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Three deviations often used together in Toyota Production system that jointly explains inefficient allocation of resources/wasteful practices to be eliminated. This is also called a 3M model of Toyota Production System. These are called be enemies of Lean – Muda (Waste), Muri (Overburden) & Mura (Unevenness). What are these wastes - Muda, Muri and Mura? Muda (Waste): - There are many definition of Muda which helps to understand what Muda is: - 1. It refer to the work which doesn’t add value for customer. 2. Activity that consumes resources but didn’t create values. 3. It doesn’t help business or workers in any ways. 4. It refers to direct obstacle of flow. Two types of Muda:- Type 1 – Non value added activities in the processes but essential for end customer. Example – inspection and safety testing. Type 2 – Non value added activities in the processes but non-essential for end customer. There are eight categories of Waste which can be eliminated as this is not essential for end customer. It has several abbreviation – TIMWOOD(T) , DOWNTIME, WORMPIIT. Here you go with wastes name:- 1. Transport 2. Inventory 3. Motion 4. Waiting 5. Overproduction 6. Over-processing 7. Defects 8. “Non use of resources or Talent” or Intellect. Muri (Overburden): - There are many definition of Muri which helps to understand what Muri is: - 1. Man power or equipment/machines are utilized for more than 100% for task completion. 2. Running higher or harder pace with more force for a longer period than its designed. 3. Overburden, excessiveness, very close to impossible or unreasonableness. 4. Overly difficult or ones that overburden workers. Muri can result from Mura and in some cases from Muda also. Why its causing:- 1. Ineffective training 2. No standards operating procedures 3. Wrong tools/equipment 4. Wrong process 5. No Optimization Long term impacts:- 1. Absenteeism due to illness 2. High attrition rate (people leaving) 3. More breakdowns (as machines will run more than designed capability or less/no time for maintenance) Avoid Muri:- 1. Define standard work 2. Evenly distribute load to avoid overburden 3. Preventive maintenance or Autonomous maintenance Mura (Unevenness): - There are many definition of Mura which helps to understand what Mura is: - 1. Type of waste occurred due to unevenness in production system or services 2. Its unevenness in an operations 3. Non-uniformity or irregularity Mura is a result for existence of any of the seven/eight wastes in system/processes. Why it’s causing:- 1. Fluctuation in customer demand (Basically Production system which can’t handle customer demand) or Uneven workplace 2. Variation in Cycle time 3. Uneven workload 4. Low volume but high product variation 5. Flexibility is more important than volume Long term impacts:- 1. Defects are manufactured 2. Delivery of inconsistent product 3. Capacity loss (at some point of time – Production floor struggle to complete large order and become idle as with less orders) 4. It creates Muri (overburden) and this reduced the efforts of eliminating Muda (8 wastes) Avoid Mura:- 1. Just-In-Time (JIT) 2. Kanban System 3. Pull System 4. Level scheduling 5. Workload balancing 6. Standard work How can the healthcare sector address these wastes? Healthcare is really huge industry and it has different & multiple start and end points which leads to a lot of wastes, unbalance situation and overcrowding in specific causes. Let’s understand one by one how healthcare sector address these wastes especially in this Pandemic situation of COVID19. Muda: - As explained above Muda has eight wastes (TIMWOOD-T) and we can co-relates to current situation of COVID19. 1. Transportation: - Inefficient movement. a. Patient movement from room to lab/diagnostic department or different places i. Example – Limited hospitals or labs are allowed to do the COVID19 test which lead to massive movement from one location to another. b. Daily essential needs moves from storage room to different floor i. Example – Mask and gloves movement from storage room to different floor where COVID19 people are admitted. (Mask and Gloves are most essential for COVID19) c. Medication from pharmacy to different floor as required i. Example – Few specific medicines which are still under trial and used for other diseases 2. Inventory: - Huge inventory in stock, Bulk ordering a. Overstocked Consumption i. Example – Gloves and Mask which has been ordered or kept in bulk keeping in mind that it will be used most. b. Stationary i. Example – Pre-Printed stationary with specific details can’t be used as limited sections are open in hospital during COVID19. ii. Example – Now mostly doctors are going in digital way to see patient. c. Medicines expiry i. Example – Bulk ordering of Medicines which has expiry dates. Since very limited departments are open now days in hospital and People also avoid to come hospital lead to reduce the purchasing of medicines from Hospitals. 3. Motion: - Unnecessary movement of people in hospital. a. Layout i. Example – One doctor has to move from one building to another to see patients as his office is building A but due to pandemic situation Patients have specific COVID ward in building B. b. Goods are not stored where needed i. Example – Gloves/Masks and COVID specific medications are kept in building A whereas patients are kept in building B. c. Testing equipment’s i. Example – Patient movement from building A to building B or on different floors for specific testing. 4. Waiting: - it occurs when the flow is blocked due unavailability of material or due to problems like downtime in specific machines. a. Patients in OPD waiting area i. Example – The queue has increased in this pandemic situation fearing they have COVID19 even they feel minor symptoms. b. Patient waiting Testing i. Example – Testing queue has also increased due to unavailability of enough kits to match the demand of COVID19 testing. c. Patient waiting for test result i. Example – Huge test requests resulting in massive queue of testing d. Patient waiting for admission i. Example – Limited beds in hospital resulted Patient waiting for admission 5. Overproduction: - It occurs when providers to more than it’s needed by the customers. a. Unnecessary diagnostic test i. Example – In this pandemic situation normal flue creates the fear in people and they ask for the COVID19 test fearing they might be suffering with COVID19. b. More medicines orders i. Example – Giving more medicines considering future need 6. Over Processing: - Doing more than it’s required by making it more complex. a. Looking big hospital and highly qualified doctor i. Example – Looking for specialist doctor even in light flu which can be easily recovered by resting at home b. Over testing i. Example – Referring for COVID19 test for each type of flu without looking the symptom’s 7. Defects: - Defects in healthcare can cause a life of human. Let’s understand with below reason why it can be deadly. a. Wrongly diagnosis after test i. Example – Test result of COVID19 were highly ineffective due to bad kits. b. Administrative mistakes (incorrect medication) i. Example – Wrong name mentioned on testing sample c. Wrong codification related to patient i. Example – Wrong name mentioned on test results 8. Talent: - Unutilized resources. a. Not using right resource at right place i. Example – Doctors or nurseys who are really aware to use PPE kit are not being used in COVID19 treatment. ii. Example – Or their ideas are not being implemented which can help to control the cases. Muri (overburden): - As explained above, the Man power or equipment’s are utilized for more than 100% or running higher or harder pace for a longer period than its designed. In Current Pandemic situation what is happening. - Doctor and Hospital staff is working more than 8 hours and in some places doctors and nursing staff is working even more than 12 hrs. (considering as per labor law 8 hrs. are standard time for working) - Cleaning staff in hospital and in factory and offices are working more than defined hours and in some place they are even doing 24 hrs as required due to shortage of man power. Why it’s happening, let understand? - [No Standard Operating Procedure/ Ineffective training] Since there is no specific medication for COVID19 o This needs lot of time to spend on different trials by doctors and testing different ways and medicines - [Wrong process] Life of COVID19 virus is not really know and information is shared based on experience o This is why lot of frequent cleaning and sanitation requires. Mura (Unevenness): - As explained above, Type of waste occurred due to unevenness in production system or services and Mura is a result for existence of any of the seven/eight wastes in system/processes. As explained above there are eight wastes of Muda and they are linked to current pandemic situation fully/partially. Why it’s happening, let understand? - [Fluctuation in customer demand (Basically Production system which can’t handle customer demand) or Uneven workplace] o Currently COVID19 patient are more than the number of available beds in hospitals o Also not every hospital is equipped to handle COVID19 patients - [Variation in Cycle time] o Recovery rate is varying patient to patient - [Uneven workload] o Since limited hospital are allowed to handle COVID19 patient hence the doctors and staff is more loaded as COVID19 patients are coming to only these hospitals. Thanks to resource:- https://theleanway.net/muda-mura-muri https://www.mudamasters.com/en/lean-production-theory/toyota-3m-model-muda-mura-muri https://www.lean.org/lexicon/muda-mura-muri https://www.kaizen.com/blog/post/2018/05/09/muda-mura-muri.html https://blog.kainexus.com/improvement-disciplines/lean/7-wastes-of-lean-in-healthcare