twi martha purrier - home | lean frontiers
TRANSCRIPT
2/10/20
1
Auditing Standard WorkMartha Purrier MN, RN
Director of Nursing
TWI Summit- Austin, TXFeb. 17, 2020
1
© 2020 Virginia Mason Medical Center
Example Issue: Medication Carts
• Point of Use philosophy• On the genba, at the room• In flow documentation• PPE requirements for
hazardous medications• Human behavior to overstock• Expiration of “House Supply”• Communication issue with
pharmacy to replace “PRN’s”• Many users, multiple shifts
2
2/10/20
2
© 2020 Virginia Mason Medical Center
Standard Work Document
3
© 2020 Virginia Mason Medical Center
Principles of 5S Need help with this form? Contact KPO at [email protected] or 206-223-7621
5S Levels of Achievement
Sorting Simplifying Sweeping Standardizing Self-Discipline
Level V
Continuously Improve
Cleanliness problem areas are identified and mess-prevention actions are in place
Map has been created for each item in storage room showing general location and layout of materials and can be retrieved quickly with minimal effort
Potential issues are identified and countermeasures are documented
Reliable methods and standards are shared throughout similar work areas
Root causes are eliminated and improvement actions focus on developing preventive methods
Level IV
Focus on Reliability
Work area has documented housekeeping responsibilities and schedules, and the assignments are consistently followed
Items move from storage to vise; visual control; created to identify point of use
Inspection of area occurs daily, and work areas and equipment are restocked and organized
Reliable methods and standards are adhered to by all members of the work group
Sources and frequency of problems are documented as part of routine work, root cause of noncompliance are identified and corrective action plans are developed
Level III
Make it Visible
Initial cleaning has been completed; items are disposed of according to auction disposition
Needed items are outlined, dedicated locations are properly labeled, and required quantities are determined
Visual controls and indicators are established and marked for the work area equipment, files and supplies
Documentation for all visual controls exists
Work group routinely checks area to maintain 5S agreements
Level II
Focus on Basics
Needed and not-needed items are identified, and those not needed are removed from wok area
Needed items are stored and organized according to frequency of use
Work group has agreed on items to be checked, and acceptable performance levels are documented
Work group has documented agreements for needed items, organization and work area controls
Documentation of completed 5S is posted in work area; 5S is incorporated into new-staff orientation
Level I
Just Beginning
Necessary and unnecessary items are mixed together throughout the work area
Items needed are located in various places throughout the work area
Key work items are missing and current location is not known
Standards for work area organization are not followed or documented
Work area checks are not done regularly, and there is no visual measurement of 5S performance
4
2/10/20
3
© 2020 Virginia Mason Medical Center
Job Instruction
No. _______ JOB INSTRUCTION BREAKDOWN SHEET – HEALTHCARE Task:
Supplies: Instruments & Equipment:
IMPORTANT STEPS KEY POINTS REASONS A logical segment of the operation when something happens to advance the work
Anything in a step that might – 1. Make or break the job 2. Injure the worker 3. Make the job easier to do, i.e.
“knack”, “trick”, special timing, bit of special information.
Reasons for key points
5
© 2020 Virginia Mason Medical Center
Audit Card Elements
6
2/10/20
4
Scheduling Sequence
• Use of Production Board- this is coated wall in Leadership Office
• Assignments by day of week and by role (24/7 opportunity)
• Can assign team the same audit or check multiple processes (deep or wide)
• Cards are laminated, audit conducted on genba,
• Results taped back onto wall to the right side
• Review by team for % completion and RCA for abnormal conditions
7
© 2020 Virginia Mason Medical Center
Assignment of the Audit
Benefits beyond the numbers….messaging
• Impress upon team the importance of the Standard- Leader • “Go and see for yourself” Leader Standard Work- Leader• New Standard, or if there is instability- Leader• Practice External Inspector- Leader from different department• Responsibility/Expection of SW for frontline leader- Charge Nurse• Expectation of the Standards for individual – RN assigned to cart• Expectation to re-set the cart- Oncoming RN audits off-going RN
8
2/10/20
5
© 2020 Virginia Mason Medical Center
Review Results
If great results: reschedule for future…next week? Next month?If abnormal/less than great results: attempt to understand why, course correct, reschedule audit asap.
Failure of Standard Work Root Cause Analysis
Title: Problem Statement: Last known metrics:
Barriers to Standard Work – (check all that apply)
1. Can’t find it
2. No longer relevant
3. Not enough detail or incomplete
4. No accountability after training
5. Training incomplete or
6. Staff issues/crisis mode
7. Leadership changes
8. Can’t be done as designed
9. Process Owner unprepared
10. Lack of enthusiasm to continue or improve
11. Mutiny
12. Relaxed after training – drift
13. Other – be specific
Plan to Return to Standards – (corresponding counter to each item listed)
9
“Without Standards, there can be no improvement.”
Taiichi Ohno
10