March, 2010 1 Standardized Work. Transform Your Care 2 Solutions That Perform Page 2 | Copyright ©2008, RWD Technologies, LLC. All rights reserved. Implementation

March, 2010

1

Standardized Work

Transform Your Care

2

Solutions That PerformPage 2 | Copyright ©2008, RWD Technologies, LLC. All rights reserved.

Implementation Goal

Anyone responsible for implementing and using Standardized Work will gain an appreciation for Standardized Work by learning: WHAT it is HOW it fits into the lean system WHY it can help in your daily job performance

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Objectives

Define Standardized WorkState the reasons and benefits for implementing

Standardized Work Compare and contrast current work performance to

Standardized Work performanceIdentify barriers to implementing Standardized

Work and develop ways to remove themUnderstand and learn how to develop

Standardized Work

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1. Standardized Work Defined

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Work conditions, methods, and procedures that allow consistently repeatable results.

Work-group generated Guided by documentation Starting point for Problem

Solving Foundation for continuous

improvement

What is it ?

Highest Quality Care in Healthcare Service

Continuous improvement

Justin

time

Builtin

Quality

Problem solving

Standardization

Human Centered work

5sWorkplace

Organization

Visual Management


Continuous improvement

Justin

time

Builtin

Quality

Problem solving

Standardization

Human Centered work

5sWorkplace

Organization

Visual Management



Continuous improvementContinuous improvement

Justin

time

Justin

time

Builtin

Quality

Builtin

Quality

Problem solvingProblem solving

StandardizationStandardization

Human Centered workHuman Centered work

5sWorkplace

Organization

Visual Management

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History of Standardized Work

Based on proven U.S. military methods

Incorporated by T. Ohno during the 1950’s at Toyota

Part of Standardization, which is the foundation of Toyota Production System

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Old Paradigm

“I don’t care how you get the job done, just do it.”

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New Paradigm

“Everyone does the job the same way each time.”

The Process not the Person

Consistent working sequence, cycle time and standard in-process stock regardless of which team member is performing the job.

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Traditional vs. Standardized Work

Traditional Work• Reacts to fires• Searches for things• Processes designed

without input from staff• Work is equipment-

centered• Uses a variety of individual

methods• Produces inconsistent

results

Standardized Work• Prevents problems• Finds things easily• Processes designed by

staff & supervisors• Work is human-centered• Follows and improves

the standard process• Produces consistent

results

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Standardized Work Allows for…

Worksite Management: Abnormal situations can be easily identified Problem solving can occur based on the discrepancy

from the Standard Efficient training that produces operators who perform to

the Standard

Continuous Improvement: Identification of waste in the process Team members can suggest improvements

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Standardized Work Ensures…

Built-in Quality at every process in the system.

Just-in-Time processing

The next process is provided with the right product and/or service, at the right time, in the right quantity

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Standardized Work Summary

Four Main Advantages 1. Prevents Over Processing (Waste)2. Ensures Quality Requirements3. Lowers/Stabilizes Cost4. Establishes Normal vs. Abnormal Criteria

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2. Standardized Work Pre-requisites

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Pre-Requisites

Repeatable Human Motion

Reliable Equipment

Quality Incoming Materials and/or Supplies

Accurate Information – On Time

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3. Standardized Work Components

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Three Components of Standardized Work

Takt Time

Work sequence

Standard In-process stock

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Takt Time

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Takt Time…

Sets the pace Is….

1. The time allowed to complete one procedure 2. Based on available time and demand3. Computed and adjusted as demand changes

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Takt Time Formula

TT =Available Time

Demand

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Daily Available Time

Total daily operating time: The total time to treat the demand MINUS the scheduled

downtimeEXAMPLE:

ED department runs 24 hours per day Total available time in a day – 1440 minutes No scheduled downtime

Daily Available Time = 1440 minutes

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Daily Demand Rate

The total processing requirementEXAMPLE:

ED department is treating patients at the rate of 3,000 per month. Based on 30 days per month, 100 patients must be treated per day.

Daily Processing Requirement =

Patient Takt Time =

3,000 pts./month

30 days/month= 100 pts./day

1440 mins/day

100 pts./day= 14.4 mins/pt.

Takt Time = 14.4

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Work Sequence

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Work Sequence Is…

The repetitive performance of work elements that produce quality in an efficient manner:

Work sequence can be work performed at multiple processes or multiple elements at a single process.

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Example

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4. Standardized Work Forms

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Standardized Work Forms

Time Study Sheet

Standardized Work Chart or Spaghetti Diagram

Standardized Work Combination Table

Standardized Work Sheet

Job Instruction Training Sheet

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Time Study

Start and stop point identified for accurate and consistent timing

Time for each individual element captured Time given to operator is based on the

average time of 10 separate studies per element

Worker effort rated if standard data not used

Person with knowledge of area review current state assessment to check for accuracy

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Time Study Sheet

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Spaghetti Diagram and Standardized Work Chart

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Spaghetti Diagram orSTW. Chart…

Diagrams operator work sequenceDocuments:

Walking patterns Sequence of job elements

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Lab Process Current State Spaghetti Diagram

Average time for lab process was 13 minutes with excessive walking

Spaghetti Diagram for Lab Process

PAT ENTRANCE 3 PATIENTS

4PAT

PAT lab walk timeOne patient 210 feet process

PAT 20 per day =4200 feet per day WILMA0.5 second per foot = 35 minutes walk time

PAT

3PAT 1PAT

LAB AREAPAT

Dispatch box

lab tubecubicles

7lab 2cubicleslab cupboard 6 workbenchcubicleslabcubicles 8lab 5cubicles

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Combines human and machine movements, based on Takt Time.

Visually displays times for: Operator:

Working Walking Waiting

Automatic machine times Cycle Time compared to Takt Time

Creates a timed picture of human work and process flow. Helps identify waste within the cycle.

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Example

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Example

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5. Additional Uses for Standardized Work

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Standardized Work Uses

Safety Reduces ergonomic burden Highlights potential hazards

Training Training New Team Members Cross-Training for Flexibility

Problem Solving Pin Pointing Discrepancies

Continuous Improvement Work Balancing Kaizen Activities

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Job Instruction and Training

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Purpose of Job Instruction

Transfer the needed knowledge and skills to the team member so that Standardized work is performed resulting in the work being completed: Safely Correctly Consistently

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Job Instruction Training Sheet

Major Steps WHAT to do

Discreet value-

added actions

Simple, Correct,

Consistent

Key Points HOW to do it

Specific motion or information needed to perform the major step correctly

Safety is always a key point

►Reasons– WHY to do it

– Effects on: Safety Ergonomics Gov’t. Reg’s Quality Productivity Cost Other

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JIT Sheet

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Job Instruction Methods 4 Step Approach

Prepare

Present

Tryout

Follow-up

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Problem Solving

Yamazumi Chart

Seven Wastes

Motion Kaizen

Continuous Improvement

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Yamazumi (Work Balance) Chart

An effective tool for identifying: Waste Overburden Unevenness

A graphical tool used to compare each staff member’s workload to Takt Time

Compares all of the staff members’ workloads in one chart

Used to calculate the quantity of staff members needed for a work area

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Walk back to seat

(15 feet)

Place sheet to bin

Walk sheet Back to

Lab (15 feet)

Stamp Top sheet

Receive Top sheet

Receive Top sheet

Place sheet to bin

Place sheet to bin

Receptionist Process

Current State Waste Reduced Future State

Stamp Top sheet

Receive Top sheet

Stamp Top sheet

Walk back to seat

Walk sheet back to Lab

WASTE

WASTE

Current stateCycle Time

Future stateCycle Time

Time(secs)

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Seven Wastes

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What is Lean?

“A process of continuously identifying, reducing and eliminating waste (non-value added activity)”

“Waste is defined as anything other than the minimum amount of equipment, materials, parts, space and worker's time which are absolutely essential to add value to the product”

Shoichiro Toyoda

President, Toyota

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Lean is…

A system of thinking, not just a set of tools

A learning system which encourages staff to perform better in technical operations, which, in turn, increases process performance.

The relentless pursuit of waste!!

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7 Wastes + 1

Correction/Rework Dirty instruments in Assembly, damaged instruments, bent instruments, aborted sterrad cycle

Movement Searching for paperwork, walking long distance to printer or scanner, getting wrap, obtaining containers

Waiting Waiting for scopes and light cords, waiting on sterile carts, waiting on cases to start

Inventory Extra sets and instruments, excessive amounts of filters or supplies, extra containers

Overproduction Cleaning and Assembly of several sets not needed for OR, Pulling OR cases by supplies days ahead of time

Transportation Searching for sterile, stat, or distribution carts; extra trips for decon rounds, distribution of sets

Over-Processing Second signature of assembled sets, two or more indicators in a set, extra instruments in sets

People Not using people’s abilities to their fullest potential, improper training and education of staff

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Causes of Waste

Organizational issues

Lack of workplace organization

Lack of training

Inconsistent performance measures

Poor production planning and scheduling

Operational issues

Long setup time

Lack of Preventive Maintenance

Layout (distance)

Work methods

Incapable processes

Supplier quality

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Why Reduce Waste?

• Makes Work

–Safer

–Faster

–Cheaper

–Easier

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How Do We Reduce Waste ?

Eliminate:

– Workstations, Complexity

Combine:

– Workstations, Processes

Reduce:

– Content, Complexity

Simplify:

– Process

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Motion Kaizen

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Kai = Change Zen = for the Better

“A change for the better” or “continuous improvement”

Definition of Kaizen

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Kaizen Events…

Targeted ImprovementDocument Standardized WorkStudy through observation to improveDocument and train new Standardized Work to

maintain the improvement

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Instructions for Work Kaizen

Objectives In order to Kaizen, we look at the worker’s

motions. The goal is not to make the individual tasks faster, but to develop smooth and repetitive motions with little waste.

Priority of Work Kaizen vs. Equipment Kaizen: Work Kaizen can be done in little time Work Kaizen can be done with little investment If Kaizens are unsuccessful, other Kaizens can

be easily tried

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Kaizen Example: - Current State Lab Process

Average time for lab process was 13 minutes with excessive walking


PAT ENTRANCE 3 PATIENTS

4PAT

PAT lab walk timeOne patient 210 feet process

PAT 20 per day =4200 feet per day PCA0.5 second per foot = 35 minutes walk time

PAT

3PAT 1PAT

LAB AREAPAT

Dispatch box

lab tubecubicles 7lab 2cubicleslab cupboard 6 workbenchcubicleslabcubicles 8lab 5cubicles

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Lab Process Future State Spaghetti Diagram

Implemented efficient and standardized process focusing on waste reduction ( 54% Reduction in lab process time )


LAB Triage 1 PAT ENTRANCE 3 PATIENTS

PAT

PAT Lab walk timeOne patient 15 feet process

PAT PCA

PAT

PAT

PATLAB AREA

PAT

Dispatch box

lab tubecubicles 2lab 1cubicles 2lab cupboard workbenchcubicles

labcubicles

labcubicles

3 EXITDOOR