Discussion postQuality improvement

HCA 675 Week 5 Discussion Question Two

Waste is defined from the customer's point of view, and in a hospital the customer is the patient. That single move reclassifies a great deal of activity that looks productive.

Editorial process

Last reviewed · August 23, 2026

Written by

Maren Caldwell

MSN, RN, CNE

Medical-surgical nursing, pharmacology and NCLEX preparation

Reviewed by

Dr. Tessa Redmond

DNP, RN, CNE

Evidence-based practice and clinical education

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Assignment instructions
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Proposed outline
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Final review

Value is defined from the patient's point of view

The definition carries a move that changes what counts, and it is worth making explicit: value is judged from the customer's point of view, and in a hospital the customer is the patient. Once you apply that test, a great deal of activity that feels productive fails it. The patient does not value being transported between departments, waiting for a decision, having the same history taken four times, or having a test repeated because the first result could not be found. Nor do they value documentation that exists solely for billing. Applying the test honestly is uncomfortable, because some of what it classifies as waste is work that staff experience as their job. Say which of them staff experience as their job, because that is where resistance to removing it will come from, and a post that anticipates it reads as management rather than theory.

Then map the recognised categories onto hospital examples so the post is concrete. Waiting is the most visible and the most measurable, in emergency department boarding, discharge delays and time to decision. Rework covers repeated tests, medication reconciliation done again because the first attempt was incomplete, and readmission for a problem that should have been resolved. Overprocessing covers care that produces no benefit, which is where low-value testing and screening beyond the recommended interval sit. Transport and motion cover both patients moved between units and staff walking to find supplies. Defects cover harm, which is the most expensive waste of all. On the thirty to fifty percent figure, be careful: it is a claim about processes generally, not a measured health care number, but it is broadly consistent with the health services literature on low-value care and administrative cost, so cite that rather than the anecdote.

Likely learning objectives

Apply the customer-value test rigorously to clinical activity.
Map waste categories onto specific hospital processes.
Distinguish an anecdotal figure from measured health services evidence.
Recognise harm as the most costly category of waste.

Assignment instructions

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Review every instruction before using the planning guidance that follows.

Discuss the concept of “waste” from the Deming perspective. How do you think it could apply to hospitals and other health care entities? Not long ago I came across a wonderful quote from Peter Drucker, probably our most noted management author. He stated “There is nothing so useless as doing efficiently that which should not be done at all.” Doing what should not be done at all is another definition of “waste”. W. Edwards Deming, the father of continuous quality improvement or TQM, defined waste as any effort, expense, step in a process that does not add value to the product from the point of view of the customer. He stated that he had never found less than 20% waste HCA 675 Week 5 Discussion Question Two in any process he encountered. When I read that, my first thought was “Wow, that seems high”. However, over the years, our experience with waste was even greater, averaging as much as 30-50%. Waste is rework, it is duplication, it is poor quality, it is waiting for a decision or result. It is a primary cause of lost revenues, high costs, dissatisfied customers and frustrated employees. Increasingly, our clients have been looking to root out waste in their systems and find innovative new ways to deliver a consistent, better end result. So how do they find it and get rid of it? identifying_waste_blog.pngThe number one key to root out waste is to ask those doing the work to identify the waste, and to design the system that eliminates it. You may question, “Why would employees blow the whistle on themselves, pointing out that they are not producing optimally?”. Well, because they are usually not the architects of the system, and the system or process slows them down considerably. Therefore, they aren’t able to win in the current process. So, in essence, they are not blowing the whistle on themselves, they are blowing the whistle on the system management defined for them. Asking isn’t enough, however. You must also give employees the freedom and the tools to fix the process and redesign it as friction-free. They truly can do it. Ask them to implement their changes and improvements, they can also do that. Ask them to define innovations that go beyond simply eliminating waste, done. Proceed with Caution Essential to this approach is that the employees must feel safe to do the work. If you ask them to find and eliminate the waste, but they sense that it will lead to them losing their job, their survival needs will prevail and waste will remain. Show them that no waste can mean not just greater productivity, but also prosperity for themselves, and they will root it out when given the tools to do so. And, they actually love the journey because the basis of morale is productivity, and waste gets in the way. Another word of caution, the waste may well be in the decision making or lack thereof of management. When you give employees the license to tell you what is wrong in the system, you must be prepared to respect and then act on what they tell you, even if it is admitting you’re your leadership is a stumbling block. Leadership’s lack of support has been the number reason for change efforts failing in our experience. What’s it worth? What would it be worth to you and your organization to be able to produce the results you have now with 30-50% less resources? Or, to be able to increase output 30-50% without increasing cost? If the answer seems obvious, why don’t more organizations invest in process improvement? Multiple contributors. Among them: they don’t know how, they have tried and failed (as many as two thirds of these efforts fail nationally), they don’t want to invest the time or money, they don’t want to confront that the system they have designed isn’t optimal. But it has been our experience that the investment in process improvement, if done correctly, is the highest leverage investment an organization can make in performance improvement. If you want to learn more about how to do it right, view our library article on the Keys to Implementing Change or contact us for a free consultation.

What HCA 675 Week 5 DQ 2 asks for

01A discussion of the concept of waste from the Deming perspective.
02An account of how it could apply to hospitals and other health care entities.
03A contribution meeting the course's participation requirements.