BMJ Qual Saf 22:826-835 doi:10.1136/bmjqs-2012-001683
  • Original research

Hospital workers’ perceptions of waste: a qualitative study involving photo-elicitation

  1. Michael B Rothberg4
  1. 1Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
  2. 2Department of Academic Affairs, Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts, USA
  3. 3Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, Massachusetts, USA
  4. 4Department of Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Sarah L Goff, Department of Medicine, Baystate Medical Center, 280 Chestnut St. Springfield, MA 01199, USA; sarah.goff{at}
  • Received 13 November 2012
  • Revised 8 May 2013
  • Accepted 14 May 2013
  • Published Online First 8 June 2013


Objectives To elicit sources of waste as viewed by hospital workers.

Design Qualitative study using photo-elicitation, an ethnographic technique for prompting in-depth discussion.

Setting U.S. academic tertiary care hospital.

Participants 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.

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