JACR: Lean could help radiology cut waste

Applying the Toyota business concept of Lean Manufacturing--a quality improvement (QI) method aimed at reducing waste--to radiology can spur optimized value and enhanced QI, according to an article published in the June issue of the Journal of American College of Radiology.

Lean classifies eight types of waste that can be targeted to enhance value by reducing work. With Lean showing promise in the healthcare sector, Jonathan Flug, MD, MBA, of the department of radiology at Winthrop University Hospital in Mineola, N.Y., and Paul G. Nagy, PhD, from the department of radiology at University of Maryland School of Medicine in Baltimore, translated the concept to radiology.

The egregious eight
The eight types of waste, with radiology applications, are:

1. Defects cause rework: Often the result of poor processes, defects include wrong procedures performed, nondiagnostic studies requiring retakes and misinterpretations. Causes include mistiming of contrast injection. One result of defects is a high percentage of patient recalls.
2. Excess motion decreases productivity: Excess movement that does not produce value is waste. The mouse is often the culprit in radiology with incomplete PACS, RIS and speech integration necessitating excess clicking and image manipulation.
3. Waiting: Waiting for people, equipment or information is a clear indication of poor system processes. A value stream map, which depicts processes flows and time delays, can pinpoint steps requiring interventions.
4. Transportation: “Delays in transportation lead to wasted time and increase the opportunity for mistakes and injuries,” wrote Flug and Nagy.  The spaghetti diagram, which displays movement of personnel and equipment, can help practices untangle delays by minimizing non-value-added transportation.
5. Non-value-added processing: Examples includes inappropriate radiology orders and unnecessary sequences in MRI. Flug and Nagy pointed out that up to one-third of all CT scans in the U.S. may not be medically necessary because of inappropriateness, duplication, medicolegal issues and poor communication.
6. Inventory: Idle inventory constitutes waste, wrote Flug and Nagy. Lean advocates “just-in-time” inventory control to minimize damage, obsolescence, spoilage and quality issues. The authors referred to an academic interventional radiology department that halved the costs of expired products by using Lean processes.
7. Overproduction: Overproduction is a problem on its own and also can increase other types of waste. Examples include excess radiology and lengthy fluoroscopy times. Simply measuring these inputs and alerting radiologists to them can help curb overproduction, explained Flug and Nagy.
8. Underutilization: Underutilization applies to equipment and personnel. In many cases, operational inefficiencies, rather than a lack of patients, cause equipment underutilization.