• Home
  • quality control - MD of Chiriqui

Muri, Muda, Mura

In his 1993 book, "Japanese Manufacturing Techniques," Richard J. Schonberger addresses within "just-in-time" production the concepts of muri (excess), muda (waste) and mura (irregularity) as one of the principles for a quality control oriented to the worker and not to some clerk in a refrigerated office.

You will see that many of the entries in this blog have to do with logistics issues precisely because when wanting to standardize the final product and delivery times, we have had to do a lot of research on manufacturing.

We all make sense of the "cheap batch" concept, that is, accumulating enough cases to make it a processing session because it saves the work of doing it in small quantities all the time. This strategy is certainly economical and practical, but having to accumulate the cases delays its exit.

Avoiding "muri" (excess) requires reducing the size of the batches, firstly because it reduces the time to exit the case and secondly because when dealing with smaller batches, one could pay more attention to detail and therefore improve quality.

Avoiding "muda" (waste) requires correcting errors on the spot, without resigning yourself to a percentage of cases being defective. This is where the role of the worker in the implementation of quality control policies is recognized.

Avoiding "mura" (irregularities) requires avoiding protective inventories, purchases of inputs in large quantities whose original intention is to ensure that the final product will not have variations. Protection inventories often sit idle taking up space and subtracting money from your practice operations. Smaller inventories expose variations whose causes may be hidden in larger inventories.

How does this apply to health care?

Let's say you see patients, but you live far away and it is more profitable to travel once a week to see them all on the same day. Some patients will be seen on time, others will get tired of waiting for the date and will not show up for their appointment, and still others will be seen late on the day of care when you are tired. Here we incur "died" because a bottleneck is created.

Let's say that you acquire a diagnostic test for an important disease, but when you apply it, you realize that there are patients with the entire clinical picture for whom the test is protocol to complete the medical record, but there is a percentage of tests in these patients that result in false negatives . If you resign yourself to this percentage without looking for other alternatives, you will be incurring a "mute" because you will have wasted resources in the diagnosis that could be used in the treatment by having to use another confirmatory test by default of the first test.

Let's say you have a clinic and someone offers you a box of a million syringes at a great price. You buy it, having to invest your money in that inventory and find a suitable space for it so that they do not get damaged. Here you incur "mura" because you run the risk that the product expires or that it comes with a manufacturing defect that you could not perceive as it is the same lot.

Our strategy

  1. Avoid large batches. It would be better to see few patients per day, every day, all patients together on the same day.
  2. Acquire products of better quality in relation to cost. Cheap inputs may ultimately be expensive on demand or have to use several instead of one to perform a certain function.
  3. No idle inventory. You're better off paying a little more for a unit of something that you won't have to dedicate a lot of space to and won't risk breaking until you're done with it.

Vertical integration for quality control

When we started this laboratory, like anyone in our province or in the country who decides to start a health care enterprise, we adapted to the market by finding a variety of products of very different qualities, very inconsistent and adapted for other conditions. Clear examples were formalin for biopsy tissues and fixative solutions for cell preparations (so-called "pap smears").

This, in turn, made it difficult for us to produce preparations of a consistent or uniform quality. At that time, my concept of "quality control" was very vague and my biggest criticism is that it was a standardization of processes, rather than a clear way to raise the quality itself. I did not understand then, and it was only after an article on statistical quality control in cervical and vaginal cytology, that quality measurement is one thing and corporate strategies to arrive at a uniform, desirable product is another.

In vertical integration, the mother company creates several daughter companies that it controls and which in turn provide it with all the raw material to allow it to produce a product or service, creating a kind of monopoly, because the daughters only work for the mother and these companies do not provide materials to other competitors of their mother. This would be possible, I don't know if ethical or practical, if we were a large chain of laboratories, but we use the concept aimed at maintaining a standardization of processes and obtaining a product that is, within a standard deviation, uniform.

The type of vertical integration was "backwards", as I explained in the example above. There are no other companies except this one, but we started to produce our own formalin and cellular fixative based on the experiences in the field that we acquired throughout the years of operation. The doctors and clinics that use our services were pleased, because we took away the expense of having to purchase them and that expense was borne by us. This allowed us to use the containers that we consider appropriate, the amount of formalin that we consider necessary for the average of the samples, as well as the type of formalin that allows the best fixation and then the performance of special tests on the processed tissues.

In the same way, when we began to see the cytologies, we began to notice that many cases could not really be examined satisfactorily because a variety of water-based fixatives were used that did not really fulfill their function and we assumed at the time that it was due to dilution of the product in the hands of its users, not because the product was defective. We did some research and after a phase of experimentation and development, we were able to formulate an alcohol-based preparation that allowed us to produce uniform preparations for our environmental conditions and personal preferences.

This control over the variables that affected the final product, increasing the standardization of the preparations. This capacity presented a competitive, cost-effective advantage.

Teléfono de Contacto

+507 774-0128 EXT. 3089