Examples of Waste in Healthcare


So I'm trying to find a dermatologist to schedule an appoint (no it's nothing serious). What amazes me is that all of the dermatologists in a reasonable driving distance have no open appointments until September or October.

Talk about the “waste of waiting”. I suppose if you thought you had something serious, they could work you in sooner, but I'd hate to think what happens if someone ignores or delays getting something looked at that turns out to be skin cancer. I guess you would have to push and fight your way to the front of the line, if that's possible, but some people don't operate that way.

I asked one receptionist, “Why is there a shortage of dermatologists in Texas?” She said, “I don't know, but it's the same way in California, we need more people going into that specialty, I guess.”

They do have slots that open up when people cancel. But, there is again much waste involved. From the patient standpoint, you have to keep calling in to see if there are cancellations. The receptionist said “we don't mind you calling to ask every day. We don't maintain a call out list.”

So it would waste my time to call and waste their time to answer (the “waste of motion”). I wonder how many “do you have a cancellation?” calls they get every day. How hard would it be for their computer system to track a call-back list of patients who would like to get in sooner? You could even program it for days/times that each waiting patient could more easily get in., for example, I'm real flexible on Thursdays if you can ever get me in.

It seems like a little bit of effort would reduce a lot of waste all around. Having a staff answering questions that amount to “are we there yet?” definitely increases costs for the office, which then are probably passed on through the insurance payer. I wonder if they are really able to fill the open cancellation slots? You want to keep that doctor resource utilized. But, to do that, I'm guessing that they “overbook” slots to account for cancellations. It's like quality yield in a factory. If the cancellation rate is 10% (on average), they might overbook by 10%. God forbid if you show up on a day where nobody cancelled. You're going to wait a while! That smells like the waste of “overproduction” to me.

I also got a note from a friend who saw the waste of “defects” and potential “overprocessing” when he took his girl to the ER for breathing problems.

“They gave her albuterol in the ambulance, then another treatment at the hospital. Then during a shift change, tried to give her the same treatment again before I stopped them saying that they had already done that. Also, the “handoff” of a doctor requesting a steroid shot was never passed on. I had to ask twice.”

As a patient, or a parent, you really have to monitor the process. It's unfortunate that you can't trust the healthcare system. And as Deming would have said, it really is a problem with the system, not a problem with individuals in the system.

Waiting. Motion. Defects. Overproduction Overprocessing. All serious wastes, especially in health care. That makes me one inpatient patient.

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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

  1. Jamie Flinchbaugh says

    “How hard would it be for their computer system to track a call-back list of patients who would like to get in sooner?”

    Very hard. A hospital, maybe. Most doctors offices are small and are barely computerized. And it is a challenge to handle that much flexibility – one person would have preferences in days of the week, others time of the day, and so on.

    Huge waste. But when you’re always late anyway, what’s another missed appointment?

  2. Mark Graban says

    Yes, the doctors would probably overschedule, which optimizes them, than do something to improve the patient experience.

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