Lean Training

Standard Work

Agenda

What is it? What’s it for? How does it work? When do you use it? What’s an example?

What is it?

Standard work represents the best, safest, and easiest way to do a job

What’s it for?

Standard work allows an organization to: Create consistency and predictability Preserve know-how and expertise Prevent recurrence of errors Improve staff satisfaction and

productivity Improve patient and physician

satisfaction

How does it work? Standard work is a documented

record of how to do a job It must be followed by all those

performing that particular task All associates All shifts

Creating standard work involves several steps

Steps to Create Standard Work

Evaluate the current situation Identify areas of opportunity Modify the existing process Quantify improvements Implement new standard work

Evaluate Current Situation To implement standard work, the

current process needs to be understood

Direct observation is the best way to know the current process Don’t rely on procedures Don’t rely on memory or brainstorming

This process frequently follows a mapping exercise

Evaluation (cont.) There are several tools to assist in

the observation of the current process Standard work sheets Time observation sheets Combination sheets Loading diagrams

Many are best used for routine, repetitive tasks

Evaluation tools

Standard Work Sheet

Visually shows layout and work sequence

SUMMARY:

Quality Standard Safety / Risk Total Manual Cycle Time: Standard WIP:

(1 sheet per cell) Check WIP Caution

Date: 06/27/07 Cell / Process: Receipt of specimens in lab Standard Work Sheet

30 s 3 pcs

tube station

Bin

1

Receiving

2

3

4

5

6

Testing work cell

Evaluation tools

Time Observation Sheet Used to gather data on time

duration of operation elements Three key steps

Identify work elements Determine observation points Time

Evaluation tools

Combination Sheet Helps make obvious the relationship

between workers and machines - - the timing of operations performed in one cycle by one team member

UNATT'D WALK

# value-add non-v-add RUN TIME TIME

1 2

2 3 25

3 3 11

4 3 11

5 5

6 2

manual auto-run w alk w ait

(1 sheet per person) TOTALS: 18 s 12 s

Combination Sheet

DESCRIPTION

Remove specimen from carrier

MANUAL TASK TIMETakt Time = 27000 / 900 = 30 sec

Date: 06/27/07 Cell / Process: Receipt of specimens in lab

Remove specimen from bag

Enter in computer

Verify orders

Move specimen to bin

TIME (draw red vertical line at takt time)

Send tube back to sender

2

2

2

2

2

2

5 10 15 20 25 30

Evaluation tools

Loading Diagram

Visual display of cycle time observations

Manual Cycle Times (MCTs)

step5 ste6step1 step2 step3 step4

Minimum Staffing: (total MCT)= ------------------------- (takt time)

= 30 / 30

= 1

Total MCT:

30

Tim

e

Takt Time: (available time)= ----------------------------- (customer demand)

= 27000 / 900

= 30 sec/pc

4 5 5 5 7 4

TT=30 s

4

7

45 5 5

Evaluations For duties that are less frequent,

evaluations can be done more informally

You can create your own tool for evaluating the current process as needed

Time, motion, frequency, and interruptions are the most commonly-used evaluation criteria

Identify areas of opportunity There are many ways to identify

areas for opportunity 7 forms of waste Spaghetti diagrams Value added vs. non-value added

activities These methods highlight steps in

the process that can be modified or eliminated

Quantify Improvements Once opportunities are identified,

changes to the work processes can be tested, evaluated, and selected

Improvements should be measured in a live environment to ensure that they work and that they are an improvement

The new standard work can now be documented and implemented

Implement To implement new standard work, it

must first be documented Write it down

Next, the best way to hand out or display the new process should be determined Checklist? Photos? Posted in work area? Index cards?

Implement Next, the best communication and

training methods should be selected Who? How? When?

Measurements should be in place A method for ensuring that the new

standard work is being used should be developed

When do you use it?

Standard work should be used for any task that is part of a process In other words, all the time

When people depend on each other, standard work can make any work process easier, more predictable, and less prone to error

From Dr. Richard Kunkle in Toyota Talent, Jeffrey Liker and David Meier, McGraw-Hill, 2007, pg. 187.

Standard Work in PracticeJOB BREAKDOWN SHEET

Date: 7/20/20__ Team Leader: M. Warren Supervisor: P. Kenrick

Area: ER JOB: Starting IV in Peripheral Vein Written By: R. F. KunkleKey Points:Safety: Injury avoidance, ergonomics, danger pointsQuality: Defect avoidance, check points, standardsTechnique: Efficient movement, special methodCost: Proper use of materials

Reasons for Key Points

Step #1 1. Stretch skin tight over vein 1. Keeps vein from rolling2. Use thumb and index finger of nondominant hand 2. Keeps dominant hand free to guide catheter

Step #2 1. Needle bevel up 1. Easier and more accurate to enter skin2. Needle slightly angled up from skin (5 degrees) 2. Correct angle for entering skin

Step #3 1. Indent skin 1-2 mm 1. Pushes vein up in front of needle2. Maintain angle of needle 2. Greater angle may push through vein

Step #4 1. Push needle forward parallel to needle angle 1. Overcomes skin resistance and perforates skin2. Continue forward motion until slight "pop" is felt 2. Indicates you are through vein wall along with decrease in resistance3. Push slowly 3. To prevent inserting through vein

Step #5 1. Lift tip (lower back of needle) 1. Moved needle bevel to top of vein preventing puncture of opposite side of vein

2. Needle parallel to skin 2. Aligns needle with bore of vein makingadvancement of needle easier

Step #6 1. Insert completely up to the "band" 1. Band indicates proper depth for each type of catheter. Insufficient depth may dislodge

Change needle angle

Advance the catheter

Depress skin with needle

Puncture skin with needle

Major Steps

Stabilize vein

Place tip of needle against skin

Let’s Try ItJOB BREAKDOWN SHEET

Date: Team Leader: Supervisor:

Area: JOB: Written By: Key Points:Safety: Injury avoidance, ergonomics, danger pointsQuality: Defect avoidance, check points, standardsTechnique: Efficient movement, special methodCost: Proper use of materials

Reasons for Key Points

Step #1

Step #2

Step #3

Step #4

Step #5

Step #6

From Dr. Richard Kunkle in Toyota Talent , Jeffrey Liker and David Meier, McGraw-Hill, 2007, pg. 187.

Major Steps

What’s an example?

How to write your name on a flip chart1. Stand up2. Go to the flip chart3. Pick up the marker4. Write your name5. Put down the marker6. Return to chair7. Sit down

What’s an example?

STANDARD WORK SHEET  

PROCESS: Secretary workflow prior to start of new facilitators To be accomplished as soon as possible but no less than 1 week prior to arrival of new facilitator

 

 Trigger Receive an email with notification of new facilitator

from Lead Facilitator

 Work with lead facilitator to assign workspace/cube

 Contact New Facilitator to complete an equipment/supply/access needs assessment

 Assess PC needs and log a help desk call if necessary

 Obtain home phone and extension number for secretaries and modify the facilitator phone listing

 Setup a meeting with new facilitator on the first day from 8-10am with the department secretary

Etc.

What’s an example?

Admission packet instructions

What’s an example?

Report Form

For EDAdmissions

REPORT FORM Date__________ RN calling report__________________#_________ Nurse receiving report________________________ Pt. Name________________________Age_______ Admit Diagnosis____________________________ Core Measure? (circle) Pneumonia CHF MI Sepsis Admitting Dr_______________________________ ED Physician_______________________________ Pt’s Living Situation_________________________ Isolation (circle): N/A Rule Out History Swabbed in ED for: MRSA_____VRE_____ Events Surrounding Hospitalization:__________ __________________________________________ __________________________________________ __________________________________________ Past Medical History:_______________________ __________________________________________ __________________________________________ Head-To-Toe Assessment: HEENT- Card/Pulm- Abdomen- Extremeties- Skin- Neuro- IV------Started in: ED or infield (circle one) Gauge_________Site_________ Fluids_____________________

Meds given in ED____________________@________ ___________________@________ ___________________@________ ___________________@________ ___________________@________ Drips running_________________________________ ________________________________ Abnormal Test Results__________________________ _____________________________________________ Abnormal Vitals (include time)___________________ _____________________________________________ Current Vitals: Time________Temp__________ P_________R________BP________SpO2_______ O2________Pain Scale (0-10)_________________ Location of Pain____________________________ Telemetry: Y or N -- Rhythm___________ Blood Sugar____________Last Ate At_________ Normal Activity Level________________________ Ordered Activity Level_______________________ CODE Status_______________________________ STAT/Now Orders Completed_________________ ___________________________________________ Additional Information:

Questions?