Q 272. The Covid-19 pandemic has highlighted all the 3 wastes - Muda, Muri and Mura - in the healthcare sector across countries. What are these wastes and how can the healthcare sector address these wastes?

 

Note for website visitors - Two questions are asked every week on this platform. One on Tuesday and the other on Friday.

• All questions so far can be seen here - https://www.benchmarksixsigma.com/forum/lean-six-sigma-business-excellence-questions/
• Please visit the forum home page at https://www.benchmarksixsigma.com/forum/ to respond to the latest question open till the next Tuesday/ Friday evening 5 PM as per Indian Standard Time. Questions launched on Tuesdays are open till Friday and questions launched on Friday are open till Tuesday. 
• The best answer is always shown at the top among responses and the author finds honorable mention in our Business Excellence dictionary at https://www.benchmarksixsigma.com/forum/business-excellence-dictionary-glossary/ along with the related term

Muda(waste) :- wasting any of the resources is known as Muda.

Mura (uneven) :- Muri is something which is not equally divided between resources. 

Muri (Overburden):- over usage of any resource which will lead to failure

 

In current pendamic situation healthcare industry facing all three wastes.

 

Below practices may help to overcome all three.

 

1)Creating right awareness about symptoms to avoid unnecessary penic about the situation as well avoid repeating test multiple times for one case instead test a new case (which will reduce the testing waste)

2) Strict norms & action plan to be created for people going out for work to be adhere & quick action on non adherence specifically for areas with high number of cases(if possible complete lockdown)

3)To make equal distribution/usage of healthcare equipments either patients to be shifted to nearby city/district where count is less or unused/vacant healthcare equipments need to be shifted to nearby city/district which have higher number of cases.

4)Hotels/Lodges/Schools/Colleges can be converted hospital wards and utilised where the cases count is high.

5)A volunteers should come up to help the health workers and provided a short term training to increase the Health workforce.

6)All the citizens are requested to contribute more towards the company they work for as well towards society as much as possible.

 

 

 

The covid 19 pandemic highlighted 3 waste Muda, Muri, Mura in Health care sector.

Muda – This is the waste comprising of other few waste on shop floor, In this case let us consider Health care system.

It is denoted as - WORMPIT.

W = Waiting time for the patients to get admitted – Taking lessons from other countries suffering from this pandemic, State Governments has to be prepared well in advance regarding facilities for patient like, beds, dedicated Hospitals or wards in the Hospitals.

O = Over production – It was been observed the excessive documentation in processing every individual traveling to other places and it had created lots of burdon on the system. They had to apply few specific and effective testing system to keep it simple and specific. Less than 1% people travelling were detected positive.

R = Rework – There were complaints about quality of PPE kits and it may have resulted in infection to the doctors and nurses wearing them. This point had to be taken care well in January and February 2020.

There had have to be strict standards for the quality of PPE lits with SOP for their quality check, and it had to be followed very seriously. It was like Sharpening the saw, few deaths must have been saved. Few health care workers might have been infected due to low quality kits.

M = Motion – The patients had struggled a lot to find vacant space, beds and ventilators in suitable hospitals and there were no common place or control room to guide them in such painful situation. This led to few deaths as no facility were available and patients kept searching for facility.

There has to be a central control room in every district particularly giving information on essential facilities with transportation facility.

P =  Over Processing – Though Quarantine was a essential thing, it was applied all across without giving due consideration on the place person coming from, the situation there the possibility of might be having infected, all were sent to 14 days quarantine and it increased a heavy load on the system with respect to manpower, expenditure and delays in results after testing. At so many places they could not manage basic facilities to the peoples.

Local administration had already devided the localities, town and cities in Green, orange and Red zones, instead of focusing on complete districtor state health care staff had to consider the individual area from where person is coming, its own health and the way he had kept himself in isolation before traveling.

I – Inventory – It was the biggest issue. In this case it was shortage of inventory of PPE kits for doctors and it also led to infections to the doctors, nurses and other staffs, police etc. It was really a serious challenge.

Also beds for patients were not available and they are forced to take care at homes increasing chances of spread to other family member. Also due to non availability of beds in time there were few deaths.

Health ministry had to plan the sufficient number of PPE kits and beds well within the time taking lesson from other countries.

T – Transport – Transportation of dead bodies was a major issue and they remained on the beds around the patients creating threat and tension to the common patients.

Hospitals had to keep dedicated staff for the transportation of dead bodies to their destination. Even a common team handling this operation would had given effective results with less manpower.

Muri – This is the overburden, excess workload and things which are not directly visible.

                Yes in this case it was been repeatedly heard that few doctors, nurses, Police staff were working excessively round the clock with very less rest. They were forced to take rest on work place. They could not visit their families due to fear of infection. This all were adding lots of Psychological and metal tension. It was also heard few deaths of health workers due to heart attack, it must be due to panic conditions they were handling.

                This all could had been saved if right from the beginning Private Hospitals would Had been given SOP to operate with respect to Bed charges, general hygiene conditions and social distancing and most importantly they had to be instructed to keep operating as most of the Private  Hospitals were closed.  

Mura – Interruptions, Unevenness, Instability and Inconsistency in the system.

                Repeated changes in the controlling power, inconsistency of the controlling power were few cases to worsen the system and adding cases of Covid 19.

                No doubt increase in the covid cases were not linear and it didn’t allowed system to plan the infrastructure in sufficient numbers. This led to scarcity of valuable resources.  

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

 

 

Muda, Muri and Mura:

It starts with Toyota Production System & Key concept of Lean, the overall system is surrounding all about the elimination of this three objects – Muda, Muri and Mura.

All the three are Japanese words and their meanings in English as follows:

·        Muda means "futility; uselessness; wastefulness in ease understanding its - WASTE”

·        Muri means “unreasonableness; impossible; beyond one's power; too difficult; in ease understanding its – OVERBURDEN, STRAIN”

·        Mura mean unevenness; irregularity; lack of uniformity; nonuniformity; inequality; in ease understanding its - IMBALANCE”

Further going MUDA classified in 7 types they are simplified as “TIMWOOD”

Whereas:

§  T indicates Transportation

§  I indicates Inventory

§  M indicates Motion

§  W indicates Waiting

§  indicates Overproduction

§  indicates Over processing

§  D indicates Defect

 

 

Muda, Muri and Mura in Healthcare:

Muda in Healthcare–

In the way of 7 types of waste in Healthcare,

1.     Transportation Waste:

Any transportation which does inefficiently and does not add value to final output is a waste,

For example:

§  Patients are moved from department to department

§  Medication is moved from the pharmacy to where it is needed

§  Supplies are moved from storage to the floor

2.     Inventory Waste:

Storage which does not required for the specific time and which blocks the space, money & consumes resource is known as Inventory Waste.

For example:

·        Overstocked consumables such as Cotton, bandage

·        Pre-printed formats

·        Unused bedside equipment

3.     Motion Waste:

Motion refers to unwanted human movement in the overall process.

For example:

·        Movement of staffs due to hospital layout not consistent with workflow

·        Movement of staffs due to Supplies are stored at not required place

·        Movement of staffs due to Equipment located at inconvenient place

4.     Waiting Waste:

Any resource in the overall process, waited (can’t flow) due to any reasons at a stage is known as Waiting waste.

For example:

·        Patients and physicians waiting for test results

·        Out patients waiting to be admitted to the hospital

·        Patients waiting for discharge report after medically ready

5.     Overproduction Waste:

In manufacturing production more than required or planned is Overproduction but today its not more equally relevant to this Healthcare, however there are few instance likely.

For example:

·        Diagnostic test recommended at unnecessary moment

·        Ordering medications which is not required by the patient

·        Over staffing during non-peak hours

6.     Over processing Waste:

Over processing refers to any process done addition to the specific requirement, in manufacturing the simple example is polishing the surface than the requirement specification. In healthcare,

For example:

·        Ordering complex diagnostic imagery for a simple bone fracture which is visible in X ray

·        Proposing surgery instead alternate simple medical treatment

·        Treatment by specialists even when it’s possible by non-specialist

7.     Defect Waste:

Any product or process which does not meet the minimum required specification is a defect.

For example:

·        Wrong surgery

·        Wrong testing reports

·        Unhygienic conditions in operation theatres

 

Muri in Healthcare:

In Healthcare Muri “Overburden / Strain” visible in overall process, any activity which cause overburden or strain to the human resource (even though it’s a part of process) is known as Muri in Healthcare.

For example:

·        Continuous working than the shift due to absent in next shift or some other

·        Continuous expose to Bio Hazards (Radiation from X ray machines etc.,)

·        Diagnosing in a dim light, low ventilated area

Mura in Healthcare:

In Healthcare Mura “Imbalance or Inconsistency” we can relate any process which is not consistent. For ease understanding the imbalance in a continuous production Assembly process is different cycle time for multiple stages.

The same context is not able to directly suit the Health care, but similar in Healthcare context as follows:

·        Single receptionist for admission process while incoming patients are higher than usual

·        More staff nurse for a Single Specialist or vice versa

·        Delay in a specific task in the overall surgery (some time Anaesthesia process takes more time than planned, due to other tasks delayed and specialist in queue to complete the task)

Thus Muda, Muri and Mura related to Healthcare, all are able to reduce or eliminate with the help of Lean tools.

 

Benchmark Six Sigma Expert View by Venugopal R

First of all, let us salute all those who are engaged in protecting us from this pandemic, which greatly includes all the people who are directly or indirectly involved in healthcare activities, under such challenging and trying circumstances. Any views on this forum should never be mistaken as a criticism towards anyone doing such noble service, but as a discussion for learning from the experiences and generate thoughts that could help society as a whole to be better prepared in future.

 

One of main issues that we see across the healthcare systems in the world with the prevailing problem is Muri, which means ‘overwork’, for healthcare workers. It would be unfair to blame the healthcare systems for the excess Muri, based on the current situation, since it is beyond anyone’s imagination. However, under these circumstances it is essential to do everything possible to provide relief to the people who are getting overburdened. It has to be mentioned that there are many efforts being taken by various governments and many volunteers to this effect as well.

 

The three components of wastes viz. Mura, Muri and Muda can affect one another and hence it is important to address all of them together. Very often, we see that Muda is the one that gets most attention.

 

I have tabulated these waste components with some examples and suggested a systemic remedy. It may be noted that this is only a very small representation, whereas there is bound to be many more situations for each category and the solutions may not be very easy to implement always.

 

S#	CATEGORY	EXAMPLE	SUGGESTED REMEDIAL MEASURES
1.0	MURI (Overburden)
1.1	Overbearing tasks	Stretched working for direct and indirect healthcare staff Forced to handle excessive number of cases than normal	Clear criteria to identify genuine cases who need to be admitted, plus awareness Consider geographical redistribution of staff based on need
1.2	Work related stress	Handling patients who are not very cooperative Personal attenders / relatives of patients are not permitted due to risk of infection. This adds burden to the healthcare staff	Support the skilled healthcare staff with other inhouse staff who can play the role of personal attenders. Maintain regular contact with patients relatives and obtain oral assistance
1.3	High risk tasks	Frontline healthcare staff are at high risk of being exposed	Continued awareness and providing equipment to staff. Ensure Routine 5S in workplace. Plan staff rotation on high risk area to prevent prolonged risk to anyone
2.0	MURA (Variability)
2.1	Materials related	For materials required by healthcare staff, mismatch between requirement and availability Variation in the quality of the materials	Material planning exercise to be done at treatment centre level and at regional level Have standards for each item and centralized compliance monitoring Establish authority who understands the risks to decide on use any material that doesn’t meet the standards in case of emergencies
2.2	Methods related	Differences with respect to diagnosis, treatment approach, handling, duration, and conditions within and between treatment facilities.	Standards for all methods with frequent updating and compliance monitoring by a central organization. Frequent sharing and synching of best practices across centres
2.3	Manpower related	Unpredictable variation on day to day patient count Variation in knowledge & skills among staff	State level planning for potential patient turnover and necessary treatment facilities Adopt buddy system to quickly orient staff and reduce knowledge variation
2.4	Machines related	Critical equipment not functioning or functioning with variations, especially during emergency situations – leading to waiting or treatment deficiencies	Equipment availability both in terms of numbers and through predictive maintenance
2.5	Measurements related	False positives / False negatives on the screening tests. Dependency on sampling for screening evaluation	MSA on the screening measurements to understand the measurement reliability and improvement actions Application of different sampling methods like stratified sampling to obtain realistic density of the problem
3.0	MUDA (Wastages)
3.1	Transportation	Transporting patients for various requirements - Testing, ICU. Transporting of equipment across centres	Study transportation data to review the facility layout for optimizing movements Consider creating ‘self-sufficient’ zones based on cost-effort-benefit analysis
3.2	Excess Inventory	Excess stock of medicines that do not get consumed for long Large number of patients queuing up for being attended at various stages Test requests / reports piled up	Value stream and Kanban methods could help in streamlining the processes and minimize inventory
3.3	Excess movements	Healthcare staffing having to move about within a centre for various activities. Too many movements required by physicians and other healthcare staff while examining / treating patients	Lay out optimization, maximise communications, review positioning of facilities Workplace management – 5S practices
3.4	Waiting time	Patients waiting for getting admitted, seeing physician, tests, reports, discharge etc. Physicians waiting for test reports	Many of the solutions for other wastes will help to reduce waiting times. Reasons for the waiting time have to analysed whether it is a result of an inefficiency from another process – to decide the best options for solution
3.5	Over processing	Assigning more staff than required for a patient Keeping a patient under care more than required Doing unnecessary diagnostic procedures Patients have to repeat the same information multiple times	Expectations at each stage need to be understood well, so that both under processing or over processing should be minimized / avoided Ensure patients inputs are recorded and the same file is maintained
3.6	Over production	Preparing for a patient too much in advance	Define preparatory lead time for effective & efficient preparation to receive a patient
3.7	Defects	Wrong diagnosis, administering wrong medicine, improper dosage, mix-up of reports etc are some serious defects Other defects are also possible such as skipping a step during an clinical test, missing out an instrument on surgical case cart	Training & certification, checklists, software-controlled protocol
3.8	Talent unutilized	Feedback / suggestions from junior and supporting healthcare staff not considered Best practices between individuals, treatment centres not captured	Institute and encourage Kaizen system, encouraging all staff to provide suggestions and best practices. Reward & recognition schemes

Muda refers to the non-value added activities or processes, these are not helpful and often result in rework in turn resulting in huge cost and delays the entire value chain . There are basically 8 different types of wastes (TIMWOOD)

Transportation – Movement of products from one place to the other

Inventory – Appropriate inventory is important but storing few of them causes an issue, excess inventory results in additional cost and storage space increase considerably

Motion – Physical movement of machinery or person to complete a task

Waiting – Process is stopped or slowed down due to a bottleneck

Over production – Manufacture is done before the requirement

Over processing – Additional or duplication of effort in completing a product

Defects – Occurs due to rework and errors that occur in the process

Non utilization of skillset – The skillset of the resource is not used properly, expertise in some other domain is leveraged for a different role which is not probably the strength.

 

Mura(inconsistency)  refers to the waste caused due to uneven production and services. There are no set standards that are followed, Mura results in muri (making the tasks very tough) which will eventually result in undermining the complexity in elimination of wastes.

 

Muri (Overburden) refers to the type of waste that is caused due to improper training, no policies in place and lack of adequate tools required to complete the task.this would inturn result in huge rework and longer time to complete the task.

 

Healthcare sector can look through the different types of wastes and proceed with lean implementation using different lean tools

 

First type of waste is inconsistency or the unpredictable workload that we see, especially during the pandemic where we have patients who are impacted vs patients who are not impacted by COVID, so getting timely support on treatment for the patients would be a great challenge. We could relate this to waiting as well..Having the right resources and preparedness for additional patients and attend them on time. Also prework around patient preparedness will help reduce time and separate sections for different checks to have different rooms would help

 

Lack of equipment – with increasing cases, the number of equipment required to treat will be impacted as well..Proper planning and proactive approach in utilizing the available equipment.

 

Inventory – surplus supplies, medicines all increase the risk of increase in waste, the employees should be trained on optimal utilization of inventory and think of innovative ways of reducing it

 

Reduce or remove defects to improve quality of treatment – Surgical issues or any misrepresentation of facts could result in dissatisfied patients and huge impact on the way patient is treated, Payers would be outcome based hence lean principles can be leveraged to improve quality and make them understand the impact on bottomline would help …

 

Reduce the overprocessing , the end to end process of treatment is very cumbersome right from filling the application till the time patient gets treated is very elaborate. Structure online procedures to ensure we save time and the patient experience is good as well..

 

 

 

 

 

 

These are three Japanese words , which were used in Japanese martial arts long before Toyota, then Toyota applied it in its production system to eliminate all three enemies of Lean , its English meaning is ,  

• Muda is Waste,
• Muri is overburden/stress
• Mura is unevenness/inconsistency.

Concept of Lean Philosophy is equally applicable in Health care as it is in manufacturing industry. In hospitals, different processes are being carried out like,

operations, medical tests, Patient admissions, emergency department care, routine checkups , with following fig we can understand diffrence betwenn these three

 

In healthcare sector , The Covid-19 pandemic has highlighted all three wastes, Muda is on of them, it is divided into the famous seven type of waste by following example we can understand it very well,

 

Motion waste-  In Health care,due to poor layout patient , Doctor, nurses need to walk more and more time will be wasted.  layout is very important if any person is suspected for COVID 19 then then very first process is registration then sampling of blood and swab of throat if this facility is available inside hospital then patient need to walk all the way inside hospital to go to lab for sampling , which will result in unnecessary movement of patient, instead of this beside of registration sampling lab booth should be there so patient need not to move.   If layout are designed as per process requirement then patients, test results , doctors, nurses and other stakeholders will have to walk less and we can avoid Motion wastes.

 

Waiting Time- waiting time in hospital is main factor in customer dissatisfaction. In current situation we observed high waiting time for test sample , waiting time for routine check up , waiting time for emergency treatment , these happenes because on workloads are not level, it is example of Mura.

As solution for this admistrative/Technical staff should be flexible and trained to handle all kind of general administrative work.

 

Over processing- During this pandemic suddenly number of suspected people are walking to hospital for testing, at this time though hospital administration are asking patient to fill forms to get register multiple time which is actually not adding value for testing of patient.

As a solution of this there should be one time registration with adhar card and person should able to do self registration process.

 

Inventory- In current situation of COVID 19 has uncovered that Inventory level of required items such as mask, gloves and PPE kit,  need to define with Minimum and Maximum level and it should get replenish as per consumption based only.

 

Overburden/stress – During this pandemic it has observed that hospital staff is working more than 8 hours which cause overburden and stress on them and their productivity goes down. These overburden may be because of 7 wastes in hospital.

While everyone has written good answers, the best answer has been provided by Sudhir G and Raj Saxena for providing specific actions that the healthcare sector can take to address the triple enemies of Muda, Muri and Mura.

 

Also review the answer provided by Mr Venugopal R, Benchmark Six Sigma's in-house expert.