Muda Reduction and Users' Needs

In middle school, my height greatly concerned my parents. Drink more milk. Eat more fish. Of all of the homespun remedies out there, my parents were sold on the idea that if I jumped more I would grow taller. My dad was convinced that 10 jumps a day would do the trick. So, we bought a trampoline. But after one week, the novelty of having a trampoline wore off. Though the trampoline was unconventionally placed in our living room, it was still located in the room that I probably spent the least amount of time in. Moving the trampoline into a hallway was just not feasible. To keep me on track, my dad hung a ball from the ceiling along the path I usually walk from my room to the kitchen; knowing that I wouldn't be able to resist trying to tap the ball as I walked. This ensured that I jumped at least twice a day, which I guess was good enough for my dad.

What I just described is a very natural and logical process: designing and adjusting a system or service to fit the user's needs. Dr. Don Berwick summaries this idea in a one line maxim, "Every system is perfectly designed to achieve exactly the results it gets." If my dad hadn't hung a ball from the ceiling, I would gradually never jump. New products and inventions are born from the needs of users and the degree of success of a new product is based on the product's ability to satisfy the user.



Google, famous for promoting innovation, takes the opinions of users very seriously in its innovations process. Before releasing a product to the public, one of Google's important first steps is to try the product internally. Google and other industries call this "eating your own dog food." And the feedback process doesn't end there! Most of Google's products have official blogs that encourage users to comment, sharing their thoughts and experiences and eventually helping to shape and improve the product. It's no wonder Google's products are so infectious (I may be biased as I use Gmail, GChat, Google Docs, Google Desktop, Picasa, Google Maps, Google Latitude, Google Reader, and Google as a search engine). The products make my time on the internet effective and enriching.

With the passing of the stimulus plan, President Obama's Tuesday speech, and President Obama's budget, we all know that health care in the US could be more efficient. While most of the talk has been about plans and actions to reduce cost via reallocation of money within the system, a closer look at how a hospital operates today will show that many of health care's processes are inefficient. The Japanese term for this wastefulness that doesn't add value is muda. Some categories of muda include: rework, delays, overproduction, defects, movement, and waste of skill and spirit. So, when trying to eliminate muda, it's not simply change that needs to occur, but change that adds value and is meaningful to the user.

Reducing hospital infections through hand-washing is an interesting example. Hospitals are teaming with tons of microbes that can make people sick. So, sanitation is of utmost importance. Health providers for the most part are very well-meaning individuals who would probably drop everything to care for their patients. Unfortunately, this sometimes means forgetting to wash their hands between seeing patients. Effective hand-washing with soap and water takes time that providers complain that they just don't have. Solution? Alcohol dispensers!



However, simply installing alcohol dispensers was not enough to increase hand-washing. Upon closer inspection, the newly installed dispensers rarely had to be refilled, which indicated that they were rarely being used! To figure out why, infection control specialists had to ask the users. What they found was that providers are often rushing into rooms with several items in their hands: prescriptions, charts, files, and pens. Placing dispensers in the hallways did not make sense because hallways were not where care was delivered. But, the solution was not as simple as moving dispensers into the rooms. Providers had to be reminded to use the dispensers and also needed a surface to place all of their things to free their hands. New solution: place the dispensers within the line of the providers' vision and include a flat surface for their things. Muda reduced.

Google's success, the increase in hand-washing in hospitals, and my dad's intervention all have their respective users to thank. The abilities to improve, innovate, and be agile and responsive are at an extreme premium in today's world. But, underlying all of these abilities is the prudence and sensitivity to address users' needs. Can you think of any other muda processes in your daily life or health care? How would you eliminate the muda and what is the underlying user need?

Perhaps the overall expert in muda reduction is my sister. She just couldn't risk having me grow taller than her. So, after a few days, she removed the ball from the ceiling and I eventually stopped jumping. Her system was perfectly designed to achieve the results that it got. I am at best 2.5 inches shorter than my sister.