lean training - iowa healthcare collaborative · 2018-08-22 · lean training standard work ....

Lean Training

Standard Work

Agenda

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

What is it?

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

What’s it for?

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

How does it work?

n  Standard work is a documented record of how to do a job

n  It must be followed by all those performing that particular task n  All associates n  All shifts

n  Creating standard work involves several steps

Steps to Create Standard Work

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

Evaluate Current Situation

n  To implement standard work, the current process needs to be understood

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

n  This process frequently follows a mapping exercise

Evaluation (cont.)

n  There are several tools to assist in the observation of the current process n  Standard work sheets n  Time observation sheets n  Combination sheets n  Loading diagrams

n  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

23

4

5

6

Testing work cell

Evaluation tools

Time Observation Sheet n  Used to gather data on time duration of

operation elements n  Three key steps

n  Identify work elements n  Determine observation points n  Time

1 2 3 4 5

min 4 s ec min 4 s ec min 4 s ec min 3 s ec min 4 s ec

min 04 sec min 04 sec min 04 sec min 03 sec min 04 sec











min s ec min s ec min s ec min s ec min s ec

min sec min sec min sec min sec min sec







30 sec 29 sec 35 sec 31 sec 30 sec 30 sec

5 sec

4 sec

7 sec

5 sec

5 sec

Time per cycle:

Observation / Data (top - total time, bottom - elapsed time)Step# Component Task

Remove specimen from bag2

3 Enter in computer

4 Verify orders

Low est Repeatable Elapsed Time

Task/Process Being Observed: Receipt of specimens in labOperator: J. Doe

Observation date: 06/27/07Observer: J. Schmo

1 Remove specimen from carrier 4 sec

5 Move specimen to bin

Send tube back to sender6

Evaluation tools

Combination Sheet n  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

n  For duties that are less frequent, evaluations can be done more informally

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

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

Identify areas of opportunity

n  There are many ways to identify areas for opportunity n  7 forms of waste n  Spaghetti diagrams n  Value added vs. non-value added activities

n  These methods highlight steps in the process that can be modified or eliminated

Quantify Improvements

n  Once opportunities are identified, changes to the work processes can be tested, evaluated, and selected

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

n  The new standard work can now be documented and implemented

Implement

n  To implement new standard work, it must first be documented n  Write it down

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

Implement

n  Next, the best communication and training methods should be selected n  Who? n  How? n  When?

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

work is being used should be developed

When do you use it?

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

n  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 Practice JOB BREAKDOWN SHEET

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

Area: ER JOB: Starting IV in Peripheral Vein W ritten 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 It JOB 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 chart 1. Stand up 2. Go to the flip chart 3. Pick up the marker 4. Write your name 5. Put down the marker 6. Return to chair 7. Sit down


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

Report Form For ED

Admissions

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?

lean training - iowa healthcare collaborative · 2018-08-22 · lean training standard work ....

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