title: Hospital workers' perceptions of waste: a qualitative study involving photo-elicitation.
abstract: OBJECTIVE
  To elicit sources of waste as viewed by hospital workers.
  
  
  METHODS
  Qualitative study using photo-elicitation, an ethnographic technique for prompting in-depth discussion.
  
  
  METHODS
  U.S. academic tertiary care hospital.
  
  
  METHODS
  Physicians, nurses, pharmacists, administrative support personnel, administrators and respiratory therapists.
  
  
  METHODS
  A purposive sample of personnel at an academic tertiary care hospital was invited to take up to 10 photos of waste. Participants discussed their selections using photos as prompts during in-depth interviews. Transcripts were analysed in an iterative process using grounded theory; open and axial coding was performed, followed by selective and thematic coding to develop major themes and subthemes.
  
  
  RESULTS
  Twenty-one participants (nine women, average number of years in field=19.3) took 159 photos. Major themes included types of waste and recommendations to reduce waste. Types of waste comprised four major categories: Time, Materials, Energy and Talent. Participants emphasised time wastage (50% of photos) over other types of waste such as excess utilisation (2.5%). Energy and Talent were novel categories of waste. Recommendations to reduce waste included interventions at the micro-level (eg, individual/ward), meso-level (eg, institution) and macro-level (eg, payor/public policy).
  
  
  CONCLUSIONS
  The waste hospital workers identified differed from previously described waste both in the types of waste described and the emphasis placed on wasted time. The findings of this study represent a possible need for education of hospital workers about known types of waste, an opportunity to assess the impact of novel types of waste described and an opportunity to intervene to reduce the waste identified.
authors.affiliation: Department of Medicine, Baystate Medical Center, , Springfield, Massachusetts, USA.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Goff
authors.forename: Reva
authors.initials: R
authors.lastname: Kleppel
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
mesh_terms: D001291:Attitude of Health Personnel; D003246:Conservation of Energy Resources; D017598:Efficiency, Organizational; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008506:Medical Waste; D010564:Personnel, Hospital / Q000523:psychology*; D010781:Photography; D036301:Qualitative Research; D017748:Time Management
chemical_list: D008506:Medical Waste
keywords: Complexity; Health services research; Qualitative research; Six Sigma