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 6
tube
Receiving station

Quality Standard Safety / Risk Total Manual Cycle Time: Standard WIP:

(1 sheet per cell) Check WIP Caution 30 s 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 Observation date: 06/27/07
Operator: J. Doe Observer: J. Schmo
Step Observation / Data (top - total time, bottom - elapsed time) Low est Repeatable
Component Task
# 1 2 3 4 5 Elapsed Time

min 4 sec min 4 sec min 4 sec min 3 sec min 4 sec
1 Remove specimen from carrier
min 04 sec min 04 sec min 04 sec min 03 sec min 04 sec
4 sec
min 9 sec min 8 sec min 10 sec min 9 sec min 9 sec
2 Remove specimen from bag
min 05 sec min 04 sec min 06 sec min 06 sec min 05 sec
5 sec
min 14 sec min 13 sec min 16 sec min 15 sec min 14 sec
3 Enter in computer
min 05 sec min 05 sec min 06 sec min 06 sec min 05 sec
5 sec
min 19 sec min 18 sec min 21sec min 20 sec min 20 sec
4 Verify orders
min 05 sec min 05 sec min 05 sec min 05 sec min 06 sec
5 sec
min 25 sec min 25 sec min 29 sec min 27 sec min 27 sec
5 Move specimen to bin
min 06 sec min 07 sec min 08 sec min 07 sec min 07 sec
7 sec
min 30 sec min 29 sec min 35 sec min 31sec min 30 sec
6 Send tube back to sender
min 05 sec min 04 sec min 06 sec min 04 sec min 03 sec
4 sec
min sec min sec min sec min sec min sec

min sec min sec min sec min sec min sec

min sec min sec min sec min sec min sec

min sec min sec min sec min sec min sec

min sec min sec min sec min sec min sec

min sec min sec min sec min sec min sec

min sec min sec min sec min sec min sec

min sec min sec min sec min sec min sec

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

Time per cycle:
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 Combination Sheet

Takt Tim e = 27000 / 900 = 30 sec MANUAL TASK TIME UNATT'D WALK TIME (draw red vertical line at takt time)

# DESCRIPTION value-add non-v-add RUN TIME TIME 5 10 15 20 25 30

1 Remove specimen from carrier 2

2
2 Remove specimen from bag 3 25
2
3 Enter in computer 3 11
2
4 Verify orders 3 11
2
5 Move specimen to bin 5
2
6 Send tube back to sender 2
2

manual auto-run w alk w ait

(1 sheet per person) TOTALS: 18 s 12 s

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)

= 27000 / 900
Time

TT=30 s = 30 sec/pc

Minimum Staffing:

(total MCT)
= -------------------------
(takt time)

= 30 / 30

7
5 5 5 =1
4 4

step1 step2 step3 step4 step5 ste6

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

Area: ER JOB: Starting IV in Peripheral Vein Written By: R. F. Kunkle

Key Points:
Safety: Injury avoidance, ergonomics, danger points
Major Steps Quality: Defect avoidance, check points, standards Reasons for Key Points
Technique: Efficient movement, special method
Cost: Proper use of materials
Step #1 1. Stretch skin tight over vein 1. Keeps vein from rolling
Stabilize vein 2. 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 skin

Place tip of needle against skin 2. 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 needle

Depress skin with needle 2. 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 skin
Puncture skin with needle 2. Continue forward motion until slight "pop" is felt 2. Indicates you are through vein wall
along with decrease in resistance
3. 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
Change needle angle preventing puncture of opposite side of vein
2. Needle parallel to skin 2. Aligns needle with bore of vein making
advancement of needle easier
Step #6 1. Insert completely up to the "band" 1. Band indicates proper depth for each type of
Advance the catheter catheter. Insufficient depth may dislodge

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: JOB: Written By:

Key Points:
Safety: Injury avoidance, ergonomics, danger points
Major Steps Quality: Defect avoidance, check points, standards Reasons for Key Points
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.
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
 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 Etc.
day from 8-10am with the department secretary
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)___________________ Report Form
For ED
Swabbed in ED for: MRSA_____VRE_____
_____________________________________________
Events Surrounding Hospitalization:__________

__________________________________________
Current Vitals: Time________Temp__________ Admissions
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_______________________
HEENT-
CODE Status_______________________________
Card/Pulm-
STAT/Now Orders Completed_________________
Abdomen-
___________________________________________
Extremeties-
Additional Information:
Skin-

Neuro-

IV------Started in: ED or infield (circle one)

Gauge_________Site_________

Fluids_____________________
Questions?