”16 This is the reasoning that allows the principles of lean production and management to be applied in healthcare, despite

these being originally developed for application in other industries. We mentioned that the lean philosophy calls for value creation through elimination of waste. These wastes are common in all industries and are not unique Inhibitors,research,lifescience,medical to healthcare. The following is a summary of these wasteful activities16,17: Overproduction—producing something in excess, earlier, or faster than the next process needs it Inventory—the cost of managinga large supply inventory may not be obvious at first glance; beside consumption follow-up and space required

to store, there is a need to follow expiration dates Inhibitors,research,lifescience,medical and to constantly ensure that the items in the inventory are not technologically obsolete. It was already shown that the overall cost of smaller and more frequent shipments is lower than a large-volume purchase for which a discount was provided Motion—a lot of walking waste can arise Inhibitors,research,lifescience,medical from poor design of the working area Transportation—in healthcare this can be evident when moving AP24534 molecular weight patients, lab tests, information, etc. Over-processing—there are times when material provided to the customers (patients) mandated by regulations can be confusing. For example, multiple insurance claim forms, including ones that are not bills, can confuse the unexperienced “novice” Defects—there are many examples for these defects that can be related to poor labeling of tests, incomplete information in patients’ charts or in instructions provided

to referrals, etc. Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical Waiting—there is not much need to explain why waiting a few hours in line is a wasteful activity Under-utilizing staff—under-use is not only time-dependent but also involves deeper levels such as not sharing knowledge or not taking advantage of someone’s skills and creativity; under-use typically shows in hierarchical structures and not using of teams It was suggested that in order to implement lean in healthcare, the patient has to be the center of the initiative, while time and comfort should be added as key performance measures in the system. Defining the patient as the primary customer requires a conceptual leap because usually the customer pays directly to the enterprise, whereas in healthcare third-party payments depending on the level of insurance are common.5 However, if it is understood that value is related to customer requirements and it will be the customer that ultimately determines what constitutes waste, it becomes evident that patients’ demands may require changes even in processes that may not be directly related to patient care.