One of the fundamental aspects of Lean Healthcare is the development, implementation, and sustainment of robust processes.  This is accomplished through standard work.  But, using standard work as a bandage that can fix anything is one of the largest gaps I have seen in Lean Healthcare journeys.

Standard work can provide the framework for sustainment and stability for a process in the elimination of undesirable outcomes (defects).  In Lean Healthcare there can be no improvement without standard work.  The hypothesis is simple; if the standard work is followed, then the defect will not occur. However, it is critical to recognize the difference between a standard work creation or revision problem and a standard work deployment problem.

Creation of new or revision of existing standard work is the right solution when one of two conditions exists:

1.  A undesirable process outcome (defect or special cause variation) occurs and:

    • Standard work exists;
    • Standard work is known;
    • Standard work is being practiced 100 percent of the time; and
    • The team members are trained, knowledgeable and have the required time.

2.  An undesirable process outcome (defect) occurs and there is no standard work.

Revision to standard work is not an answer when:

  1. There is standard work, however it is not known and is not being practiced.
  2. There is standard work and it is known, however it is not being practiced.  This is a leadership issue and developing new standard work will not resolve this issue.
  3. There is standard work, it is known, is being practiced, however the team members lack:
    • Required skills where knowledge cannot be utilized,
    • Required time to complete the standard work, or
    • Required knowledge.

In short, if the standards exist but are not known, not practiced, or the team is not capable of deploying the standards, then those problems need to be addressed first before new standards are set in place.

If a team is looking to implement standard work and you feel there may be another issue at play as I outlined here, help them to find the root cause.


Today’s blog was written by Joe Crist, Senior Manager with HPP.

For the past 17 years, Joe’s work has focused on operational improvements through lean transformations across North America and Europe.  Prior to joining HPP, he worked across a variety of industries in multiple leadership roles from the front line to the executive leadership team.  Joe received a B.S. in Engineering and Philosophy at University of New York.  Additionally, Joe earned a Masters in Human Resources and Training and Development focused on Business Improvements and Balance Sheets from Webster University.

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