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Muda, Muri, and Mura: sounds like a set of cartoon characters to me, not too dissimilar to Huey, Dewey, and Louie.  However, unlike Scrooge MacDuck’s nephews, they are intangible co-conspirators that rob customers of value and an enterprise of productivity.  Most proponents of Lean Healthcare will recognize these as forms of waste that can pervade systems and enterprises.

Many in pursuit of a Lean Healthcare journey recognize the first triplet: Muda.  These are the eight wastes present in work activity: Defects, Over Production, Waiting, Not Clear (Confusion), Transporting, Inventory, Motion, and Excess Processing.  Relentless elimination of these is often the focus of many healthcare delivery systems’ lean journey.  Often overlooked or receiving less attention are Muda’s partners in crime, Muri and Mura.

Muri is waste driven by over-burden.  When demand exceeds capacity or when required throughput exceeds processing capability there is over-burden.  This over-burden reduces flow, increases errors and undermines desired outcomes.  When we try to push volume through a pipeline that exceeds the load-rating of the pipe, flow will actually decrease.

Conspiring with Muri, Mura is waste associated with unevenness.  In manufacturing, there is significant focus and opportunity with regard to level-loading, or “evening out,” demand and thereby reducing Mura.  “Ha, try that in an emergency department on Friday night,” you say?  Yes, level loading of demand will present with challenges in some areas of healthcare.  However, not all areas of the enterprise share the same degree of challenge as an ED.  In cases such as the ED where we may not be able to pace the arrival rate of the work, we can build in the capability to rapidly flex up or down to avoid over-burden.  If this tactic is coupled with predictable processes and predictable cycle times, it becomes even more effective.

Just as many have expanded their thinking of Muda’s eight wastes to include others such as talent waste (using an RN to perform a task within the capabilities of a CNA) or resource waste (leaving the lights on), we must also expand our thinking with regard to over-burden waste.  When we, as leaders, challenge the frontline team to eliminate Muda and to perform root-cause problem-solving within the current stream of work, we often over-burden that resource by failing to allocate time and other necessary support.

While the elimination of Muda is largely a front line staff concern, the elimination of Muri and Mura is the focus of mid-level and senior management.  In fact, often the front line’s ability to eliminate Muda is challenged by the presence of Muri or Mura at a system level.  With mid and senior management focused on the elimination of Muri and Mura, and through the intentional reinvestment of the time savings captured, the frontline becomes truly empowered to solve problems.

Think of the day when all those committee meetings you attend are vehicles for rapid institutionalization of learning and best-practice as opposed to a primary problem solving vehicle; that’s empowerment in action!

Has all this talk about waste left you feeling animated? Let us know in the comments about your challenges overcoming Muda, Muri, and Mura in your organization’s daily work.


This week’s blog was written by Brad Schultz, a Vice President with HPP.

Brad serves as a Lean Healthcare facilitator, business consultant, and executive coach internationally with HPP.  Brad began his career in manufacturing with GE Healthcare and joined GE’s Performance Solutions during its infancy and remained with the business unit for seven years. He provided significant leadership to adapt the firm’s products to the unique needs of healthcare clients and to translate the firm’s published materials into the language of healthcare.

Brad’s educational background includes a B.S. in Business Administration from Cardinal Stritch University in Milwaukee, Post Graduate Certification in Quality Engineering from Milwaukee School of Engineering, a M.A. in Business Administration from Marquette University in Milwaukee, Six Sigma Master Black Belt Certification from General Electric, and Front-Line Leadership Development Certification from Achieve Global.

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