Uh-oh, Spaghettio

Uh-oh, Spaghettio

Do you regularly take blood samples from a patient without a needle and syringe? Do you regularly place intravenous cannulas without first clipping the site? Would you microchip a dog or cat without using a microchip scanner to check all is working? Answer: probably not.

Yet blood tubes are often kept in the corner along with the blood machine (it’s not the machine that takes the blood!), i/v catheters are often kept separate and away from other blood drawing equipment (even though much the same items are used for drawing blood as in placing a catheter), or you might have a drawer full of microchips in your consult room (handy) but the scanner is kept in the back somewhere (not so handy – you still need to make an extra trip to fetch it – may as well keep the microchips out there too).

And so very often we’ll find ourselves running about the practice going here and there, searching for and picking out the various individual elements of each of these activities and putting a sort of “cart” together on the spot when we need it.

When you stand back and look at it, is that logical? It’s certainly not very efficient and can be very frustrating, especially if you don’t know where everything is kept.

Muda, Muda Everywhere

If you’ve experienced this or watched someone else do this, you can probably begin to see how wasteful all the unnecessary running around is and even if these examples aren’t exactly applicable to your practice, I’m sure you can think of others..

These and similar situations demonstrate one of the fundamental principles of Lean – identifying and eliminating waste, or muda as it’s knows in Lean. At best, all this waste doesn’t add anything to the value for the client and at worst has cost and quality implications. There are several different types of muda, and waste due to unnecessary “transportation” (of a person or product) is one of them.

Going to the Gemba

To help us in our fight to eliminate waste is another important Lean principle: going to the Gemba (literally, going to “where the activities are taking place”) and directly observing the process for oneself.

Only by direct observation of where the real business happens will you be able to gain firsthand knowledge of the process and begin to understand the real issues at play including those concerning muda.

Spaghetti Diagram

A useful Lean tool when directly observing a process or going to the Gemba is the spaghetti diagram. These are used to map the pathway of, for example, a person performing a specific task and consist of a basic schematic of the room layout and the path taken by someone or something.

Here’s a real-life example of a spaghetti diagram of a nurse putting together all the elements required to place an i/v catheter in a patient:


Spaghetti Diagram

Messy, right? There’s a lot of running about between various cupboards and drawers to gather everything needed just to perform one activity, which itself might be performed several times a day. Think about all that transport waste: wasted time, frustration and opportunity for error!

Kaizen Blitz

Of course, the solution was easy! All the practice team needed was the opportunity to stand back and observe this for themselves rather than being wrapped up in the process and being unable to see the wood for the trees. Taking part in a Kaizen Blitz, a rapid improvement workshop designed to produce results to discrete process issues within a few days, gave exactly the opportunity required.

A simple solution to the wasted motion

They soon saw the muda, especially after mapping it out with the spaghetti diagram. The solution they came up with was a simple tray station with all the elements needed for placing an i/v cannula located right next to the prep table. At the end of each day, each compartment of the tray is restocked ready for the next day’s work. Amount of transport muda now? Virtually zero.


What might be an obvious problem to an observer may not be so to the person or people wrapped up in that process every day. It takes a conscious decision to stop what you are doing, go to the gemba and observe the process.

Problems such as transport muda often become easily recognisable when at the gemba and simply resolved through a structured problem-solving workshop known as a kaizen blitz. Reducing this non-value-added waste reduces frustration, minimises room for errors and frees up valuable staff time for more productive work.