VALUE
IMPROVEMENT
LEADERS
TOPIC #7
615 words + 2 activities | 30 minutes (3 reading, 17 video, 15 estimate value-added %)
7 WASTES IN HEALTH CARE
PRINCIPLE
Every step in a process is either value-added or non-value-added.

TOOLS
- Patient value stream
- The health care value-added test
- The 7 wastes taxonomy
- Value vision goggles

APPLICATION
1. Watch the " Understanding Value and Waste " video 
2. As you go through your work day, try the health care value-added test
3. Try to estimate the value-added % (We’ve linked a worksheet  to help.)

4% of Your Life

A number of studies show we spend on average 4% of our lives (3-5 years) waiting: standing in line at the store, sitting in traffic, holding on the phone, etc. This is idle waiting (not, for instance, waiting for your tax refund while you get on with your life). Just sitting there. 

Do you think that number is higher for people with more health care appointments? We spend millions on waiting rooms. We fret about the comfort and number of chairs. We hand out refreshments. My dentist has the most amazing aquarium in his waiting room. But what if we worked on reducing waits? Is it that much harder? Is it technically harder or culturally harder?

In the case study about Huntsman Cancer Institute, which focuses on the creation of integrated oncology teams , Sean Mulvihill reminds us of the bad old days of block scheduling clinic. A physician would book the entire morning of patients for 8:00 a.m. and then call them back, perhaps alphabetically or according to acuity, all the while planning to see the last patient at 11:40 a.m.
A New Way to See Processes

Improving value for your patient requires understanding a handful of core concepts, among them:

  • The patient value stream 
  • The value-added test
  • The 7 wastes taxonomy

We want value leaders to wear their value vision goggles on behalf of their patients to see the value-added and non-value-added (NVA) in their patient’s value stream. Without the value-added test and the 7 wastes, everything in health care delivery seems to make sense. But when we apply the test (when we wear the goggles) our view changes and we find ourselves asking, “could we reduce the NVA in this process?”
A Review of Value-Added and Non Value-Added

We want to make NVA easy to spot. To that end, we start by identifying the reasons patients come to us:

  1.  Information about their health 
  2.  Care provision 

These lead naturally to a value-added test which can be applied to every task in a patient’s value stream:  

  • A task is value-added if it builds on a patient’s health information or is a part of direct care provision. Everything else is NVA.

We use the common taxonomy of NVA activities called the 7 wastes , listed here roughly in order of badness:

  1. Defects (and the energy required to prevent them)
  2. Waiting
  3. Overprocessing
  4. Overproduction
  5. Travel/Transport
  6. Inventory
  7. Motion

Here’s a video, Understanding value and waste (16:19) , with great examples of some of the common NVA that patients experience in their value streams.
Pareto for Wastes

We encourage you to label value-added and NVA on a process map and estimate the value-added % (measured in minutes or hours, but never in process steps.) 

Please note: We allow ourselves to get a little academic from time to time, but labeling tasks as either NVA or value-added isn’t always useful. We’ve already applied the Pareto principle to our wastes in healthcare and it’s better to watch for the most expensive: defects, waiting, and over-processing/over-production. 

Try it: Put on your value vision goggles and go on a waste walk. Here’s that worksheet again to guide you.
ACTIVITIES



2. As you go through your work day, apply the health care value-added test.
LINKS

Quickly locate all course videos, slides, and previous emails here .
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Questions? Email:  kim.mahoney@hsc.utah.edu