1,000,000 Dishwashers
I visited Tyler at the manufacturing plant that he worked. I was amazed at the amount of dishwashers they produced – over 15,000 dishwashers every single day. Running 24 hours a day, 5 days a week, it was a typical high speed manufacturing environment that was capable of shipping over 1,000,000 dishwashers every year across the country.
The volume and scale of high speed manufacturing today is truly mind boggling if you really stop to think of it.
Producing over 1,000,000 units with consistency and quality involves a lean manufacturing environment, where every employee is trained to follow standard work.
Standard work is a core principle in lean manufacturing and can be applied to healthcare. It’s how you maintain a consistent service when you see the volume of patients you see each day. Standard work not only ensures quality, but it’s what makes providing care to patients in volume safely and with positive outcomes, possible.
Simply stated, standard work is a powerful tool that we can use to improve the consistency, efficiency, safety, and outcomes we wish.
Maintain Consistency
You don’t think twice when you go to start your car. That’s because you’ve come to expect it to turnover. Automobile manufacturers have fine tuned their processes with the help of standard work to ensure they produce a car with consistent quality every single time.
Consistency helps patients know what to expect. That’s how you build a brand and a reputation.
Consistency matters whether you sell a product or provide a service. You go to McDonalds for a Big Mac because you expect it to taste as good as the last. The same is true for when you reschedule your next dental appointment. You show up expecting the same level of care and attention as your previous visit.
Delivering consistency not only gives our customers what they expect, but it also establishes a baseline that we can use for improvement. If your product or service varies widely (in terms of quality, time required, cost to produce, etc), then it becomes nearly impossible to make sustained improvements.
Improve Efficiency
On a high speed assembly line, operators may have as little as 10 seconds to perform their job. In this case, good standard work can be the difference between capable work and an impossible task.
In manufacturing, standard work documents the sequence of steps and the best known technique for efficiently performing any given task. Without standard work, two different operators may not perform at the same level of efficiency that’s required to keep the line running smoothly.
Standard work teaches employees the best way to do something. Without standard work, the duration and quality of routine tasks can vary widely from one employee to the next.
A good place to start identifying where standard work could improve your business efficiency is to look for routine tasks that experience a lot of fluctuation in the amount of time it takes your team to perform. Another place to look is for processes that are prone to mistakes and require frequent corrections.
Benchmark those activities with your team. Are there some people who are able to complete the task much faster on average than the rest? What do they do differently? Is there something they do that makes them less prone to errors?
Standard work helps us train all team members to an accepted level of productivity. It can help alleviate bottlenecks in the value stream by smoothing out fluctuations and reducing mistakes.
Ensure Safety
Walk into any manufacturing facility and chances are good that you’ll find standard work posted near any piece of heavy equipment. For example, there are special lock-out tag-out procedures that are strictly enforced when maintaining injection molds and steel presses because serious injury is at risk if maintenance tasks are not done correctly.
By reminding employees to follow critical steps, standard work exists to decrease the risk of a safety incident when the costs of a mistake are high. But safety incidents can extend beyond those that may cause physical harm to our employees or our patients. We can also use standard work to prevent against mistakes that might cause excessive harm to the health of our business.
Are there opportunities where a simple mistake or lapse in judgement could cost you a relationship with a client or an opportunity for a sale? Sometimes you can identify appropriate tasks within the business where standard work can benefit you as a safeguard against unnecessary and costly mistakes.
Standard Work Using Checklists
Some of the best advice I’ve found for implementing standard work comes from the book, The Checklist Manifesto, written by Dr. Atul Gawande. If you’re interested in reading it for yourself, here’s a brief synopsis of the book from Amazon:
The modern world has given us stupendous know-how. Yet avoidable failures continue to plague us in health care, government, the law, the financial industry—in almost every realm of organized activity. And the reason is simple: the volume and complexity of knowledge today has exceeded our ability as individuals to properly deliver it to people—consistently, correctly, safely. We train longer, specialize more, use ever-advancing technologies, and still we fail. Atul Gawande makes a compelling argument that we can do better, using the simplest of methods: the checklist.
Checklists are a simple and effective means for creating standard work for your business. What we want to avoid are long, overly complicated documents. Those that sit in a binder and collect dust, or worse, never make it out of our hard drive.
From Dr. Gawande’s book, we find the following advice for creating standard work checklists that work. First, we need to differentiate between two types of checklists: DO-CONFIRM versus READ-DO.
DO-CONFIRM: This checklist is used after a team member has performed their task from memory. It helps them confirm that everything has been completed. When enforced, this type of checklist can greatly reduce the amount of omission errors.
For example, I use a DO-CONFIRM checklist after I finish writing a new post. It reminds me to make sure I’ve updated the category, added SEO search terms, and included a featured image before I schedule the post.
READ-DO: With this checklist, team members carry out the tasks as they check them off. It’s kind of like a recipe. Read-do checklists are great for documenting processes that aren’t done very often and can be referenced for new employee training or when someone needs to fill in for another team member and perform tasks they don’t normally do.
Regardless of what type of checklist you make, keep it short and simple. Long lists are ignored. The ideal checklist is 5-9 items long and doesn’t exceed one page.
At the end of the day, standard work is only effective if we use it. For that reason, simple checklists are a quick, easy, and proven way to introduce standard work to your team.
Conclusion
Checklists seem to provide protection against such failures. They remind us of the minimum necessary steps and make them explicit. They not only offer the possibility of verification but also instill a kind of discipline of higher performance.
The Checklist Manifesto
Standard work isn’t’ just for large scale manufacturing companies. It’s a tool that can be used by any business that seeks to improve their performance through increased consistency, efficiency, and safety.
More than all of that, following standard work shows a commitment to excellence. It demonstrates a willingness to hone your craft by using methods of sustained improvement.
Take a look at your current processes and find some small wins to get you started. Do your patients receive mixed experiences when they shouldn’t? Does a step in your care process take more time depending on the day or team member involved?
It might be time for you to consider taking a page out of the manufacturing playbook.
Does your team use standard work in your practice? Do you find it beneficial? Or is it just one more thing that gets ignored? Share your thoughts on how checklists and other forms of standard work have impacted your practice in the comments below!
This post was co-authored by Tyler DeVries. Tyler is an engineer and graduate of the University of Michigan. You can read more from Tyler by visiting his blog.
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