Lean Training
Standard Work
Agenda
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What is it?
What’s it for?
How does it work?
When do you use it?
What’s an example?
What is it?
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Standard work represents the best,
safest, and easiest way to do a job
What’s it for?
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Standard work allows an organization
to:
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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?
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Standard work is a documented record
of how to do a job
It must be followed by all those
performing that particular task
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All associates
All shifts
Creating standard work involves several
steps
Steps to Create Standard Work
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Evaluate the current situation
Identify areas of opportunity
Modify the existing process
Quantify improvements
Implement new standard work
Evaluate Current Situation
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To implement standard work, the
current process needs to be understood
Direct observation is the best way to
know the current process
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Don’t rely on procedures
Don’t rely on memory or brainstorming
This process frequently follows a
mapping exercise
Evaluation (cont.)
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There are several tools to assist in the
observation of the current process
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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
Date: 06/27/07
Cell / Process: Receipt of specimens in lab
Standard Work Sheet
SUMMARY:
Testing work cell
Bin
5
4
1
3
2
Receiving
(1 sheet per cell)
6
tube
station
Quality
Standard
Safety / Risk
Check
WIP
Caution
Total Manual Cycle Time:
30 s
Standard WIP:
3 pcs
Evaluation tools
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Time Observation Sheet
Used to gather data on time duration of
operation elements
Three key steps
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Identify work elements
Determine observation points
Time
Task/Process Being Observed: Receipt of specimens in lab
Operator: J. Doe
Step
#
Component Task
1
Remove specimen from carrier
2
Observation / Data (top - total time, bottom - elapsed time)
1
4
5
3
4
Low est Repeatable
Elapsed Time
5
4 sec
min
4 sec
min
4 sec
min
3 sec
min
4 sec
min
04 sec
min
04 sec
min
04 sec
min
03 sec
min
04 sec
min
9 sec
min
8 sec
min
10 sec
min
9 sec
min
9 sec
min
05 sec
min
04 sec
min
06 sec
min
06 sec
min
05 sec
Remove specimen from bag
14 sec
min
13 sec
min
16 sec
min
15 sec
min
min
min
05 sec
min
05 sec
min
06 sec
min
06 sec
05 sec
min
19 sec
min
18 sec
min
21sec
min
20 sec
min
20 sec
min
05 sec
min
05 sec
min
05 sec
min
05 sec
min
06 sec
Verify orders
min
25 sec
min
25 sec
min
29 sec
min
27 sec
min
27 sec
min
06 sec
min
07 sec
min
08 sec
min
07 sec
min
07 sec
Move specimen to bin
30 sec
min
29 sec
min
35 sec
min
31sec
min
30 sec
min
05 sec
min
04 sec
min
06 sec
min
04 sec
min
03 sec
min
sec
Send tube back to sender
min
min
min
min
min
min
min
30 sec
Time per cycle:
sec
sec
sec
sec
sec
sec
sec
min
min
min
min
min
min
min
min
29 sec
sec
sec
sec
sec
sec
sec
sec
sec
min
min
min
min
min
min
min
min
35 sec
sec
sec
sec
sec
sec
sec
sec
sec
min
min
min
min
min
min
min
min
31 sec
sec
sec
sec
sec
sec
sec
sec
sec
min
min
min
min
min
min
min
min
30 sec
4 sec
5 sec
14 sec
Enter in computer
min
6
2
min
min
3
Observation date: 06/27/07
Observer: J. Schmo
5 sec
5 sec
7 sec
4 sec
sec
sec
sec
sec
sec
sec
sec
sec
30 sec
Evaluation tools
Combination Sheet
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Helps make obvious the relationship between
workers and machines - - the timing of
operations performed in one cycle by one
team member
Date: 06/27/07
Cell / Process: Receipt of specimens in lab
Takt Tim e = 27000 / 900 = 30 sec
MANUAL TASK TIME UNATT'D
WALK
value-add non-v-add RUN TIME
TIME
#
DESCRIPTION
1 Remove specimen from carrier
2
2 Remove specimen from bag
3
25
3
11
3
11
3
Enter in computer
4
Verify orders
5
Move specimen to bin
6
Send tube back to sender
5
2
Combination Sheet
TIME (draw red vertical line at takt time)
5
18 s
15
25
20
30
2
2
2
2
2
2
manual
(1 sheet per person) TOTALS:
10
12 s
auto-run
w alk
w ait
Evaluation tools
Loading Diagram
Visual display of cycle time
observations
Manual Cycle Times (MCTs)
Total MCT:
4
5
5
5
7
4
30
Takt Time:
(available time)
= ----------------------------(customer demand)
Time
= 27000 / 900
TT=30 s
= 30 sec/pc
Minimum Staffing:
(total MCT)
= ------------------------(takt time)
= 30 / 30
7
4
step1
5
5
5
step2
step3
step4
4
step5
ste6
=1
Evaluations
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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
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There are many ways to identify areas
for opportunity
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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
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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
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To implement new standard work, it must
first be documented
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Write it down
Next, the best way to hand out or display the
new process should be determined
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Checklist?
Photos?
Posted in work area?
Index cards?
Implement
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Next, the best communication and training
methods should be selected
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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?
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Standard work should be used for any
task that is part of a process
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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
Standard Work in Practice
JOB BREAKDOWN SHEET
Team Leader: M. Warren
Date: 7/20/20__
Supervisor: P. Kenrick
Written By: R. F. Kunkle
Step #1
Stabilize vein
JOB: Starting IV in Peripheral Vein
Key Points:
Safety: Injury avoidance, ergonomics, danger points
Quality: Defect avoidance, check points, standards
Technique: Efficient movement, special method
Cost: Proper use of materials
1. Stretch skin tight over vein
2. Use thumb and index finger of nondominant hand
Step #2
Place tip of needle against skin
1. Needle bevel up
2. Needle slightly angled up from skin (5 degrees)
1. Easier and more accurate to enter skin
2. Correct angle for entering skin
Step #3
Depress skin with needle
1. Indent skin 1-2 mm
2. Maintain angle of needle
1. Pushes vein up in front of needle
2. Greater angle may push through vein
Step #4
Puncture skin with needle
1. Push needle forward parallel to needle angle
2. Continue forward motion until slight "pop" is felt
along with decrease in resistance
3. Push slowly
1. Overcomes skin resistance and perforates skin
2. Indicates you are through vein wall
1. Lift tip (lower back of needle)
1. Moved needle bevel to top of vein
preventing puncture of opposite side of vein
2. Aligns needle with bore of vein making
advancement of needle easier
1. Band indicates proper depth for each type of
catheter. Insufficient depth may dislodge
Area: ER
Major Steps
Step #5
Change needle angle
2. Needle parallel to skin
Step #6
Advance the catheter
1. Insert completely up to the "band"
Reasons for Key Points
1. Keeps vein from rolling
2. Keeps dominant hand free to guide catheter
3. To prevent inserting through vein
From Dr. Richard Kunkle in Toyota Talent, Jeffrey Liker and David Meier, McGraw-Hill, 2007, pg. 187.
Let’s Try It
JOB BREAKDOWN SHEET
Date:
Team Leader:
Supervisor:
Area:
Written By:
Major Steps
JOB:
Key Points:
Safety: Injury avoidance, ergonomics, danger points
Quality: Defect avoidance, check points, standards
Technique: Efficient movement, special method
Cost: Proper use of materials
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.
Reasons for Key Points
What’s an example?
How to write your name on a flip chart
1.
2.
3.
4.
5.
6.
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Stand up
Go to the flip chart
Pick up the marker
Write your name
Put down the marker
Return to chair
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
Date__________
RN calling report__________________#_________
Meds given in [email protected]________
Nurse receiving report________________________
[email protected]________
Pt. Name________________________Age_______
[email protected]________
Admit Diagnosis____________________________
_______________[email protected]________
Core Measure? (circle)
Pneumonia
CHF
[email protected]________
MI
Sepsis
Drips running_________________________________
Admitting Dr_______________________________
________________________________
ED Physician_______________________________
Abnormal Test Results__________________________
Pt’s Living Situation_________________________
_____________________________________________
Isolation (circle): N/A
Rule Out
History
Abnormal Vitals (include time)___________________
Swabbed in ED for:
MRSA_____VRE_____
_____________________________________________
Events Surrounding Hospitalization:__________
Current Vitals: Time________Temp__________
__________________________________________
P_________R________BP________SpO2_______
__________________________________________
O2________Pain Scale (0-10)_________________
__________________________________________
Location of Pain____________________________
Past Medical History:_______________________
Telemetry: Y or N -- Rhythm___________
__________________________________________
Blood Sugar____________Last Ate At_________
__________________________________________
Normal Activity Level________________________
Head-To-Toe Assessment:
Ordered Activity Level_______________________
HEENTCODE Status_______________________________
Card/PulmSTAT/Now Orders Completed_________________
Abdomen___________________________________________
Extremeties-
Additional Information:
SkinNeuro-
IV------Started in: ED or infield (circle one)
Gauge_________Site_________
Fluids_____________________
Report Form
For ED
Admissions
Questions?
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Standard Work Sheet