he 8th waste is underutilization of employee talent. Sometimes talent is scratched out and replaced with potential or intellect. You get the idea.

So why not teach it? Answer: Actually, we do; we just choose not to add it to the original list of 7.

The value-added test (VA) is a cold economic concept, economics being the “dismal science” that simply does not care. Economics essentially assumes reward is its own virtue; it doesn’t get much colder than that.*

The cold and robotic VA test asks about value provided, not who came up with the ideas, who was on the team, whose intellect was tapped, nor whose was perhaps brutally ignored.

Collectively, the 7 wastes are the opposite of value-added. Each of the 7 is a form of energy spent without providing value to a patient. You can measure VA and non value-added with universal economic units such as dollars or minutes. Not so with untapped intellectual potential.

But we do teach it. In fact we teach it as three principles:

1. Respect for People

We quote Taiichi Onho who said respect for people (employees) is equally important as continuous improvement and standard processes. Respect for people is the heart of the Team section of the vision summary and is manifest in our cultural requirement for cross-representation on teams. It’s also plainly practical facilitation advice.

2. Work at the top of your license 

We consistently teach top of license. That is, we remind process redesign teams to place task ownership appropriately, e.g.: providers shouldn’t be drawing blood.

3. Avoid Systematic Disrespect

We highlight systematic disrespect which is never personal but disrespect nonetheless. Examples include: providing our coworkers with unclear expectations; providing inadequate time, tools, and authority to complete a task; ergonomically incorrect workplaces, just to name a few. (Systematic disrespect impacts patients as well in the form of the 7 wastes.)

At Utah, we’re not purists about LSS, but with respect to Ohno’s taxonomy, we’re unapologetic originalists because the list of wastes is stronger without the 8th.