The lean concept of waste in radiology.

Whenmostpeoplethinkofqualityim-provement, they immediately think ofpreventing mistakes. Although a corecomponent of a quality program is pa-tientsafetyandpreventingunnecessaryharm,qualityhasabroadergoalofcon-sistently delivering optimal outcomes.Consider an emergent pelvic ultra-sound examination ordered for acutepelvicpaininafemalepatient.Thepa-tient is rapidly brought to the ultra-sound department. The technologistdeftlyperformstheexamination,trans-fers the images, and alerts the radiolo-gist on cue. A diagnosis of ovariantorsionismadeimmediately,thegyne-cologist and operating room are in-formed, and the patient is transferreddirectlytotheoperatingroomfortreat-ment. We often store star-aligningmemories such as these, where com-munication and coordination are or-chestrated perfectly, as insulationagainst the daily delays and frustra-tions we too often encounter. Theheart of quality is striving to makethese scenarios the norm, not theexception.When looking for a quality proj-ect to conduct as part of the ABR’sMaintenance of Certification re-quirements, it is necessary tobroaden your definition of qualityto include the concept of waste.The Toyota Production System,which became known as “Lean,” de-veloped a highly successful qualityimprovement methodology with itsprincipal goal of reducing waste. Themantra of Lean involves “preservingvaluewhile reducingwork”byiden-tifying non–value-added steps [1].Toyota identified and classified 8specific types of waste that consti-tuteareasforprocessimprovement.Although Lean was conceived in amanufacturing environment, theconcepthasbeentranslatedintothehealth care service sector withpromising results [2]. We have“translated” this concept for radiol-ogy, with relevant examples in eachcategory.