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Friday, February 7, 2014

Waste in healthcare

Becker's Hospital Review has a nice little write up called the 8 Types of Waste in Healthcare.  I think the article is great.  I have posted the article below, and I have added my own comments in red.

The term "waste" encompasses an array of definitions for hospitals and health systems, including wasted time, finances, steps and human potential, to name a few.  The profession of respiratory therapy is a perfect example of wasted potential.  Studies have proven that about 80% of the procedures performed by respiratory therapists is either a waste of time or delays time.  

Here are eight types of waste in healthcare, as defined by Mark Graban in his book Lean Hospitals, and shared in Ernst & Young's Health Care Industry Report 2013.

1. Defects. This includes all time spent doing something incorrectly and inspecting or fixing errors. One example of defect waste is the time spent looking for an item missing from a surgical case cart. In the 30 years I've been in the profession I can attest that administrators are more concerned with that you charted as compared with that you helped a patient. 

2. Over-production. This includes doing more than what is needed by the patient or doing it sooner than needed. A broad example of this is the performance of unnecessary diagnostic procedures.  An even better example is EKGs.  Since it's so easy to do, EKGs are a part of nearly every order set in the hospital.  Most EKGs that are ordered are merely to make sure a doctor (or hospital) covers his bases to make sure he doesn't get sued or to make sure the hospital gets reimbursed. Most EKGs are a complete waste of time.  

3. Transportation. Unnecessarily moving patients, specimens or materials throughout a system is wasteful. This type of waste is evident when the hospital has a poor layout, such as a catheter lab located a long distance from the emergency department.  Most RT departments are located in whatever space is left over after every other department is settled.  Most RT departments are stuffed in basements, old closets, or even old shacks on the other side of a river across the street from the hospital.  

4. Waiting. Waiting for the next event to occur or the next work activity can eat up time and resources. Patients waiting for an appointment is a sign of waste, as is employees waiting because their workloads are not level. If I had a dime for every stat EKG I've been called to do only to have to wait 10 minutes for the nurse to put in an IV, or a catheter, or to check a rectal temp, I'd have retired twenty years ago.  
5. Inventory. Hospitals create waste when they incur excess inventory costs, storage and movement costs, spoilage and waste. One example is letting supplies expire and then disposing of them, including out-of-date medications.  Respiratory therapy departments are notorious for wasting medical supplies.  Probably about half of the endotracheal tubes in RT storage bins are yellow.  This is, however, not necessarily the fault of anyone in particular.  It's just one of the things that must occur when you have to be prepared for every occasion. 

6. Motion. Do employees move from room to room, floor to floor and building to building more than necessary? That accounts for one type of waste. Lab employees may walk miles per day due to a poor hospital layout, for example.  Studies show that respiratory therapists walk an average of 20 miles a day.  The main reason for this is to perform procedures that are a waste of time or delay time.  So for those of you who say these wasteful therapies make money for the hospital and keep us at work, they also result in lots of wasteful steps.  

7. Over-processing. This describes work performed that is not valued by the patient or caused by definitions of quality that aren't aligned with patient needs. One example is extra data stamps put onto forms, but that data never being used. This is over my head and between my legs. 

8. Human potential. This waste is caused when employees are not engaged, heard or supported. Employees may feel burnt out and cease sharing ideas for improvement.  Most respiratory therapists develop some type of apathy and burnout due to the fact that our talents and knowledge are rarely utilized.  I have had doctors order breathing treatments for a wheeze, even though the RT has notified the doctor that it wasn't a wheeze but a larygospasm, or cardiac wheeze, or otherwise not bronchospasm.  I have had doctors order BiPAP to offset the pressure from a bloated stomach, or to too tick a patient off and increase his blood pressure.  I kid you not.  It is no wonder so many RTs develop apathy, or as Mr. Frea says, RATS

With all due respect, however, it's pretty much like this in any profession whereby you work with people.  Apathy is pretty much something that sets in regardless of your profession, and this should not be a reason to avoid the respiratory therapy profession.  We're just having fun here on this site. 

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1 comment:

migrainer said...

I laughingly state that the hospital placed our RT dept as a sanitary buffer zone between dinner (dietary) and the dead (morgue)