iSixSigma

Is a Wait Always a Waste???

In healthcare, we are definitely trying to speed things up for our patients. Billboards around our area (and maybe, around the country) promise 30 minute door-to-doc time in their Emergency Departments (EDs). One promises no waiting to be seen by a healthcare professional! Mini-offices are springing up in chain pharmacies, promising no waiting for minor problems. One health system promises a “money-back” guarantee if you have an “excessive wait time.”

But there are still some things in healthcare that you have to wait for, with good reason. When you receive a medication, sometimes you have to wait for it to take effect. If you receive a breathing treatment, it may take awhile to breathe a little easier. When you have surgery, you usually have to wait for some healing to occur before you are sent home – even if everything else is ready for the patient to be discharged and all other medical tasks have been completed.

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In these cases, the waiting periods can’t be made faster – they’re processes, but not processes over which we have control. When mapping these timeframes in a lean value stream map, are they automatically wastes? Or something else?

In the automotive industry, it takes a certain amount of time for paint to dry, but you can work on faster-drying paint. When you are working on a process that has a wait time required for a patient to heal up,should you just skip over that part and work on a different part of the value stream?

I’d like to know your thoughts on that matter, and thanks in advance for helping to clarify my thinking!

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Comments 8

  1. Marty

    I agree with all the comments. Waiting implies that the task is inactive and non-value added. The process steps you are referring to arenot waiting at all, but rather a value-added process step.

    I would suggest that you change the name of the step to better imply the active necessary action that is taking place such as "Recovery", "Digestion" etc.

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  2. JWH

    From a Lean systematic point of view waiting is bad. However, can "waiting" actually be considered waiting since the body is reacting to the medical procedure that was performed. The staff is observing and monitoring to ensure that the change has indeed occured from the patients perspective.

    In other words, is the patient process in control? Did the change that was made to this person’s body actually perform according to what was medically theorized? Did the patient adversely react? Were there complicating circumstances or confounding factors in this procedure that are not apparent? If it didn’t go right, what more do we need to learn about the this person or the body in general to prevent adverse waiting times, pain, or even death.

    I also agree that long heal times or drug reaction times or repeated monitoring would require further research from highly qualified subject matter personnel to determine what is blocking the healing and reactions. There is definite waste in health care. However, caution must be exercised.

    My outlook is that some providers think things should move faster or be cheaper to meet their cost objectives and in some areas the staff or even medical research can’t keep up to the providers expectations. This can result in misdiagnosed care, poor recovery times, and "cost reductions" which harm the patient. This is one industry where the unknown human element is key on both sides of the equation.

    If anything a good doctor will follow the DMAIC process with you, your body, and your care.

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  3. Sean

    When you mention faster drying paint you acknowledge that the lean professional is not a chemist and can’t create the faster drying paint. They can identify the need for faster drying paint. They can find the largest impacts on cycle time and process capability and direct research where it will be most valuable. So, for processes with a long convalescence, it is good to note this.

    Additionally, these longer waits in the hospital increase the patient’s risk of exposure to Staph infection and other nasty bugs that are common in hospitals. If innovation can solve the recovery time problem, the patients can be treated faster with higher quality (less chance of dying from infection in the hospital).

    The lean professional doesn’t “control” the recovery process, but they identify the process step and direct research to innovate around the problem. Also, if the person can’t be discharged, I would consider it value-add time in the current process. They have a bed and hospital resources to continue monitoring their condition. Even without active treatment, they are still in a necessary step of the overall process, given current technology.

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  4. R.Burney MD

    Yes, all waiting is waste. The “waiting episodes” you describe are part of the process. It’s waiting to see the doctor that’s wasteful. Those times within the process when nothing is happening to the patient constitute waste.

    Waiting, because the paint didn’t dry as quickly as expected. Waste. If the medication requires 30 minutes to take effect, then I want to see every patient out the door at 30 minutes +/- 10 seconds.

    My wife waited 4 hours to go home after shoulder surgery (in DC). My daughter had the same surgery at Duke and was home within 60 minutes. Which system has higher waste? Who has higher costs? Where do you want to go for your shoulder surgery?

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  5. Ian

    It’s wrong to consider necessary steps as waste. Waiting is not waste, non-value added time is wasted. There is definate value to waiting to see if a medication works or time to heal (in a larger map a percentage of patients do not go onto additional treatment because the medication worked or the surgery healed).
    But, there is a lot of non-lean work in healthcare — I believe most of it exists because the perspective is typically viewed from the provider of the service not the patient.
    Yes –they’ll get you in and out in 30minutes but will happily make you come back another day for more tests. You’re wait could be days or weeks but the provider is running very "lean". What the system needs is to change it’s frame of reference to the client to find the real benefits.
    I blog on this at http://www.waittimes.blogspot.com with more details/ideas. I’d appreciate it if you add my link to you’re blog. Thanks Ian.

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  6. SB

    To answer your specific question: Wait times for healing should not be skipped over. Thinking about healing times is what has led to minimally invasive surgical techniques.

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  7. Sue Kozlowski

    Thank you all for your comments. Like many other organizations (healthcare or non-healthcare) we always feel the pressure mentioned by JWH for "faster-better-cheaper." I agree with Sean that the lean six sigma professional isn’t the one who has to make the paint dry faster – and also appreciate SB’s comment that "impatience" with healing times has led to minimally invasive surgery, which has been a great benefit to many patients. Dr. Burney’s comment about wanting to go home faster targets the motivation behind the door-to-doc billboards – a rival health system promises "in and out within two and a half hours" while our own organization’s advertisements say "Do you want it fast? or good? We give you both."

    Ian points out a dilemma that we face in healthcare – for example, physicians who order an MRI (special imaging procedure) on an inpatient, for reasons unrelated to the admitting diagnosis. Our hospitals don’t get reimbursed for this. So, we ask the physicians to write an outpatient order that the patient can have performed after they are discharged. Who benefits? The hospital loses less money, but the patients are unhappy having to come back for a procedure. Whose efficiency do we care about most?

    I like Marty’s comment about calling the therapeutic time period "recovery" or "digestion" – that clarifies what the waiting is all about.

    Thanks again all for your perceptive comments.
    –Sue K.

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  8. kennyg33

    Waiting is definitely a waste and certainly considered non-value added, but in some instances one may consider this waste necessary. However, it is the customer perception of value which must be satisfied and in this case a reduced wait time is a CTC, or Critical To Customer [characteristic]. Or obligation is to reduce the time to satisfy the CTC and thereby satisfy the customer. It is the pursuit of improvement and challenging the process that can lead to unfathomable changes, greatly satisfied customers, and a market advantage.

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