Does Standard Work Destroy Creativity?

“But this isn’t an assembly line!”

When you start talking about standardizing processes in healthcare, people begin to perspire, lips clamp tightly and are pursed thin.  The declaration, “we don’t make widgets”  is oft proclaimed.  You see, “healthcare is different,” I am frequently told.  “We’re dealing with people’s lives and every patient is unique and most are complex….this isn’t an assembly line!”

When I left the automotive industry and joined healthcare, my response to such statements was that everything involves a process.  Whether you’re building cars or delivering life-saving patient care, it takes a sequence of highly coordinated tasks and processes to deliver the end result.  When this sequence of tasks is standardized, you’re well on your way to radically improving patient safety and eliminating significant sources of waste.

Standard work establishes the best method to perform a task with the least amount of waste while providing the best patient care.  It is an agreed-upon method and procedure for the best sequence and timing to perform a task.

Standard work is frequently misinterpreted and misunderstood.  Generally, people have a tendency to resist standard work until there is understanding of what it really means and how it impacts both themselves and the organization.  People don’t want to do their work the same way every time, nor do they think everyone should perform work the same way.  For this reason, it is not uncommon for healthcare providers to be cautious of jumping onto the standard work bandwagon. Medicine is a combination of art and science after all.  Surely, implementing a “standard” is comparable to throwing darts at the artistry that is needed to understand the nuances of medicine.  If standard work was rigid and unchanging, this point of view could indeed be valid.  However, it is important to understand that standard work is neither rigid nor inflexible.  Quite the contrary, standard work is alive and should change in response to changes in work conditions.

When standard work is consistently and uniformly adhered to, it drives continuous improvement by exposing problems within the process.  Making problems easier to see inspires planned experimentation to discover better ways to perform the work.  Standards are the foundation for continuous improvement.  Without them, you can’t effectively measure where you are.  Standards are the yardstick by which you analyze and test improvements that can then be systematically adopted by everyone.

When continuous improvement activity becomes part of your culture, creativity will flow from employees at all levels of the organization.  Problem solving at the front line often results in creative solutions never dreamed of in the boardroom.  Recognition for solving problems and making improvements builds self-esteem while skill levels increase through training to the standard work.  As the training becomes more effective and widespread, communication increases. People know what they’re supposed to do, when to do it, and how it should be done.

So, by all means, set up an environment of improvement activity that becomes part of daily work and see creativity skyrocket!   Once standard work is in place, creativity bubbles to the surface as people continuously improve their work.  This results in improved morale and job satisfaction, which can also lead to reduced turnover and, yes, improved creativity!

Needless to say, none of this happens overnight.  It’s a long process that requires a lot of determination and even more perseverance.

Does standard work destroy creativity or perpetuate it?

Let’s look back at past articles that discussed how standard work can be implemented in healthcare:

Today’s blog was written by Janet Dozier, Senior Manager with HPP.

Janet has twenty years of process improvement experience in healthcare and manufacturing.  She has led lean transformation efforts in clinical, non-clinical, and business operations of hospitals.  Prior to her work in the healthcare industry, Janet was in the automotive industry for ten years where she was a lead instructor of Lean Principles for the Ford Production System.

Janet received her Master’s Degree in Engineering from Case Western Reserve University and undergraduate degree in Industrial Engineering from North Carolina State University.  She is certified as a Six Sigma Black Belt.


  1. Great article! Question is, as leaders, how are we responding to those spontaneous “creativity bubbles” when they come “to the surface” while people are faithfully performing standard work? Are we encouraging playful “bubble” blowing and immediately capturing that moment of enlightenment or are we, in essence, popping those “bubbles” – telling our team we can “play later?” I believe an opportunity to improve our standard work and reduce resistance to the concept lies in finding a way to capture those emotive “bubbles” the moment they rise to the surface as a result of standard work. Not easy, but how about a PDCA on a minute video of the “bubble” moment using your cell phone? Ideas?

  2. I am certainly in agreement that a standardized process is the most effective manner of ensuring tasks are performed consistently and without variation. However, it runs a slippery slope if not communicated correctly by administrative leadership. For example, in my current role at a lean hospital frontline staff are given the standard work with is very task-oriented, but does not include the soft skills so important in healthcare. We are then teaching nurses and docs to address the corporal wellbeing of the individual, but excluding the mental, emotional, and spiritual needs we know to be necessary in the healing process. Soft- skills must be addressed when educating staff to the standard, and more importantly when introducing a lean methodology. I have heard countless nurses say standard work and the associated takt timing are inappropriate in a service industry due to the unpredictable human variable. They are losing the “why” of the standardization. I am by no means discounting the importance of standard work’s intended objective merely giving a word of caution for those looking for a sole solution to be problem of behavioral variance

  3. Great comments above and great article on standard work. I have found without standards, I am not sure if improvement is moving in the right direction. Standards and measures allow me to know if a trialed improvement moves us closer or further from ideal.

    Great work, Janet! keep it up!

  4. I enjoyed reading this counterargument to the age-old ‘people are not cars’ comments made off-hand about standardized medicine. I agree that creativity in medicine can and will thrive when processes are measured and a culture of continuous improvement pervades. I am anxious to see how organizations will cross over the chasm that exists between traditional craft medicine to technology-based medicine. Intermountain Healthcare in Utah has taken the first steps in this direction, and in doing so has proved that quality of care can improve without skyrocketing costs. The key ingredients there were evidenced-based medicine and the willingness of physicians to work in teams to {creatively} problem solve.



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