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Defining Lean Waste and Potential Failure Modes

Project RED (Re-Engineered Discharge) Training Program

Provides a four-module training program to help hospitals implement Project RED.

Lean Thinking, or more simply "lean," is a system of tools and principles that began as Toyota's Production System Model. The system is used to create solutions to problems by increasing the value-added delivery to the customer by reducing waste.

Within every process, there are opportunities to eliminate lean waste. Easily recalled by the acronym DOWNTIME, waste during the hospital discharge process can exist in the eight forms that follow.

1. Defects, or failure modes. Examples include:

  • Omission of discharge order.
  • Omission of follow-up appointment.
  • Incorrect selection of medication.
  • Failure to provide discharge prescriptions.
  • Incomplete discharge instructions.
  • Failure to assess patient comprehension.
  • Omission of medical equipment ordering.

2. Overproduction. Example: Overproduction of discharge teaching sheets that are not individualized or become outdated.

3. Waiting. Example: Wait times for patients and staff.

4. Non-value-added processing. Examples: Rework and redundancies.

5. Transportation. Example: Too few wheelchairs, creating discharge delays.

6. Inventory. Example: Over or under supplying discharge materials.

7. Motion. Examples include:

  • Having to go to another location to retrieve discharge materials instead of having them near or at the point of service.
  • Having to stoop, stretch, pull, or push inappropriately.

8. Employee, or underutilizing or not using staff-based knowledge. Example: Not having staff members who perform the actual work as part of the problem-solving process.

After the team creates high-level maps, team members can begin to visualize and then eliminate waste at each step within the process.

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Page last reviewed August 2011
Internet Citation: Defining Lean Waste and Potential Failure Modes: Project RED (Re-Engineered Discharge) Training Program. August 2011. Agency for Healthcare Research and Quality, Rockville, MD.


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