Efficiency management and achieving targeted outcomes are becoming more and more important in the emerging health care delivery system. Operations managers are charged with delivering outcomes on budget and on time. Their skills in the future know-based economy will be demonstrated by their problem-identification and problem-solving skills, by their competency and ability to work across disciplines, departments and with people. The work done at Cleveland Clinic is team-based; the team identifies waste in SPD. Begin by identifying the 8 (7 is acceptable- as there are various "approaches" to identifying them) types of waste; discuss the relationship of waste to cost and efficiency. How many types of waste were present in SPD and which ones were the most prominent? How does reducing waste in SPD affect the culture of the Cleveland Clinic?