A late September edition of Mark Zeidel's weekly tutorial on Lean process improvement. See this pig exercise for a great example of this week's principle.
We have been describing the strategies for improving patient care, called, in Toyota parlance, “countermeasures.” Last week we described visual systems as tools towards standardizing processes and improving reliability. This week and next, we discuss standardized work. If we do not have a stable, standardized way of doing our work, we cannot develop ways to improve it.
Standardized work is a form of “playbook” for workers, defining the methods to be used, and the outcomes that we expect each person to reach, each day. Standardized work spells out the number of workers needed and what each needs to do, and in what order, to make sure that defined customer expectations are met.
The workers must understand the need for standardization. They must be trained and practiced in the expected methods to do the work and they must have the ability to improve and adjust the processes as they gain experience with them. Unfortunately, in much of what we do, any two people trained to do the same task likely perform it in completely idiosyncratic manners. Interestingly, we have policies and procedures manuals that fill shelves of storage, but these do not specify how the work is done.
Standardized work is the best way we know today to do the job to ensure that desired outcomes are met. In part because we have standardized the work, we are able to experiment with changes in the process, and then to modify the process of work to make it more effective. Without standardization it is impossible to improve.
There are many benefits to standardized work:
1. Improved process stability: Stability means repeatability and the ability to meet quality, cost, lead time, safety and environmental targets every time.
2. Clear start and stop points for each process: These plus an understanding of the customer’s rate of demand allow us to see if things are on track, ahead or behind, and to divide work among people in a sensible manner.
3. Organizational Learning: Standardized work permits us to preserve know-how and helps avoid problems that occur if work methods are not documented and key employees leave.
4. Audit and problem solving: Standardized work makes it easier to define the current condition and identify problems.
5. Employee involvement and error-proofing: If we have a stable process, then those doing it can improve it and can build in visual systems and other devices to avoid errors.
6. Kaizen: Standardized work provides the baseline against which to measure improvement.
7. Training: Standardized work makes it possible to train new people effectively.
Next week we will discuss the elements of standardized work, and approaches towards standardizing where possible the clinical care of patients.
What a great idea in the healthcare setting! From my experience at my local hospital, every nurse has their own way of doing things with varying results.
ReplyDeleteTo what extend has the work of nurses been standardized? Can you provide some examples?
"Unfortunately, in much of what we do, any two people trained to do the same task likely perform it in completely idiosyncratic manners. Interestingly, we have policies and procedures manuals that fill shelves of storage, but these do not specify how the work is done."
ReplyDeleteMaybe you should get rid of the Policy and Procedure Manuals. The company that I retired from had hundreds of sets of manuals scattered around the plant and it was impossible to keep them all current. The solution was to put all manuals on line. If someone printed a copy it was dated and watermarked to indicate that it was only a copy of the official procedure that was on line.
I suspect that a procedure could be found with a search more quickly than from a shelf.
Procedures could be supplied with links to training material and contact information for appropriate resource persons. A training and qualification record could be kept on line, with some on-line refresher and testing.
The system could be linked to medical records and anyone using or reporting on use of a procedure could be checked to see if their training is current.
As they say at the end of a list of patent claims, "Other uses this invention will be apparent to those skilled in the art".
I expect that it is standardization of clinical care which will be the most significant challenge, and yet the most significant imperative, facing the entire organization - and actually, the entire health care system.
ReplyDeletenonlocal
Anon 10:50,
ReplyDeleteCheck this blog below for examples of Lean process improvements in a number of clinical settings. Just search "Lean" and you will see a whole bunch.
Nonlocal,
Exactly. We all know that 90% of stuff could be standardized, and that doing so is the only way of eliminating harm to patients. Getting there, though, is a slog and takes a huge commitment.
Engineer,
Correct. We are currently reviewing lots of policies and procedures and finding them too dense, off target, and the like. Obviously, this was not intentional, but it is the product of overly bureaucratic approaches to work and learning -- also, sometimes it is the approach that regulators expect you to adopt. As you suggest, it happens virtually everywhere, and it takes time and effort to unlearn such things.
Hi Mr. Levy, I'm a medical student from outside of Boston and am interested in learning more about how to apply Lean Manufacturing to health care systems.
ReplyDeleteIs there a way for interested medical personnel from other institutions to take these classes at BIDMC? Who might we contact to set this up? I assumed from Dr. Zeidel's description in the inaugural edition that these courses have been adapted to the health care settings. I'm guessing there are classes elsewhere on just Lean Manufacturing, but if BIDMC has already thought about how to apply it to the hospital setting, it would be great to learn from you and not re-invent the wheel.
On another note, I'm sure your blog fans will be delighted if these classes are taped and posted online for us to watch.
Anon 8:12,
ReplyDeleteI'm sorry, but our classes are quite full. You might contact the Greater Boston Manufacturing partnership for other ideas.