1. Ronnalea Hamman, Leader, imPROVE, PHSA Shawn Smith, Quality Improvement Advisor, NHA Presented on behalf of the Education Working Group of the BC Provincial Lean Network

2. We will turn into robots! This allows for no creativity.But every patient is different and we couldnt possibly standardize the work we do with them.Standardization doesnt address the clinical expertise that I bring to my work. 3. 3 4. 5 5. Sources of Variation6 6. Which management problem would you rather have? PerformanceTarget *Taken from Continuous Performance Improvement The Basics (JWA Consulting)7 7. CONTENTSEQUENCEOUTCOME Standard Process can potentially incur better OUTCOMES by establishing What steps (CONTENT) The order (SEQUENCE) A result (OUTCOME) 8 8. CONTENTThe necessary steps required to provide a service or to do a task. Hiring Package Compilation Compile package HR Associate Final Check Place pkg. in envelope and send Retrieve hire list Sort hire list & print Produce hire letters from templates Perform cursory check Print letters & labelsPrep of Patient Lab Samples for transport to Lab Place requisition in outside pocket of biohazard bag Place biohazard bag in appropriate bin at unit clerk desk & inform UC there is a sample Gather the supplies Prepare sample for transport Record the required info on requisition 9 9. The order that the steps need to be carried out in order to provide the service. Hiring Package CompilationSEQUENCE1) Retrieve hire list 2) Sort hire list & print 3) Produce hire letters from templates 4) Perform cursory check 5) Print hire letters and labels 6) Compile hiring package 7) HR associate final check 8) Place package in envelope and sendPrep of Patient Lab Samples for transport to Lab 1) Gather the supplies 2) Prepare sample for transport 3) Record the required info on requisition. 4) Place requisition on pocket outside of bag 5) Place biohazard bag in appropriate bin at unit clerk desk and inform UC there is a sample.10 10. This process is designed to achieve an objective which ultimately may lead to bigger outcomes.Hiring Package CompilationPrep of Patient Lab Samples for transport to LabObjective:Objective:Complete and accurate hiring package in a timely fashionCorrect sample, with correct label arriving to lab intact in a timely fashion Outcomes:Outcomes: OUTCOME Good first impressions Happy New Hire (SATISFACTION) Better reputation for PHSA Correct results to the correct patient Increased patient SAFETY Decreased delays11 11. May Impact:Standard ProcessQUALITY:Standard Process for Patient preparation for C-section.SAFETY:Standard Process for Group and Screen Blood Specimen labeling by unit staffDELIVERY:Standard Process for timely submission of procedure dates to OR BookingCOST:Standard process for stocking bedside carts in unitSATISFACTION:Standard Process for office submission of leave requests.12 12. About process data No data have meaning apart from context Data is critical to understanding the voice of the process Improvement should bring the voices of the process and the patient into alignmentReference: Wheeler, Donald J., (2000). Understanding Variation: the key to managing chaos. 13. 40012/10/2012 12/11/2012 12/12/2012 12/13/2012 12/14/2012 12/15/2012 12/16/2012 12/17/2012 12/18/2012 12/19/2012 12/20/2012 12/21/2012 12/22/2012 12/23/2012 12/24/2012 12/25/2012 12/26/2012 12/27/2012 12/28/2012 12/29/2012 12/30/2012 12/31/2012 1/1/2013 1/2/2013 1/3/2013 1/4/2013 1/5/2013 1/6/2013 1/7/2013 1/8/2013 1/9/2013 1/10/2013 1/11/2013 1/12/2013 1/13/2013 1/14/2013 1/15/2013 1/16/2013 1/17/2013 1/18/2013 1/19/2013 1/20/2013Contextual Process Data: 6005009 OOC Conditions3002001000 14. Contextual Process Data: Zero OOC Conditions 15. Quality LevelInflection Point: Key Moment for Standardizing workLikely Trajectory: Without Standardizing workTime16 16. Episode Count 163-beforeRange 400 sec.On the similar scale as above.-afterAverage 20 sec.Episode Count 435Range 50 sec.17 17. Standardized work without improvement Employee motivation is killed, human creativity wasted Problems repeat, unidentified, unsolved, unabated Employees dont take initiative, improvement stopsImprovements without standardized work Chaotic change, the saw-tooth effect of progress and regress Problems repeat, PDCA not followed, no root cause analysis Progress impossible to identify, Improvement stops Kaizen as an expression of the scientific method - requires a baseline of comparison. John Shook; Five Missing Pieces in Your Standardized Work; www.lean.org19 18. Observe Kaizen Trial (PDSA) Document Make Visual1. Observe current state and identify waste 2. Perform improvement, remove waste and design and draft new process 3. Trial new process many times (PDSA) 4. Document the standard process (sequence of steps) 5. Make the standard process visual 6. Post Standard Process and Educate 7. Sustain and continuously improvePost Sustain 20 19. A technique for achieving consistent performance: - reduces variability - reduces waste - reduces cost Based upon the best known method to get the job done Standard Operating Procedures (SOP)21 20. If the process is unstableunpredictable Find the causes of the instabilityAND Remove those causes from your systemOR Remove the effects of those causes from your system Reference: Wheeler, Donald J., (2000). Understanding Variation: the key to managing chaos. 21. Manage Variation Create a Formal Process Stop tampering Develop operational definitions Improve predictions Develop contingency plans Sort products and services into grades Desensitize Exploit variation Reference: The Improvement Guide, Langley, Nolan, Nolan, Norman, and Provost, p.359, 2009 22. Design Systems to Avoid Mistakes Use reminders Use differentiation Use constraints Use affordancesReference: The Improvement Guide, Langley, Nolan, Nolan, Norman, and Provost, p.359, 2009 23. Changes You KeepA P S DSImplementation HunchesWider TestingA P S DFollow-upsSmall Tests26 24. A P S DThe New Normal27 25. If the process is stable & predictable Ignore or tweak the good predictable processesAND Redesign the bad predictable processesReference: Wheeler, Donald J., (2000). Understanding Variation: the key to managing chaos. 26. Lets Draw a Pig!Follow instructions givenIn 5 minutes, share your creation29 27. Standardized process may not be enough to consistently meet customer demand. Standard work adds the role of time. 28. Standard Process (Reliable Methods)Has the elements: Content Sequence OutcomeProcess may involve more than one operator32Standard WorkHas the elements: Content Sequence Timing Outcome Process is for one operator Establishes cycle times Involves looking at demand and takt times (and matching CT = TT) 29. Thank You