Earlier this month, Shingo Prize-winning author and Master of Business Operational Excellence instructor Beau Keyte wrote a fascinating article on the Huffington Post titled “The Silent Killer of Health Care Transformation: Being Overburdened by Too Many Choices.” This addresses a key concept in lean called “muri,” or overburdening.

Keyte defines overburden a phenomenon where equipment or people are pushed to run at a harder pace and with more effort than is appropriate.  Using the analogy of going to a Brazilian steakhouse faced with multiple choices, with an eager waiter waiting for a signal from you to bring more varieties of meat, Keyte makes the point of how health-care organizations are laden with a vast range of priorities. As a customer at the steakhouse you can choose what you want to have on your plate but leaders in health-care organizations do not have the choice. Multiple stakeholders, internal and external bombard the leadership with ideas that are important to them with a very restricted timeline. The executives take on the burden of execution of these great ideas to the employees in the organization that are already overburdened with a previous task list.

Similar to the customer in the steakhouse who leaves half-eaten good food on the plate to try the new kind of meat, the employees leave projects halfway to bite on the new initiatives. Due to lack of time and resources, the new initiatives do not get the kind of attention they need and this nips the possibility of transformation in the bud. How do you address this problem? Keyte emphasizes that it is the leaders in the organization who can LEAD the organization on a path that reduces the burden – but how?

The first thing is to focus on the real stakeholder, the patient. Think about how the initiatives suggested by the other stakeholders impact the patient. Would the initiative result in the right outcome for the right patient at the right time? Do the initiatives align with the strategic goals? Do you have the human resources to work on these initiatives? Do you need to do all the initiatives? What are the few things that you NEED to get done to meet the three to five most critical goals this year? Could you drop or delay some? By answering these questions, leaders can dedicate the available resources to only the critical projects. This way, employees can spend their time wisely while providing patient-centered care.

The second thing the leaders can do is to think long term instead of saying yes to all the projects and trying to instantly gratify the stakeholders.  However, it is important to think forward and pick three to five strategic initiatives to work on in future and plan on carving out capacity to take these on.

Keyte puts it well in the last paragraph: “Like all silent killers, overburden sneaks up on you and your organization. Learn to sense it, see it, analyze it, and deal with it to help your organization not only survive, but thrive.”



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