The Seven Deadly Wastes: Is Your Practice Full of Muda?

The elimination of waste is one of the key principles of Lean Systems Thinking, a philosophy and practice that originated from the Toyota Production System back in the 1940s. Lean is now a recognised discipline whose ultimate goal is to align everything in the business to deliver exceptional customer value whilst eliminating waste. 

Waste, or muda as it’s known in Lean, is all around us, every day and everywhere: we all waste our time waiting in traffic jams on our way to work, queuing at the store because there isn’t enough staff on the tills, throwing away groceries when they go out of date, running around the house searching for things we’ve misplaced.

To define what waste is, the Toyota Production System originally identified seven forms of waste: transport, waiting, overproduction, defects, inventory, motion, and excess processing. A simple mnemonic to remember these is TWO DIME.

And these days, a bonus eighth waste is recognised, that of wasted human potential.

Although Lean may have been developed within a manufacturing environment, you will see how applicable the principles are to service industries and how we can learn from other sectors of the business world. Let’s now examine each of the seven wastes in a veterinary context.

1. Transport

In the manufacturing world, movement of product or materials between transformational operations is waste. The more you move, the more opportunity there is for something to go wrong as well as the time and energy wasted in moving.

We’re not necessarily talking about vehicular transport; think about the pet and how he or she is transported within your practice. For example, transporting an animal off the operating theatre table to a recovery room that is at the other end of the building for whatever reason opens up all manner of issues: injury to the carrier, injury to the animal if dropped, and time wastage. Poor layouts are a very common cause of transport waste.

Transportation waste can equally apply to drugs, bedding, surgical equipment, specimens, consumables etc., therefore consider how these are moved about within your practice. Is there any unnecessary transport here? Are you experiencing problems that arise as a result of transportation?

With some creative thinking, you are likely to be able to reduce transportation and the problems or time wastage associated with it.

2. Waiting

I’m quite sure we can think of many instances of waiting or delay within a veterinary practice environment!

However, waiting comes in many forms. There is the obvious one of client waiting but think about other forms such as a nurse waiting to prep an animal but can’t until the vet is free to tell him or her how much to clip up. Or perhaps a drugs order has not arrived because it was made too late the day before or something has been missed off the order and a client needs to wait another day.

And some practices may have clients waiting for considerable lengths of time in the morning for a vet to be free and yet in the afternoon a vet may be sat idle drinking tea.

There are various causes and solutions to the waiting problem. Client waiting is often due to poor workflow and planning. Of course, things crop up out of the blue and can’t be helped but even here systems can be put in place to be able to deal with such situations should they arise.

Better communication may help the nurse waiting to prep up the animal on the table and a more efficient and possibly automated ordering process could solve ordering issues.

3. Overproduction

A legacy from its manufacturing origins, overproduction refers to producing more product than the customer requires, or producing it sooner than required

In a veterinary context this could be overproduction of services such as performing unnecessary diagnostic procedures. Perhaps a blood test isn’t required every time a patient comes in with a case of the runs, or maybe there are occasions when a simple pre-anaesthetic profile might suffice over a full biochemistry and haematology.

I’ve worked at a practice that had a whole drawer in the consulting room full of balled-up cotton wool ready to be used as swabs. Certainly a bit of overkill as there was probably two months’ worth of swabs taking up valuable space.

Another example I have come across is a helpful nurse who makes up all the vaccines before the cat or dog comes in for its vaccination – how many times do people cancel or fail to turn up?

4. Defects

If it isn’t done right the first time, it’s a defect and therefore a waste. Also known as rework because it has to be done again, examples abound. The waste comes in the form of the time to re-do the work and/or the consequences of the defect down the line.

For example, a client is wrongly entered into the appointment system for a day when the specified vet is not there. It’s too late to rebook so the client either has to wait for another vet to become available and get “squeezed in” or to come back another day to see her specified vet. Either way, we’ve actually created another waste, waiting, and probably have not done too well on the customer satisfaction front either.

A patient comes in for a blood sample, the blood is taken and the patient leaves. You realise afterwards you’ve not taken enough blood for the specified test or you’ve placed it in the wrong tube. Or worse, the blood may be sent off and a day or two later you get a message from the lab saying it needs to be taken again for the same reason.

A patient is admitted for a cruciate ligament repair and the nurse manages to clip-up and prep the wrong leg. The vet blames the nurse, the nurse is upset and morale drops.

If the process is looked at, these mistakes could all be avoided as it’s rarely bad people at fault, but bad processes! It’s worth trying to pre-empt where mistakes could be made and actually prevent them from happening in the first place (error-proofing). Even if this is not possible, a system of checks should be able to flag an error before any consequences.

5. Inventory

Inventory and/or work-in-progress anywhere is non-value-added, even if it is eventually needed. It ties up financial resources and is at risk to damage, obsolescence and spoilage. It can also take up floor space and other resources to manage it.

The obvious inventory waste in veterinary practice is excess stock. Most practices are pretty good at keeping stock levels to a practical minimum through just-in-time ordering systems arranged with their suppliers.

But do be careful about promotional offers such as two-for-ones. They seem like a good deal on the surface but make sure you really need that stock level over a given period and that you will get through it, otherwise you’ll be offering a two-for-one deal to your clients just to get it off the shelf!

6. Motion

Any movement of people’s bodies that does not add value to the process is waste. So any walking, twisting, bending, lifting and reaching should be adding value otherwise we should eliminate it.

Ever checked out how many steps you’ve taken at work on your health app? The classic study is to do a spaghetti diagram where you draw the pattern of a person’s steps onto a plan of the building over a specified time. Guess what it ends up looking like? Yes, a bowl of spaghetti.

The point is that we often run around like headless chickens unnecessarily because of poor layout or because someone hasn’t replaced that bottle of antibiotic and we need to go look for it.

Try to look at the flow of steps in a process and design it so that as little motion as possible is required to complete the process. There’ll be many opportunities out there for improvement.

7. Extra (or over-) processing

This is defined as any process or action that does not add value to the product or service and that the customer may not be prepared to pay for. I call this one the “pointless exercise”.

For example, does the x-ray room really need a deep-clean twice a week? I know of one practice that does this and it’s never questioned.

Or why bother recording fridge temperatures if certain readings exceed the defined limits and are never acted upon? It’s a fairly pointless exercise. Similarly, it’s good to know you might be filling in your Dangerous Drugs log but what’s the point if you write down “discrepancy” every time the numbers don’t add up and do nothing about it?

And now we tend to accept a bonus eighth waste: wasted human potential. An organisation’s greatest asset is its people yet this pool of talent is so often overlooked. The Lean practice engages employees, listens to their ideas and supports their careers giving rise to a happy, content workforce that embodies a culture of continuous improvement.

So there you have a whistle-stop tour of Lean’s seven wastes. A full-scale Lean programme addresses waste and much more, including customer value, process flow, Lean tools and techniques, and creating a culture of continuous improvement through engaging staff. Although addressing wastage is vastly more effective as part of a full Lean programme, understanding sources of waste will allow you to take some valuable immediate action and I hope this has encouraged you to get rid of your muda.