Standardized Work as the Foundation for Improvement

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Information about Standardized Work as the Foundation for Improvement
Health & Medicine

Published on March 7, 2014

Author: bcpsqc

Source: slideshare.net

Description

This presentation was delivered in session G6 of Quality Forum 2014 by:

Ronnalea Hamman
Lean Leader, imPROVE Promotion Office
Provincial Health Services Authority

Shawn Smith
Quality Improvement Advisor
Northern Health

Ronnalea Hamman, Leader, imPROVE, PHSA Shawn Smith, Quality Improvement Advisor, NHA Presented on behalf of the Education Working Group of the BC Provincial Lean Network

 “We will turn into robots!” This allows for no creativity.  “But every patient is different and we couldn’t possibly standardize the work we do with them.”  “Standardization doesn’t address the clinical expertise that I bring to my work.”

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5

Sources of Variation 6

Which management problem would you rather have? Performance Target *Taken from ‘Continuous Performance Improvement – The Basics (JWA Consulting) 7

CONTENT SEQUENCE OUTCOME • Standard Process can potentially incur better OUTCOMES by establishing • • • What steps (CONTENT) The order (SEQUENCE) A result (OUTCOME) 8

CONTENT • The necessary steps required to provide a service or to do a task. Hiring Package Compilation • • • • • • • • Compile package HR Associate Final Check Place pkg. in envelope and send Retrieve hire list Sort hire list & print Produce hire letters from templates Perform cursory check Print letters & labels Prep of Patient Lab Samples for transport to Lab • • • • • Place requisition in outside pocket of biohazard bag Place biohazard bag in appropriate bin at unit clerk desk & inform UC there is a sample Gather the supplies Prepare sample for transport Record the required info on requisition 9

• The order that the steps need to be carried out in order to provide the service. Hiring Package Compilation SEQUENCE 1) Retrieve hire list 2) Sort hire list & print 3) Produce hire letters from templates 4) Perform cursory check 5) Print hire letters and labels 6) Compile hiring package 7) HR associate final check 8) Place package in envelope and send Prep of Patient Lab Samples for transport to Lab 1) Gather the supplies 2) Prepare sample for transport 3) Record the required info on requisition. 4) Place requisition on pocket outside of bag 5) Place biohazard bag in appropriate bin at unit clerk desk and inform UC there is a sample. 10

• This process is designed to achieve an objective which ultimately may lead to bigger outcomes. Hiring Package Compilation Prep of Patient Lab Samples for transport to Lab Objective: Objective: Complete and accurate hiring package in a timely fashion Correct sample, with correct label arriving to lab intact in a timely fashion Outcomes: Outcomes: • OUTCOME • • Good first impressions Happy New Hire (SATISFACTION) Better reputation for PHSA • • • Correct results to the correct patient Increased patient SAFETY Decreased delays 11

May Impact: Standard Process QUALITY: Standard Process for Patient preparation for C-section. SAFETY: Standard Process for Group and Screen Blood Specimen labeling by unit staff DELIVERY: Standard Process for timely submission of procedure dates to OR Booking COST: Standard process for stocking bedside carts in unit SATISFACTION: Standard Process for office submission of leave requests. 12

About process data • • • No data have meaning apart from context Data is critical to understanding the “voice of the process” Improvement should bring the voices of the process and the patient into alignment Reference: Wheeler, Donald J., (2000). Understanding Variation: the key to managing chaos.

400 12/10/2012 12/11/2012 12/12/2012 12/13/2012 12/14/2012 12/15/2012 12/16/2012 12/17/2012 12/18/2012 12/19/2012 12/20/2012 12/21/2012 12/22/2012 12/23/2012 12/24/2012 12/25/2012 12/26/2012 12/27/2012 12/28/2012 12/29/2012 12/30/2012 12/31/2012 1/1/2013 1/2/2013 1/3/2013 1/4/2013 1/5/2013 1/6/2013 1/7/2013 1/8/2013 1/9/2013 1/10/2013 1/11/2013 1/12/2013 1/13/2013 1/14/2013 1/15/2013 1/16/2013 1/17/2013 1/18/2013 1/19/2013 1/20/2013 Contextual Process Data: 600 500 9 OOC Conditions 300 200 100 0

Contextual Process Data: Zero OOC Conditions

Quality Level Inflection Point: Key Moment for Standardizing work Likely Trajectory: Without Standardizing work Time 16

Episode Count 163 -before Range 400 sec. On the similar scale as above. -after Average 20 sec. Episode Count 435 Range 50 sec. 17

Standardized work without improvement •Employee motivation is killed, human creativity wasted •Problems repeat, unidentified, unsolved, unabated •Employees don’t take initiative, improvement stops Improvements without standardized work •Chaotic change, the saw-tooth effect of progress and regress •Problems repeat, PDCA not followed, no root cause analysis •Progress impossible to identify, Improvement stops Kaizen – as an expression of the scientific method - requires a baseline of comparison. John Shook; Five Missing Pieces in Your Standardized Work; www.lean.org 19

Observe Kaizen Trial (PDSA) Document Make Visual 1. Observe current state and identify waste 2. Perform improvement, remove waste and design and draft new process 3. Trial new process many times (PDSA) 4. Document the standard process (sequence of steps) 5. Make the standard process visual 6. Post Standard Process and Educate 7. Sustain and continuously improve Post Sustain 20

• A technique for achieving consistent performance: - reduces variability - reduces waste - reduces cost • Based upon the best known method to get the job done • Standard Operating Procedures (SOP) 21

If the process is unstable……unpredictable… • Find the causes of the instability AND • Remove those causes from your system OR • Remove the effects of those causes from your system Reference: Wheeler, Donald J., (2000). Understanding Variation: the key to managing chaos.

Manage Variation  Create a Formal Process  Stop tampering  Develop operational definitions  Improve predictions  Develop contingency plans  Sort products and services into grades  Desensitize  Exploit variation Reference: The Improvement Guide, Langley, Nolan, Nolan, Norman, and Provost, p.359, 2009

Design Systems to Avoid Mistakes  Use reminders  Use differentiation  Use constraints  Use affordances Reference: The Improvement Guide, Langley, Nolan, Nolan, Norman, and Provost, p.359, 2009

Changes You Keep A P S D S Implementation Hunches Wider Testing A P S D Follow-ups Small Tests 26

A P S D The New Normal 27

If the process is stable & predictable… • Ignore or tweak the good predictable processes AND • Redesign the bad predictable processes Reference: Wheeler, Donald J., (2000). Understanding Variation: the key to managing chaos.

Let’s Draw a Pig! • Follow instructions given • In 5 minutes, share your creation 29

  Standardized process may not be enough to consistently meet customer demand. Standard ‘work’ adds the role of time.

Standard Process (Reliable Methods) Has the elements: • Content • Sequence • Outcome • Process may involve more than one operator 32 Standard Work Has the elements: • Content • Sequence • Timing • Outcome • • • Process is for one operator Establishes cycle times Involves looking at demand and takt times (and matching CT = TT)

Thank You

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