Lean Healthcare - Standard Work, Airline exampleOn a recent business trip I received an upgrade to a seat in the first row. I was thrilled. Free upgrades are a big deal for business travelers; I would be able to get what I want for lunch since options are limited and the flight attendant begins taking orders in the first row.

So as I made my way through a busy day with no time to eat before boarding the plane, I was feeling pretty good about my first row seat.  Upon arrival at my gate and scanning my boarding pass, the machine beeped and reassigned me.  I had been moved to row four.  Darn!  Now I will be relegated to whatever lunch items are left over.

To my surprise, the flight attendant began taking orders before we left the gate.  She took an order in row five, then two, then three; then she came to me.  I had the pleasure of ordering my choice for lunch.  As I was enjoying my lunch, my Lean mind began to think about the process I had just observed.  In the spirit of Lean thinking, I knew I needed more data before I could make a judgment so I began to talk to the flight attendant.  She told me that she serves her most frequent fliers first based on the passenger manifest.  That is her way of making sure that the airline’s most loyal customers get the service they expect.  But why don’t I see this happening on all flights?  Her response was, “I don’t think we have a standard way of serving, so this is what I do.”

The next time I was in this situation, the flight attendant started taking orders in the last row.  The flight after that, row one was first.  What’s going on?  Once again, in the spirit of understanding the process, I talked to the flight attendants to gather more data.  “We do have standard work,” they informed me.  “On odd numbered flights, we are to take orders starting with the last row.  On even numbered flights, we start with row one.”  Now isn’t that interesting?  It was not apparent to me that a standard was being followed.

Why is that?  It all comes down to communication and follow-up.  When we use lean thinking to improve a process, often times we create standard work to improve the process and reduce variation.  That’s the easy part.  What we typically struggle with is how to communicate the expectation to all front line workers.  Nor are we good at auditing the process to ensure that the standard work is being followed.  These are two critical parts of managing lean processes after the improvement is made.

For the communication plan, follow the Who, What, How, and When principle.  Who do we need to communicate with (typically called stakeholders)?  What do we need to tell them (The new process and standards)?  How are we going to tell them?  When will we have this completed?  Be aggressive with the timeline so that the new process takes hold in a short timeframe.  Then audit the process.  The key to effectively doing this is to create a schedule whereby you observe small data sets on a regular basis.  For example, if you have 50 employees using the standard work and you observe five daily, you will have seen all 50 employees in action every two weeks.

So remember, for standard work to be successful, everyone needs to know and we have to audit to follow up.  After all, it is only a standard if everyone is following it.


Today’s blog was written by Dan Littlefield, Director at HPP.

Dan has 30 years of healthcare experience in many clinical and leadership roles. He leads Lean and process improvement consulting engagements for HPP.  His experience includes deploying Lean across numerous healthcare disciplines including Imaging, Laboratory, Nursing, Pharmacy, and Physician Offices.  Dan began his healthcare career as a nuclear pharmacist and has also severed as Director of Operations, responsible for 13 facilities.  He has been a featured speaker at a variety of healthcare industry events.

Dan holds a Master’s Degree in Business Administration from the University of Pittsburgh, Bachelor’s Degree in Pharmacy from Purdue University and a Specialty Certification in Nuclear Pharmacy from Butler University.

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