As we watch the Olympics this week, we can’t help but want “Gold” in each and every event.  Those swimmers make it look so easy as they glide on top of the water in world record fashion.  I remember during the 2004 Olympics, I couldn’t wait to hit the local YMCA pool to see what I had to offer (what a joke).  I even bought one of those caps and some goggles. Those Olympians made it look so easy.  Needless to say, after about 50 meters I realized that I was in big trouble.  I looked like a complete idiot with that cap on, 40 lbs overweight, not to mention that my goggles were fogging up and I was out of breath.  Thank God I spared everyone by passing on the Speedo.  Needless to say, I wasn’t ready to “Go For the Gold”.   Heck, I did well to climb out of the pool.

This week, while in London on business and taking in some Olympic events, I’ve reflected on the article below written by a former associate at a company I once owned.  Many Hospital_Standard_Workorganizations are much like my Olympic dreams in that they’re not prepared to do what it takes to achieve the “Gold”.  Whether Gold for you is the best service, the highest quality, profit growth, the safest processes, the lowest cost, or the highest volumes, we hope that we can just dive in with minimal investment in time or resources, armed with a couple of tools, and achieve our goal.

Enjoy the article and enjoy the Olympics.  They all started somewhere!  Charles Hagood

Go For the Gold

There is gold to be mined in all organizations!  And it can be yours for the taking.  A primary objective of lean is to remove waste from the processes in order to better flow value to the customer (i.e. “patient”).  One of the most powerful tools available in your Lean Healthcare activities for identifying and removing waste from processes is Standardized Work.

Yet, we have found that many organizations, as they begin their lean healthcare journeys, are reluctant (even downright resistant) to standardizing their processes.  They offer all sorts of excuses: the processes are too complex and variable to be standardized; qualified, knowledgeable resources are not available; standardization will require too much effort and take too long; the workforce is not disciplined enough to follow standards; etc.  Yet, Standardized Work most often generates some of the most significant bottom-line results of all the lean healthcare tools.  Unfortunately, organizations often can’t see the gold for looking at the waste that first must be removed.

The fact is without Standardized Work there can be no lean.  Without Standardized Work the current best method for doing the work in the most effective manner, with perfect quality, and without risk to health or safety (of both caregiver and patient) has neither been determined nor documented.  Without standards there is variation in the process.

Take a hard look at your operations (go to the Gemba) where the work is actually being accomplished.  Do you see staff searching for equipment, supplies, or materials?  Are there instances where one staff member is waiting for a second staff member to complete work?  Do you see two staff members doing what one could do?  Are there staff members searching for their supervisor to clarify some detail of their assigned task?  Do you see staff waiting for an “inspector” to come to the work area to make a required inspection?  Do you have staff redoing or reworking a step that had just previously been performed?  Do you have floor spaces or closets covered up with inventory?  If done right, Standardized Work can remove these and many other forms of waste from your operations.

What is Standardized Work? 
It is the primary lean tool for determining who, what, when, and where work is to be performed.  Standardized processes are created by defining, validating, making visible, and consistently utilizing the methods that will ensure the best possible results.  Standardized Work consists of three basic elements:  

1. Best Work Sequence
First of all, it specifies the best work sequence to do the process.  The objective is not to document the current process, but to improve it and then standardize it.  In this way Standardized Work becomes an agreed-upon set of work procedures that establishes the best and most reliable methods and sequences for each process and each staff member considering quality, quantity, safety, satisfaction, and cost.  The objective is to develop processes that reduce variability and eliminate wasted effort wherever possible.

2. Synchronized & Balanced Work Assignments
The second element is synchronized and balanced work assignments.  Once the current best method is captured and documented, the work elements are allocated to specific staff.  The objective is to achieve balancing among all steps in the flow and to balance the cycle times of the operations against the pace of demand (takt time).  The work is thus synchronized and balanced among the staff so as to have each member perform assigned work within takt time and to work as close to 100% value-added time as practical.  This enables the process output to match the needs of the customer in such a way that overproduction does not occur.

3. Standard Inventory
The third element is standard inventory.  Standard inventory is the minimum amount of work-in-process inventory required to create flow in the processes.  Specifying a standard amount of inventory at each work station or area reduces the amount of work-in-process (waste).

It is important to understand that before a process can be standardized, it first must be stabilized to some reasonable degree.  Variation in the process is a bad thing but it will always vary as long as there is excessive waste.  If the work is different each time, it is virtually impossible to standardize.  

The Benefits- “Large Amounts of Gold”
Standardized Work produces tremendous benefits (large amounts of gold).  Including:

  • Productivity will definitely be increased.  By determining and standardizing the most reliable and efficient methods and sequences for each process and for each staff member and consistently working to those best practice standards, productivity will be enhanced.
  • On-time delivery of services will be greatly strengthened.
  • Standardized Work facilitates operating flexibility.  As demand rises and falls, Standardized Work can be quickly reallocated among the staff with little disruption.
  • It preserves know-how and expertise.  It promotes organizational learning.
  • It provides a basis for employee training.
  • Standardized Work promotes continuous improvement.  It provides the baseline from which we strive for improvement.
  • Quality will greatly be improved.  Quality problems often occur from some sort of variability in the process.
  • It provides process stability and predictability.

Creating Standardized Work

Yes, there is a lot of work involved in creating Standardized Work.  Fortunately you have the process experts to do the job – i.e., your staff on the “front lines” of your processes. The people doing the work understand it in sufficient detail to make the biggest contributions.

Therefore, get organized and go for the gold.  Support your staff with appropriate supervisors, lean healthcare champions, and engineers in creating Standardized Work.  First, make sure your team is thoroughly trained in the details of the several tools involved in process stabilization and Standardized Work. Next, select a critical process, stabilize it, and then standardize it.  Select another and another until your entire flow within each value stream is standardized.  Then turn your attention to continuously improving your standardized processes to squeeze more and more waste out.  Once achieved, Standardized Work becomes the platform from which the next level of advancement can be achieved.  Above all, keep your eye on the gold as you mine the many opportunities for improvement.

Now that you know the “What” and “Why” of Standardized Work, check back for next week’s blog on “How”.  Dave Munch, MD, will follow up on Standardized Work with instructions on how to create Job Instruction Training (JIT) – a tool used to train and sustain Standard Work.

This blog was written by Samuel Beaird.  Sam is a previous associate of HPP’s former parent company, The ACCESS Group, LLC (TAG).  Sam has over 35 years of progressive experience in a wide variety of environments, processes, & products. He has held senior level positions and has worked in a diversity of industries.  Sam has a B.E. in Mechanical Engineering from Vanderbilt University and an M.S. in Industrial Administration from Carnegie Mellon University.

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