Lean Training Standard Work Agenda What is it? What’s it for? How does it work? When do you use it? What’s an example? What is it? Standard work represents the best, safest, and easiest way to do a job What’s it for? Standard work allows an organization to: 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? Standard work is a documented record of how to do a job It must be followed by all those performing that particular task All associates All shifts Creating standard work involves several steps Steps to Create Standard Work Evaluate the current situation Identify areas of opportunity Modify the existing process Quantify improvements Implement new standard work Evaluate Current Situation To implement standard work, the current process needs to be understood Direct observation is the best way to know the current process Don’t rely on procedures Don’t rely on memory or brainstorming This process frequently follows a mapping exercise Evaluation (cont.) There are several tools to assist in the observation of the current process 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 Time Observation Sheet Used to gather data on time duration of operation elements Three key steps 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 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 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 There are many ways to identify areas for opportunity 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 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 To implement new standard work, it must first be documented Write it down Next, the best way to hand out or display the new process should be determined Checklist? Photos? Posted in work area? Index cards? Implement Next, the best communication and training methods should be selected 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? Standard work should be used for any task that is part of a process 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. 7. 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 ED____________________@________ Nurse receiving report________________________ ___________________@________ Pt. Name________________________Age_______ ___________________@________ Admit Diagnosis____________________________ ___________________@________ Core Measure? (circle) Pneumonia CHF ___________________@________ 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?