What is Natural Variability

Hospitals have to focus their efforts on identifying and eliminating waste of all forms if they are to succeed in today’s competitive landscape. A recent study by the Murphy Leadership Institute (Murphy, 2003) concluded that wasteful work consumes more than 35% of hospital employees’ time. This wasteful work includes activities such as completing multiple forms for the same task, filing inefficient shift-to-shift departmental reports, waiting for medications, and searching for misplaced records. Jimmerson warns that the actual amount of waste in health care lies closer to 60% (Panchek, 2003). In this chapter, we briefly review principles of lean philosophy for improving performance and then present a classification of waste that is relevant to hospital management. This classification is aimed at directing hospital initiatives toward understanding and controlling waste in its health care delivery processes. Through several examples from real-life hospital case studies that we have investigated, we trace much of the waste to various types of variability (both natural and artificial) and offer prescriptions to control variability. We then provide some guidelines for streamlining processes and show how this would benefit various stakeholders. We conclude the chapter with some directions for further research.