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To the Editor: In his Commentary on reducing waste, Dr Bush¹ has adapted the methods of the Toyota Global Production System to construct a thoughtful analysis of health care resources. Applying a "manufacturing model" to hospital-based services, he proposes remedies to the generation of waste, defined here as the misallocation of time and product. However, among the 7 categories of waste, absent is any mention of its more common definition: the generation of disposable materials. The "waste of stock on hand" alludes to materials excess,¹ but only as a miscalculation of required inventory, implying that every product purchased will be used. Persons watching unused products hit the trash bin as expiration dates lapse recognize the difficulty in maintaining a tight alignment between purchases and use.

There are several problems with the type of analysis put forward by Bush. By omitting discussion of medical product disposal, physicians are relieved from addressing . . . [Full Text of this Article]

Warren Sherman, MD
wsherman@crf.org
Columbia University Medical Center
New York, NY

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