Table A1.

List of encountered wastes

WasteDescription/Effects
Missing pathways indicationsPatients get lost inside the hospital
Wrong data entered in the hospital databaseThe timing of visits and exams are not accurate
Missing data in the hospital databaseData on patients, services provided and timings are often missing: physicians often skip the data entry activity
The same visit/exam has different denominations in the hospital databaseThere is no standardisation among different hospital departments: every department registers the required information using the preferred denomination
Waste of time looking for information in paper sheetsGiven the lack of digitalisation, doctors and nurses register most of the information on paper sheets
Waste of time searching for patient information in the hospital softwareSoftware interfaces are not user-friendly: physicians and nurses have to take several steps to grasp the needed information
Waste of time searching for patient information in the medical recordThe medical record has the format of a free text, so grasping specific information is very difficult
Waste of movements between hospital and outpatient clinicsMammography and biopsy are performed in the hospital: patients who undergo a breast specialist visit in outpatient clinics then have to move to the hospital to proceed with the care pathway
Lack of ultrasound scannerBreast specialists do not have ultrasound scanners
Radiologic technologist’s waste of timeWhile doctors perform X-ray exams, radiologists wait next to them without doing anything
Lack of standardisation of medical reportRadiology medical reports are not regulated in a standardised format, complicating the assessment of breast specialists and oncologists
Lack of prioritisation and logic in MRI scans reportingThe MRI scan arrives in the reading room randomly, so the reporting timings is very variable
Equipment and materials located in the wrong roomThe equipment needed in the mammography room is located in the warehouse; the material needed for the MRI scan is located in the mammography room
Mammography room overcrowdingToo many radiologists stay simultaneously in the mammography room
Waste of timeIf a visit finishes before the time slot dedicated to those patients, doctors have to wait before calling the next patient
Source: Authors’ own work

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