More Work on Standard Work

“Curmudge, at the end of our conversation a week ago, my mind had become boggled by the magnitude of the whole standardization issue. To help me get my head on straight, please tell me where we are ‘at’ and why we are here.”

“Jaded Julie, Masaaki Imai has answered your ‘why are we here?’ question most clearly in his book, Gemba Kaizen: ‘Where there is no standard, there can be no improvement.’ If Generic General Hospital wants to improve—and especially to develop a Lean culture—they must have standards.”

“Now I recall where we stopped last time. We were talking about the requirements of documented procedures for standard work. We had discussed established and documented and were ready to tackle implemented, or as specified by JCAHO, accessible to nursing staff. These are the requirements for implemented: ‘All pertinent staff must be made aware of the procedure, trained in its use, and then use it. Training, proof of competency, and use of the procedure must be documented in appropriate records.’”

“The documentation requirements are pretty onerous; but if I were to be the subject of a procedure, I would want the nurse to be trained and able to demonstrate her competence. Another aspect of implemented is that standard work needs to be managed to assure compliance with the standard. However, as Mark Graban suggests in Lean Hospitals, the manager who observes a deviation should always ask ‘why?’ There may be a perfectly valid reason for the deviation, and it might lead to an improvement in the method. Another way to gain compliance with a standard method is for it to have been written by the people who use it. Compliance is undoubtedly proportional to one’s sense of ownership.”

“Curmudge, are you ready for the fourth requirement, maintained? This means that the procedure must be approved, reviewed on a defined schedule, and promptly revised when improvements are developed.”

“JCAHO requires review every three years, but that’s a long time for people to wait to learn about an improvement. If it’s difficult to create a standard and gain its approval, it’s probably going to be difficult to revise it. The hospital’s organization should facilitate rapid revision. One certainly doesn’t want a procedure to be done by a method that differs from an out-of-date standard, especially in front of an auditor. People should remember the old laboratory rule, ‘say (write) what you do, and do what you say.’”

“Curmudge, I surely hope that the people in Generic General Hospital know they don’t have to write all of their standards from scratch. They can adopt their standard work from lots of existing sources.”

“And that, Julie, is what we are going to talk about next week.”

Affinity’s Kaizen Curmudgeon