The article titled “Waste Management Approaches in Hospital Organizations and an Example of Practice” by Kurutkan et al. (2014) explores the critical need for systematic waste identification and management in healthcare institutions, with a specific focus on the Turkish hospital setting. The study responds to global and local pressures to enhance healthcare quality while reducing excessive operational costs, emphasizing waste as a key barrier to efficiency and patient safety.
The core framework used in the study is the Hospital Inpatient Waste Identification Tool (HIWIT), developed by the Institute for Healthcare Improvement (IHI), which is grounded in Lean Service principles. HIWIT consists of five customizable modules: Ward, Patient, Patient Care, Diagnosis, and Treatment. The tool is designed to identify inefficiencies, categorize waste, and facilitate cost analysis across diverse clinical operations.
A cross-sectional quantitative study was conducted at the Duzce University Research and Education Hospital in Turkey between June and December 2012. Data collection involved bedside observations, patient record reviews, and staff interviews across 19 wards. Three trained healthcare professionals implemented all five HIWIT modules, assisted by academic consultants for clinically intensive modules.
The study identified 27 distinct waste types, and calculated their relative proportions and economic impact. The module with the highest proportion of waste was the Diagnosis Module (44.2%), followed by Treatment (25.29%), Patient Module (16.5%), Ward (11.11%), and Patient Care (2.52%). Particularly significant waste categories included healthcare-associated infections, clinical care delays, and process flow delays, which were considered crucial for reimbursement systems like the Turkish Social Security Institution (SGK).
Notably, the Ward Module alone accounted for a waste cost of approximately $1.7 million annually, primarily due to inefficient bed occupancy and preventable infections. The Diagnosis Module showed the highest inefficiency rate in the use of the metabolic panel (83%). These findings suggest large potential savings and improved outcomes if waste is systematically addressed.
The authors emphasize that waste is not only a financial burden but also a threat to patient safety and care quality. They advocate for establishing expert teams to analyze waste data and recommend that health institutions adopt HIWIT or similar tools to guide interventions. The ultimate goals outlined include enhancing performance, reducing operational costs, shortening clinical cycles, and ensuring patient safety.
In conclusion, the article demonstrates that structured waste identification frameworks like HIWIT are effective for diagnosing inefficiencies and informing cost-effective healthcare practices. The findings underscore the necessity of institutional commitment, expert analysis, and integration of waste data into strategic decision-making in hospital management.
Reference. Kurutkan, M. N., Usta, E., Simsir, I., Orhan, F., & Bagis, M. (2014). Waste management approaches in hospital organizations and an example of practice. Balkan Military Medical Review, 17(1), 10–15. https://doi.org/10.5455/bmmr.159148
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