create value – as far as the patient is concerned this is why you exist – and it is vitally important that you always have a perfectly clear understanding of what it is. You gain this understanding by correctly answering the question, “What is important to the patient?”, and you answer this question by talking to patients.

Anything that happens in the job that does not directly create value for the patient is what we call waste.

When you have drawn your process map your next step should be to look at every activity in the process and put them into one of these three categories:

  1. Value creating activities
  2. Activities that create no value for the patient but are necessary due to current technology or systems, and so cannot be eliminated just yet. These are called Type 1 waste.
  3. Activities that create no value for the patient and can be eliminated straight away. These are called Type 2 waste.

The idea, of course is to get rid of Type 2 waste immediately. When you have done that you can then go to work on Type 1 waste by making the work flow, setting the drumbeat, and continually improving the process.

Please refer to the anticoagulant blood testing process that we looked at in Process Mapping to see how you would categorise its activities:

Value-creating activities in that process are

Type 1 waste would be

Type 2 waste would be

To help you decide whether an activity is waste or value-adding, a good question to ask is, “If patients were paying for this service would they be happy to pay us for carrying out this particular activity?”

Examples of Waste in a Process

  1. Over buying/stocking/producing
    • Goods and services the patient does not want
  2. Waiting Time
    • Patients/employees waiting for goods and services
  3. Logistics
    • All forms, including handling of material – internal and external to the organisation
  4. Processing
    • Processing operations which contribute nothing for the patient e.g. meetings, communication delays, checking, policing the budget, politicking and unnecessary procedures.
  5. Inventory
    • Inventory wastes space, money, movement, consumes energy and hides many problems.
  6. Movement
    • Workers making unnecessary movements e.g. multi-site departments.
  7. Mistakes/Rework
    • All mistakes/rework is waste
  8. Not Recognising, Using, Developing Talent