Muda? Don’t Forget About Mura and Muri!
Recently, I blogged about how a Lean hospital would focus on reducing overwork on nurses and other staff:
Another term that could be used is “overburden.” The Japanese word for this is “muri,” for what it's worth.
Many Lean practitioners talk about reducing waste. The Japanese word for this is “muda.” It's generally good to reduce waste for a number of reasons: If it improves safety or quality, if it makes work easier, if it improves flow.
But, if we're not careful, local waste reduction can cause overburden or unevenness (“mura”) in other departments.
Let's say the operating rooms reduce waste (such as reducing the room turnover time between cases) and that improves their productivity — they can do more cases per day.
That might cause a problem downstream in the nursing units that receive patients after surgery. The was reduction in the surgical department has created (or worsened) overburden in the nursing unit.
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“I wish healthcare organizations focused more on reducing overburden on nurses, doctors, and others.”
Overburden causes problems like:
- Stress and burnout
- Safety risks, errors, and harm
- Lower quality
- Lower patient satisfaction
I wrote about this in my book Lean Hospitals.
As I shared on LinkedIn recently… an excerpt from the book:
“The Japanese not only has a word for waste (muda), but also has specific words that describe overwork (muri) and uneven workloads (mura). Having respect for people means we do not allow our employees to be over- worked or overburdened.”
I added, on LinkedIn:
“It's unfair to ask a nurse to do 75 or 80 minutes worth of work in an hour. It's impossible and it puts nurses in a horrible position of having to cut corners or decide which tasks can be skipped. And, of course, if skipping
- Please don't focus only on waste (
muda), especially if the waste reduction is done in just one part of the value stream
- Make sure you also focus on overburden… and “unevenness” often creates short-term overburden. It's not enough to say, “On average, you can handle the workload” over the entirety of a shift. People need to have enough capacity each hour. They can't be expected to do three things at once.
What are you or your organization doing to focus on all three of “the 3Ms” — muda, muri, and mura?
Or, just call it “waste, overburden, and unevenness.”
If the workload is too heavy, what are you doing about it? If your leaders and executives are unaware of the overburden, how can you help them see? Hint: it might mean a “gemba walk” that goes beyond going to stare at a metrics board…Please post a comment and join the discussion. Subscribe to get notified about posts daily or weekly.