Leading with Lean: Eliminating Waste Improves Engagement

Added on Jun 22, 2020


By Brad Pollins, Senior Manager, Strategic Consulting

For clinicians and other health care employees, spending time on wasteful activities is demotivating, erodes engagement, and reduces the time available for direct patient interaction, which can have a negative downstream effect on the patient experience. By focusing on eliminating waste, Lean management can reverse the tide.

I recently consulted with a health system interested in Lean management methodology. To help the leadership team understand the magnitude of waste in their everyday operations, we looked at the results of a time and motion study of a nurse on an orthopedic unit. The goal was to track the amount of time the nurse spent away from a patient’s bedside to locate walkers, supplies, bedside commodes, and wheelchairs. The study found that the nurse had traveled two miles unnecessarily during a 12-hour shift. That amounted to 45 minutes the nurse could have spent with patients and engaging in direct patient care! It was not surprising, then, that patients on this unit consistently expressed concern and disappointment about the lack of time nurses spent with them. This sentiment was also reflected in the system’s patient experience survey findings. At the time, performance on the Nurse Communication domain was below the 20th percentile.

Lean methodology identifies and eliminates inefficiencies such as those observed in the time and motion study to improve performance and reduce costs. Specifically, Lean targets eight types of waste:

  1. Defects: Time spent detecting and correcting errors, usually resulting in rework
  2. Waiting: Time waiting for the next step in the process
  3. Overproduction: Producing more than is needed before it is needed
  4. Transportation: Unnecessary movement of materials
  5. Motion: Unnecessary or excessive movement by people
  6. Inventory: Excess products or materials that do not get used
  7. Extra processing: More work than is necessary
  8. Unused talent: Underutilizing people’s talents, skills, and knowledge

Transforming Culture to Reduce Waste

For Lean principles to take root, leaders must nurture a respectful culture that embraces continuous improvement. Doing so creates an environment in which leaders can work with employees to identify and reduce waste. Leaders can initiate this process by doing the following.

  • Ask employees this question: “What elements in your work frustrate you the most and prevent you from performing at your very best?” The answers will likely reveal where waste—and therefore improvement opportunities—exist.        
  • Educate employees about the eight types of waste. Armed with this understanding, leaders and employees can perform a “Waste Walk” on their units to identify potential waste, capture observations, review findings as a team, identify and prioritize improvements, and decide on actions to reduce or eliminate the waste.    
  • Engage patients in interviews and focus groups, asking, “What about your experience frustrated you the most?” The answers to this question will also reveal opportunities to reduce waste and improve processes.

Most people who choose to work in health care enter the field because they want to make a difference in people’s lives. Waste gets in the way of this essential mission, diminishing employees’ sense of pride and purpose and keeping them from making more meaningful connections with patients. Lean management can help remove some of these unnecessary obstacles so that employees, patients, and health care systems benefit.


To learn more about this topic, please reach out to the Press Ganey Strategic Consulting team at info@pressganey.com.