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INTRODUCTION

Ms. Davis sits in the waiting room of her primary care physician’s office. She knows that her doctor often runs late, but this time she has been sitting for 20 minutes after her appointment was supposed to start. And this in spite of the fact that she arrived 15 minutes early, just as she was asked to do on her appointment reminder. She completes the preclinic questionnaire, which contains many of the same questions she has answered before, including basic demographic information that the front desk just asked her to update. She continues to wait, as the minutes tick on. No one seems to notice.

Dr. Sanchez stands in the supply room of the intensive care unit (ICU) at Arbitrary Regional General Hospital. She knows that the large-bore central venous catheter she is working with has to go in quickly. Her patient is rapidly losing blood but only has in place in her arms tiny intravenous (IV) catheters, so any blood that she wants to put back into her patient will go in very slowly. As she looks around, she finds that all the pieces she needs to put the central line in the patient safely are spread out on all of the towering shelves before her. Saline flushes… saline flushes… She finds the nonsterile flushes, but she needs the special sterile ones for the field. And she can locate sterile gloves and a gown (all in large sizes, not her size), but not the mask and hat she needs for the procedure. She feels her heart thumping in her chest as she knows the minutes spent in this room looking for supplies are minutes the patient cannot afford to lose.

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Throughout this chapter, we will return to Dr. Sanchez’s experience of the process of central venous catheter placement in the ICU at Arbitrary Regional General Hospital. By way of quick explanation, the placement of a central venous catheter is necessary to give critically ill patients certain medications or fluids rapidly. The catheter, or central line, is often placed in the internal jugular, the subclavian, or the femoral vein, large veins that run near arteries; and is often placed with ultrasound guidance, as Dr. Sanchez intends to do. The process can be simplified to several critical steps, although substantial variation remains between providers and across hospitals.

Waste is everywhere in healthcare. We are constantly tolerating wasted time in ways that would never be acceptable in other industries. Imagine showing up for restaurant reservations but reliably sitting down to eat 30–45 minutes late–and without a word of apology. Waste can be disrespectful to patients, causing them to feel their time is considered less valuable than the providers’ time. But in other cases, waste can actively be dangerous. What additional interventions will Dr. Sanchez’s patient have to receive because her physician couldn’t find the tools she needed, lost and pacing through a supply room ...

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