Standard work for lean healthcare

Proven to increase efficiencies in the manufacturing sector, Standard Work has become a key element in reducing process waste, ensuring patient safety, and improving healthcare services. Part of the Lean Tools for Healthcare Series, this reader-friendly book builds on the success of the bestselling, Standard Work for the Shopfloor.

Standard Work for Lean Healthcare explains how to apply this powerful Lean tool to increase patient safety and reduce the cost of providing healthcare services. It illustrates how standardization can help you establish best practices for performing daily work and why it should be the cornerstone for all of your continuous improvement efforts. Presented in an easy-to-assimilate format, the book describes work in terms of cycle time, work in process, takt time, and layout. It also:

Defines the key concepts of standard work and explores the essential elements of a continuous improvement culture Provides detailed guidance through the process of creating, maintaining, and improving standards Illustrates the application of standardization and standard work in healthcare with a range of examples Includes access to helpful websites and further reading on standardization, standard work, the 5S System, and Lean healthcare

A joint effort between the Rona Consulting Group and Productivity Press, this book presents invaluable insights from pioneers in Lean thinking to help you avoid common mistakes that can lead to unnecessary wastes of time and resources. Each richly illustrated chapter includes a chapter summary, reflection questions, and margin assists that highlight key terms, how-to steps, and healthcare examples--making this an essential resource for healthcare professionals starting out on their Lean journey.

Author Notes

Rona Consulting Group & Productivity Press

Thomas L. Jackson, Editor

Thomas L. Jackson, JD, MBA, PhD, is the former CEO of Productivity, Inc., and Productivity Press, and a member of the influential Ford Lean Advisory Group. Tom has been a student of lean enterprise since 1988, when he copyedited Hiroyuki Hirano's JIT Factory Revolution for Productivity Press and reworked two chapters of Yasuhiro Monden's groundbreaking Japanese Management Accounting. Looking at pictures of Japanese factories and reading about how differently the Japanese count their money, Tom became so fanatical about lean that he left his comfortable position as a professor of business at the University of Vermont to start his own lean consulting company--in Malaysia! There, he learned that the powerful techniques of lean enterprise-- JIT, SMED, TPM, and kanban--were only half of the story of Toyota's great success. The other half of the story was hoshin kanri (a.k.a. the "balanced scorecard") and a revolution in the structure of modern business organization.

In 2005, Tom started applying Toyota's operational and management methods in healthcare in a small rural clinic in Seward, Alaska. In 2008, Tom decided to trade his Levi's Dockers for a pair of black scrubs and joined Mike Rona, former president of Seattle's Virginia Mason Medical Center, as a partner in the Rona Consulting Group, where he and Mike are "transforming healthcare and pursuing perfection." In 2007, Tom was awarded a Shingo Prize for his book, Hoshin Kanri for the Lean Enterprise. In 2009, Tom was appointed Clinical Associate Professor in the Department of Health Services of the University of Washington's School of Public Health.

Preface	p. ix
Acknowledgments	p. xi
1 Getting Started	p. 1
1.1 The Purpose of This Book	p. 1
1.2 What This Book Is Based On	p. 1
1.3 Two Ways to Use This Book	p. 2
1.4 How to Get the Most Out of Your Reading	p. 2
1.4.1 Becoming Familiar with This Book	p. 2
1.4.2 Becoming Familiar with Each Chapter	p. 3
1.4.3 How a Reading Strategy Works	p. 3
1.4.4 Using the Margin Assists	p. 4
1.5 An Overview of the Contents	p. 5
1.5.1 Chapter 1: Getting Started	p. 5
1.5.2 Chapter 2: The Production of Healthcare Services	p. 5
1.5.3 Chapter 3: Standards and Beyond	p. 5
1.5.4 Chapter 4: Standardization	p. 6
1.5.5 Chapter 5: Standard Work	p. 6
1.5.6 Chapter 6: Applications of Standardization and Standard Work	p. 6
1.5.7 Chapter 7 Reflections and Conclusions6
2 The Production Processes and Operations of Healthcare	p. 7
2.1 The Industrial Origins of Lean Healthcare	p. 7
2.2 Production, Process, and Operation	p. 9
2.3 Summary	p. 11
Reflections	p. 12
3 Standards and Beyond	p. 13
3.1 What Is a Standard?	p. 13
3.1.1 Characteristics of Standards	p. 13
3.1.2 Sources and Types of Standards	p. 14
3.1.3 Standards and Standard Work versus Best Practice	p. 14
3.2 What Is Standardization?	p. 15
3.3 What Is Standard Work?	p. 17
3.3.1 Lean Healthcare Methods = Standard Processes and Reliable Methods	p. 18
3.3.2 Standard Work Is a Prerequisite of Lean Healthcare	p. 19
3.3.3 Standard Work Drives Further Improvement	p. 19
3.4 Standard Work and Evidence-Based Practice	p. 20
3.4.1 Evidence-Based Practice	p. 20
3.4.2 A Culture of Continuous Improvement	p. 22
3.5 The Benefits of Standardization and Standard Work	p. 24
3.5.1 For the Organization	p. 24
3.5.2 For Patients	p. 24
3.5.3 For Clinicians and Support Staff	p. 24
Summary	p. 25
Reflections	p. 26
4 Standardization	p. 29
4.1 The Path to Reliable Methods	p. 29
4.1.1 Types of In-House Standards	p. 29
4.1.2 100 Percent Adherence to Reliable Methods	p. 29
4.2 Communicating In-House Policies and Standards	p. 31
4.2.1 Often Manuals Are Not Designed for the User	p. 32
4.2.2 Revisions Are Unsystematic	p. 32
4.2.3 Manuals Are Not Designed to Be Improved	p. 33
4.3 What to Include in Standards Documentation	p. 34
4.3.1 Technical and Process Standards Sheets	p. 34
4.3.2 Equipment Manuals	p. 35
4.4 The Value of User-Friendly Standards	p. 36
4.5 Creating and Maintaining Improvements to Standards	p. 37
4.5.1 How Do You Create Standards and Standard Operations?	p. 38
4.5.2 Stages of Standards Improvement	p. 39
4.5.3 A Review of the Process Analysis Tools	p. 42
Summary	p. 44
Reflections	p. 45
5 Standard Work	p. 47
5.1 Standard Task	p. 47
5.2 Standard Work Sequence	p. 49
5.3 Standard Time	p. 50
5.3.1 Takt Time	p. 51
5.3.2 Cycle Time	p. 52
5.3.3 Wait Time	p. 52
5.3.4 Lead Time	p. 52
5.4 Standard Work-in-Process (SWIP) Inventory	p. 53
5.5 Standard Work Documentation	p. 53
5.6 Five Steps to Standard Work	p. 54
5.6.1 Step One: Conduct a Running Time Observation	p. 54
5.6.2 Step Two: Create a Standard Work Sheet	p. 59
5.6.3 Step Three: Percent Load Chart	p. 61
5.6.4 Step Four: Create a Standard Work Combination Sheet	p. 64
5.6.5 Step Five: Standard Work Instruction Sheet	p. 69
5.7 Ten Guidelines for Maintaining and Improving Standard Work	p. 71
Summary	p. 72
Reflections	p. 74
6 Applications of Standardization and Standard Work	p. 75
6.1 Applications of Standardization	p. 75
6.1.1 New Employee Training	p. 75
6.1.2 Evaluating Improvement Ideas	p. 78
6.2 Applications of Standard Work	p. 81
6.2.1 Managing Healthcare Service Production Processes	p. 82
6.2.2 Patient Safety	p. 83
6.2.3 Hourly Rounding	p. 84
6.2.4 Satisfied Employees	p. 91
Summary	p. 92
Reflections	p. 94
7 Reflection and Conclusions	p. 95
7.1 Reflecting on What You Have Learned	p. 95
7.2 Applying What You Have Learned	p. 96
7.2.1 Possibilities for Applying What You Have Learned	p. 96
7.2.2 Implementing Standardization and Standard Work in Your Organization	p. 96
7.2.3 Your Personal Action Plan	p. 98
7.3 Opportunities for Further Learning	p. 100
Conclusions	p. 101
Appendix	p. 103
Further Reading about the 5S System	p. 103
Further Reading about Lean Healthcare	p. 103
Useful Websites	p. 104
Index	p. 105

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