A3.1. Waste, waste wheel, waste walk

Waste, Waste Wheel, Waste Walk

What should I expect the outcomes to be of using the tool?

Eliminating waste with a focus on value for people who use our services results in improved quality, safety, efficiency and customer / staff satisfaction.

Eliminating waste with a focus on specific waste categories results in:

Transportation – less risk, loss, damage, lower transaction costs as products are moved less

Resource – Underutilisation of resources, both physical and people

Inventory – reduced storage costs, better use of floor space, increased cash flow

Motion - fewer accidents – damage to people, equipment, better layout of workspace

Waiting - reduced backlog, faster, more responsive flow of service, more responsive scheduling to meet demands of work

Over-production- quantities of items meet needs without exceeding demand – less expenditure, less un-used surplus, risk of “going out of date”, clearer specification of who needs what

Over – processing - the right amount of work is done that is required by the customer –now, better work layout that promotes continuous flow, forms that document only essential information, simplified & consistent delivery systems for medications/ materials / information

Defects – clearer understanding of what is “defect free”, greater specifications in work processes, clear expectations of outcomes and safe environment for problem solving in the course of work, clearly understood method of addressing “defect free” right now

Tool/ method

How we deal with waste is an important tool for increasing our ability to deliver quality services to people who use our services, achieve a better work / life balance and increase job satisfaction.

 

In order for an activity to be considered as “adding value”, it must meet three criteria:

  1. Be of value from a patient/customer perspective
  2. Transform the product or service in some way
  3. Is correct – first time

 

Examples of value-added:

  • Diagnostic time – collecting & analysing information
  • Active care time – interventions
  • Passive care time – under observation – no intervention
  • Joined up working – health & social services
  • Patient journey / pathways

 

Examples of non-value added activities:

  • Check-in time
  • Wait time
  • Filling out multiple forms
  • Inconclusive tests or duplicate tests

 

Waste is any activity that consumes resources without creating value for the customer.

 

The purpose of eliminating waste is to release time / resources from unproductive actions /activities in order to gain capacity to be able to work more effectively (doing the right things, achieving a fast, responsive flow of service) and more efficiently (doing things right). See illustration – Waste Elimination:

 

 

There are “8” standard forms of WASTE. TRIM WOOD is a mnemonic device to help remember them. See diagram.

 

1. Transportation: Unnecessary movement of people or parts between processes

Examples:

  • Staff travelling to “remote” storage room to retrieve supplies
  • Multiple appointments caused by information/ test results not available as requested
  • Incomplete deliveries – wrong items delivered

2. Resource: Underutilisation of resources such as equipment or people

Examples:

  • Equipment used infrequently or over used
  • Managers not recognising skills of staff and listening to improvement ideas

3. Inventory: More stock on hand and “work in progress” than is required

Examples:

  • Overstocked items
  • Outdated supplies not deleted
  • Work in progress – “just in case” rather than what is needed

4. Motion: The action or process of moving position or being moved/changing place

Examples:

  • Materials / tools out of reach - located far from workspace
  • Actions associated with looking for information / materials / people
  • Damage to people / equipment – wear & tear / late finishes

5. Waiting: Idle time created when people, information, equipment or materials are not at hand or delaying action until a particular time or event e.g. someone arrives or is ready

Examples:

  • Waiting for others at: meetings, surgeries, procedures & reports
  • Customers waiting for appointments, visits, procedures
  • Leaving something until a later time before it is dealt with

6. Over-production: To produce a quantity that exceeds the need or demand

Examples:

  • Duplicate recording of information
  • Unnecessary diagnostic tests / assessments
  • Multiple forms / leaflets with same information

7. Over – processing: Activities which are over-prepared, over-handled , duplicated or do not add value from the customer perspective

Examples:

  • Chasing up appointments / information
  • Redundant information gathering / recording
  • Emails – reply to all

8. Defects (Rework): Outputs – (products, documents, services) that causes outputs to be disposed or need rework due to error

Examples:

  • Errors – misdiagnosis / medication errors
  • Human reasoning – failure to revise risk assessments
  • “Sticking Plaster” solutions – which don’t eliminate the problem at source

Why we may choose to use this tool/ method?

By their very nature, processes are full of waste, and the longer people work in a system, the easier it is to accept things and no longer ‘see’ waste. In order to fix any problem, people must first learn to see the waste. Taking a “waste walk” (see how you might use this tool – next) is one way to make the waste visible again. Encouraging the people who do the job to use this tool, upholds the principle that people’s talents and contributions are to be respected, recognising they are best placed to explain issues, propose possible solutions and assist with any changes. Eliminating waste allows staff to take control and improve their working lives.

 

Benefits:

  • Staff can be shown how to identify waste easily – with minimum explanation / training (great way to educate on continuous quality improvement & develop “waste eyes”)
  • Waste walks are a quick and easy way to identify areas of improvement – and establish a baseline of the current state using minimum resources
  • Waste walks encourage PDSA cycles of improvement
  • Waste walks engage teams in solving problems, finding solutions which benefit them

How you might use this tool/ method?

What is needed to use this tool:

Materials

Printed Waste Walk Tool for each person

Pen for each person

Camera - optional

Timing

Depending upon the scope of the Waste Walk activity, it could take one hour, one working day or a calendar week

Setup

None required.

 

How to use the tool:

1. Distribute the printed Waste Walk Template to all staff engaged in the Waste Walk. Explain:

  • purpose of the task
  • different types of waste
  • location where the Waste Walk will be conducted
  • timeframe for the Waste Walk
  • where to hand in completed Waste Walk templates
  • 2. Have the staff / team:
  • walk the predetermined work area with the Waste Walk template and note down examples for as many of the seven types of waste as they see
  • consider some common sense questions as they walk (for example):
    • Is there space that is under-utilised?
    • Is the stock storage area too large?
    • Is equipment sitting idle in the corridors?

3. When the waste walk is completed, organise a time and place for your team to review the findings – responses can be put onto a flipchart, categorising them into the seven wastes and or “other” if any miscellaneous observations fit best into this.

 

Useful tips

  • The Waste Walk can be done in small groups or alone – it is helpful to ask someone who does not spend much time in the area that is being observed to walk with you; they will provide a fresh pair of eyes when looking at your work area. This could be a customer.
  • Make sure you clearly understand the different types of waste before setting off.
  • When teaching people about the seven types of waste, provide examples and then ask them for examples from their own experience
  • Make sure someone who is knowledgeable about the seven kinds of waste is available to be approached for questions or clarifications during the Waste Walk.
  • Take a camera with you (where appropriate & with the consent of everyone who may feature in your pictures – however briefly) – pictures provide a powerful means of reporting observations

What next?

Now ask the team to generate ideas on how these issues (wastes) can be improved or resolved. These ideas should be listed against each of the seven wastes. Resolving an issue correctly means understanding what causes the issue to occur. Guesswork can lead to the wrong solution and the problem to simply re-occur. It is also important to think about inter-connected activities as moving waste by improving one area at the expense of another isn’t really improvement. Ultimately, the aim is to improve the entire area/system. Waste must be eliminated period!
To find the root cause of why a problem / issue occurs, refer to the 5-Whys tool in “Data Gathering and Evidence and 5 Whys”
To identify steps and tasks in a process in order to eliminate unproductive activities, refer to “Process Mapping”.
To test ideas for improvement refer to “PDSA”.
In order to create your ideal workspace, refer to “5-S”, which will help you create the sort of working environment where things are easy to find and there is room to store everything you need, exactly where you need it.
Repeat – Waste Walk, regularly to ensure once an area has been improved, the changes are maintained.

Examples/ case studies/ links to best practice/ evidence

Waste walk with Process Improvement Leaders (PILs)

  • http://www.youtube.com/watch?v=146Yn5MV85U
  • 13.48 mins
  • Video – from US healthcare that is generalizable to UK services – all types, which reinforces examples of different types of waste with both visual examples and written “key points”

Instructions for waste walk taken from: http://www.lean.org/common/display/?o=2222

  • “Waste walk template (from perfecting patient journeys)

Waste walk template adapted from: NHS Institute for Innovation & Improvement (2011) Improvement Tools, Productive General Practice, p. 85

Explanation / examples of Spaghetti Diagram: http://mckesson.bmgi.org/file.php/1/Documents/T-Spaghetti_Diagrams.pdf and Quality and service improvement: process mapping - spaghetti diagram.html

Contact for further information

Maria Howe, Cumbria Partnership NHS Foundation Trust

maria.howe@cumbria.nhs.uk 

 

The Waste Wheel

 

WASTE WALK TEMPLATE – for improving and eliminating waste

TYPE OF WASTE

Example of this waste in your

work/home environment

1. Transportation

Unnecessary transferring, picking-up, setting down or movement of customer/patient/information/items
Example

When customer/patient information/items get handled by too many staff without adding value

 

2. Resource

Underutilisation of resources – physical and people
Example

Managers not listening to issues raised by the staff or not getting them involved in improvement work

 

3. Inventory

Maintaining unnecessary amounts of people, items or information. Having more on hand than what is needed and used
Example

Excessive stock in store rooms not being used; customers waiting in a queue

 

4. Motion

Unnecessary movement of staff or that is done too slowly or quickly
Example

Staff walking to other end of department / building to pick up equipment or paperwork

 

5. Waiting

People waiting for things or information to arrive or services waiting on people to arrive
Example

Service users waiting for appointments, visits, procedures

 

6. Over-Processing

Activities which are over-prepared, over-handled, duplicated, don’t add value but add cost
Example

Asking service users for details several times, emails – reply to all, chasing up information / appointments

 

7. Overproduction

To produce a quantity that exceeds the need or demand
Example

Duplicating recording of information, multiple forms / leaflets same information

 

Templates and visualisations: