Where’s the Standard Work Binder?

Posted on by Paul Pejsa

At Catalysis, we like to ask during gemba walks: “Can we see your standard work?” Responses vary to our question. If the standard work is on the daily huddle board, marked up with the latest suggested improvement, it’s a good sign. If it’s in a binder that, once located, results in sneezing fits due to a heavy accumulation of dust on it, it shows us that there is a gap between creation and usage. If further questions about audit of standard work elicit a nervous tic from the dust-covered-binder-producing manager, it displays a gap in understanding of the purpose and process of standard work. 

What’s the problem here?

Healthcare has a historical problem with developing and sustaining standard work, although it exists in many organizations in other industries. Why is that? The too-easy answer is “we treat patients, we don’t make cars,” and it misses the key point about standard work. Standard work is simply the best-known way today of running a process. It can apply to registering patients, the flow of a primary care visit, lab testing, and many (most) areas within a healthcare organization given this definition. A simple example of this problem that we recently observed was in a healthcare organization that had different ways to admit and transfer a patient to each of three med-surg floors from the ED. Having three different ways to perform the same process caused frustration for both staff and patients as they tried to keep it all straight and avoid delays in patients receiving care.  

So how do we make it better? Below are some strategies to help you with the development and sustainment of high-quality standard work.

How can we start creating standard work?

One of the easiest ways to create standard work is to assemble the team that does the work every day. Within this team, reach consensus on their current state (which could be messy!), then together develop the best-known way of performing the process today, documenting and socializing it for agreement, and then training the team to it.  An example we recently saw was the standardization of testing for sepsis in an ED. A team of nurses developed standard work for screening and for subsequent care of sepsis, including having the right IV fluids and antibiotics on hand to rapidly respond to this serious and time – critical condition. They successfully reduced sepsis mortality by over 32%.

How can we sustain standard work?

Sustaining standard work is straightforward to execute, but often a bit more challenging when it comes to culture. You see, to sustain standard work, it has to be regularly inspected to ensure it still represents the best-known way of running the process. Traditionally, some organizations call this process “Audit” of Standard Work, a term that can carry a lot of baggage in healthcare. Some organizations choose to call it “Confirmation” instead to take what may be perceived as a punitive sting out of the process.  At Catalysis, we use the term “Process Observation.” This process observation or confirmation of standard work is simply its review between two team members or a team member and their manager. This review can identify improvement opportunities, or perhaps a training or coaching opportunity to help the team using the process to be more effective. This process helps standard work to sustain by always looking for the new “best-known way.” 

What can I try?

An easy way to get started on the creation and sustainment of standard work is to pick a process that may be either undocumented or minimally documented, assemble the team that executes that process as part of their daily work, and in a safe environment, collaborate with them to create today’s “best-known way.” Document it, train to it, and then keep it visible to the entire team, encouraging their ideas to experiment and improve it to create tomorrow’s “best-known way.” Please share in the comments below your experiences with creating and sustaining standard work!

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