Quality Improvement Methods
29. Overproduction Assessment
a. Definition: One of the most common and costly types of "waste", as waste is defined in the Lean method, that occurs in healthcare is "overproduction". This refers to work done which need not be done as far as the patient is concerned. This may mean services rendered which could have been avoided; obsolete items, excessive inventory, or work being done before it is needed. It is found in all industries but may be more common in healthcare because of the feeling that extra preparation seems like more service for the patient - even when it isn't. Economists point out that much of overproduction is caused by wrong incentives; there are revenue incentives to over-order or there are incentives to store excessive inventories and to provide more services than truly useful.
b. Literature: There are considerable literature and practice guidelines to help avoid overproduction in healthcare, although not always using that word. In terms of clinical practices it is sometimes referred to as "over-ordering" or "unnecessary ordering." The Lean literature describes the causes and types of overproduction and how to locate overproduction.
- Patients being admitted are repeatedly asked the same questions by several people. Diagnostic tests, such CT scans, are ordered more often than necessary.
- Copies of forms are stored in paper form even though they are available digitally.
- Inventories larger than necessary considering the resupply frequency.
- Preparation of carts or kits batched at the start of a day which results in more inventory being processed than necessary
- Research which develops recommended new tasks that duplicate existing ones.
d. Steps: The problem of overproduction is often best addressed as part of a larger effort for quality improvement, such as in the course of a Kaizen event or through training to sensitize staff to look for such waste. Certainly asking "Why is this done?" Or asking:"What would happen if we did not do it? " can be helpful. Failure Mode Analysis (see Section 14) can be used to identify cases of overproduction.
A tool to consider over production, as well other problems, is asking "Why?". The answer may prompt asking another "Why?" since the cause of a problem may itself be another problem. For example "Why did you do that?" may be answered by "Because the instructions say so." which may be followed by "Why do they say so?" and so on. The idea of "5-whys" is referred to as the idea of perhaps asking 5 times is necessary to get to the true cause of a problem.