Patients In Doctors Waiting Room

Excuses Enabling Waste

I first began learning about “Lean Manufacturing” in 2006, and since then I’ve had many opportunities to see this philosophy misunderstood and misapplied. Most recently I saw a variation on basic Lean terminology in a class meant to teach Lean Six Sigma principles for process improvement.

I’ve never been formally credentialed in Lean Manufacturing and it presently seemed like a good time to cross it off the list. I am taking an online program mainly consisting of recorded lectures, which means I did not have the opportunity to object when the professor started explaining the concept of “Value-Enabling Activity.”

In classical Lean Manufacturing (substantially derived from the Toyota Production System), an activity is classified as either Value Adding (VA) or Non-Value Adding (NVA). The simple rule of thumb is: would a customer reasonably pay you more money to do more of this activity?

In the case the professor was discussing, the setting was health care. Time spent in the waiting room was classified as Non-Value Adding, since nobody wants more time in the waiting room. Time spent with the physician was classified as Value Adding, since that’s the essential service that people are seeking.

But for check-in activity the professor had a category previously unknown to me, “Value-Enabling”. The idea is that the health care provider cannot safely provide care without going through the check-in activity—checking for medical allergies, other health conditions, and so on. Even though it would be hard to find a customer willing to pay more for more time spent on check-in, this activity is considered essential and not properly described as “waste,” the other term for Non-Value Adding activity.

This is a basic perversion of the meaning and purpose of classifying activity as Value Adding or waste.

While it may be true that with today’s laws, customs, and technology there might not be at present any way to eliminate the check-in activity, the fact that the patient do not enjoy this activity and would happily be rid of it should never be forgotten. That is the entire purpose of classifying activities very simply as either value-adding or waste.

It is no defense to say that the activity is necessary. It is currently necessary to ship cars from the car factory to the customer – and typical to ship them not to the customer, but to the dealership. Transportation is absolutely one of the seven wastes. Transporting the car from the factory to the dealership is waste, because no customer would pay extra to have the car shipped back and forth several more times. It is necessary but unwanted – just like the waste you flush away every day.

A reflective person will realize that, really, the only way to have no waste is if the product materializes immediately upon the customer’s first realization that they want it. Anything else involves delays and is wasteful.

More specifically, consider the case of a chunk of metal being shaped into a widget. Modern CNC (Computer Numerical Control) machines can automatically switch between several different tools to shape a part. The process of switching between tools is Motion, and therefore waste.

In most analyses, the time a chunk of metal spends in a machine is all Value-Add time. Many people would balk at the idea of being so hyper-sensitive as to classify the time switching tooling as waste. Nevertheless it is true that if you somehow had one tool which could do it all, and therefore did not need to switch tools, the process would take less time; your machine would be more efficient and therefore more productive.

The correct reason not to worry about the time a machine spends automatically changing its tooling is that this small amount of time may not be where your real problems lie. And this is perfectly consistent with the principles of Lean Manufacturing; no practitioner of Lean Manufacturing would suggest chasing a waste of a few seconds when there are problems costing you hours of time you could resolve. There is absolutely no shame in working on the biggest problems first; the only way it might not be best to work on the biggest problem is if you are not actually capable of influencing it. Otherwise, always go for the biggest problem. If it’s too complex, figure out the major causes and pick the most significant; repeat as needed until you’ve got a problem you can work on.

Going back to the health care scenario, check-in time might currently be necessary. But what if a quick scan of your retina were enough to bring up your complete medical record and verify that it is really you? This would virtually eliminate the Non-Value time and leave only the valuable part of the check-in process.

Someone might object that in this particular case, there may be a potentially viable technology solution, but that, in general, there are some things that just have to be done in order to get to the good stuff, and those things are Value-Enabling. But that category allows you to justify and excuse activity your customer dislikes, turning a blind eye toward your own inefficiency and becoming systematically indifferent to what your customer wants.

Consider that it is still necessary today for products to be shipped from the factory to the consumer. If everybody just shrugged and said “Can’t be helped,” Amazon would not be the force in commerce that it is today. On the contrary, Amazon has patented anticipatory shipping – shipping you something before you tell them you want it, so that the shipping time gets even closer to zero. Service technicians do this all the time, keeping commonly needed replacement parts in their vans, but Amazon is the first major company to realize that this basic concept could be extended across the entire range of things ordinary retail consumers might want shipped to their house.

It’s not clear whether Amazon has actually implemented this idea yet. But, with delivery drones and delivery lockers and delivery to your trunk, it is very clear that Amazon hasn’t declared the time it takes to delivery an order “Value Enabling” and thus beyond criticism. Transportation is waste. Get rid of it whenever possible.

There is no business or process anywhere in the world that has achieved fully zero waste. Some of the causes of waste are laws of physics and some of the causes are laws of governments. It should never bother you to have some part of your process described as waste; if your feelings are hurt, you’ve misunderstood the message completely. And it’s easy to test: if you are right and it’s not waste, charge more for it; do it more often; increase the amount of it you have in proportion to the other parts of your process. If it’s actually valuable you’ll make more money. But if it will increase your costs – then yes, Virginia, it is waste.

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