Ohno's 7 Mudas with Healthcare Examples

Taiichi Ohno,credited with creating the Toyota Production System in the 1950 ’s,defined for manufacturing
7 types of waste that describe all activity that adds cost but not value
Six of those seven are applicable to healthcare and are included with one additional one below. Recognizing waste in our organizations is the first and most essential step in transforming waste to wisdom.
WASTE “MUDA ” Definition Examples Causes Countermeasures
Confusion People doing the work are not confident about the best way to perform tasks

Same activities being performed in different ways by different people

Unclear MD orders

Unclear route for medicine administration

Unclear system for indicating charges for billing

Lack of standardized specification of activities of work

Lack of common language

Workers relying on memory or “figuring things out”

All activities of work clearly specified

Clear signals that trigger activities of work uniformly

Motion Movement of people that does not add value

Looking for information

Looking for materials and people

Materials,tools located far from the work

Inconsistent information systems (includes communication)

Materials stocking that does not match the demand

Scheduling that creates “work-arounds ” and “re-work ”

IT systems that match the demand of work Reliable communication systems

Fluid materials availability that meet the current demand

Consistent scheduling that meets the demand

Waiting Idle time created when people, information,equipment or materials are not at hand

Waiting for other workers at meetings,surgeries, procedures,reports

Patients waiting for appointments, MD visits, procedures

Poor understanding of the time required to do a task

Poor accountability for delivering on time

Compounding delays

Unresponsiveness of scheduling systems to demand of work

“Right now ” scheduling

Fewer meetings;work done in small focus groups

Matching capabilities to demand for services, supplies

Processing Activities that do not add value from the patient/customers perspective

Clarifying orders

Redundant information gathering/charting

Missing medications Regulatory paperwork

Work area layout that does not promote continuous flow

Complex flow of medication delivery from pharmacy

Multiple/complex forms

Work area re-designs to create continuous flow

Simplified/consistent delivery systems for meds/materials/information

Forms that document only essential information

Inventory More materials on hand than are required to do the work

Overstocked medications on units

Overstocked supplies on units and in warehouses

Supply/demand not well understood

Outdated supplies not deleted

Personal preferences catered,duplicated

Supply exactly what is needed;no more,no less

Keep supply availability current

Understand personal preferences and orchestrate “like ” items use

Defects Work that contains errors or lacks something of value

Medication errors Rework

Variation in outcomes Incorrect charges/billing

Surgical errors

Lack of understanding of what is “defect free”

Lack of specification in work processes

System redesigns that support workers in doing their good work by clear specification of activities of work,clear expectations of outcomes and safe environment for problem solving in the course of work

Clear definition/understanding of what is “defect free ”

Single,clearly understood method of addressing “defect free ” right now

Over-production Redundant work

Duplicate charting

Multiple forms with same information

Copies of reports sent automatically

Misinterpretation of regulations

Poor communication between departments, offices

No clear specification of who needs what

Computer systems not linked

Clear interpretation of regulations

System (electronic or paper)of information traveling with patient that eliminates redundancy