In a previous manufacturing life, I worked with Toyota and there was a huge emphasis on identifying and eliminating waste. One of the things Toyota stressed and often discussed in training and application was, “Which is the worst form of waste?”
In various Lean health care training courses, when discussing waste – or muda – I often facilitate discussions on which is the worst form of waste. (Toyota used seven forms in those days and there are different thoughts on an eighth or ninth form, but let’s focus for this exercise on these eight: defects, overproduction, waiting, not clear (confusion), transporting, inventory, motion and excess processing. The answers vary: defects is the typical first response, followed usually by waiting, then confusion and so forth. But seldom do the classes guess Toyota’s answer: overproduction.
Overproduction for Toyota meant producing more than the customer/patient needs right now.
What is it about overproduction that Toyota felt strongly enough to stress this point? They believe that overproduction is the cause all of the other forms of waste.
If we produce more than we need of something, what usually happens? Well, for one thing we have to move, process and store the excess (transportation, excess processing, inventory). This extra handling (motion) often results in damage and rework (defects). These extra efforts cause other processes to be delayed (waiting) and the whole exercise generally causes unclear connections and pathways (confusion).
So why do we do it? Because it feels so good! We do it to get ahead in the process. At Toyota,when the line ran really well and we built the quota of vehicles before the eight hour shift was up, the standard was to go home early. At another automaker I worked for if we could build beyond the schedule, “Great – go for it! Build as many as we can! Overproduce!”
So why the difference?
Before I answer, let’s look at health care. Overproduction in health care occurs every day on every unit in one form or another. Things like prepping for procedures not yet scheduled, meds prepped early, case carts batched at the start of the day, multiple forms asking the same information — these are just a few examples. So again, why do we do it? What do I mean by “because it feels good?”
We all love that security blanket. The little extra just in case I need it. The fallback stock. The 
In manufacturing I had a monthly quota to meet. So if I can get ahead “just in case” then I would do it every chance I got. In health care, we clutch that blanket and overproduce and hoard all we can.
But, root cause analysis says we need to ask “Why?” again, in order to drill down further. In this case the root cause is why we just can’t stop, even though we know it can result in waste.
The root cause of overproduction is the fact that we don’t trust (or perhaps don’t even have) systems and processes reliable enough to give us confidence we can produce on demand and meet the needs of our patients without something extra in the bank.
In order to address this root cause of waste, we truly need a Lean health care environment which surfaces problems and fixes them through a problem-solving methodology. A system that utilizes tools like standard work, visual management, leadership standard work and continuous improvement to give us processes that we can trust because we have tested and certified them to be reliable. And if they should fail we have the appropriate support mechanisms in place to identify this early and countermeasures defined to bring the process back online in a timely manner without risking patient care.
Easier said than done. That again is why we struggle to do it. It is truly a cultural change. Rock icons The Who said, “Here’s the new boss, same as the old boss.” That mindset won’t get us where we need to be to reduce waste. We have to change our thinking. It is the transformation of a traditional management system to a Lean management system.
There are some wonderful Lean health care examples of organizations that have made this change to a Lean management system and there are many more in various stages of change. Elimination of the waste of overproduction is a good gauge for how well our systems are managed by Lean fundamentals and thinking and therefore gives us the ability to let go of our security blankets.
