Tuesday, May 3, 2022

Wednesday's Words of Quality, Lesson #8: Role of the Team Member in Quality

 Wednesday's Words of Quality, 

Lesson #8: Role of the Team Member in Quality 

 Richard Zarbo, MD  © 2022 Wednesday’s Words of Quality


Lesson #8 of 13



It is safe to conclude that anyone who attempts to adopt Lean management is not satisfied with the status quo and desires to change work outcomes. Lean success is highly dependent on management’s understanding as Steven Spear put it, that “The real challenge is to expand beyond understanding Lean as a set of tools, and more aggressively pursuing an understanding of the comprehensive approach to managing organizations so they are capable of self-diagnosis, learning, and relentless internally generated improvement and innovation.” But how is this done?

 

To cut to the chase, Toyota’s success 

is the result of leadership and employee involvement.

 

 

Worker Empowerment and Engagement

 

Probably the most significant attribute of the Toyota approach is the establishment of a system culture composed of an empowered and engaged workforce that is expected to drive continuous improvements.

 

This requires consistently held weekly team meetings (brief) devoted to quality improvement of processes. The approaches are based on Lean principles of deeper

process knowledge of failures and proposed interventions for improvement (changes)

based on metrics, until targets of success are met.

 

This results in a basic expectation of continuous attention to opportunities for improvement by all staff. This also defines the foundation of work. The need to continually improve is woven into the fabric of the people and not viewed as a time consuming inconvenience, option, potential reward, or incentive, as often is the perception in the usual American workforce.

 

Your success in adapting Lean to your own work environment can be judged when you can walk away and the employee culture can sustain itself in the implementation of continual process improvements.

 

This requires a critical philosophical difference in the expected roles of your employees.

If you have organized them into teams, we can now refer to them as team members.

 

 

Management Failures

Worker Empowerment

Every worker is a potential team member. If they don't understand that they are part of a team and who their team leader is, then that is a management failure.

 

If they haven't been instructed in the expectation of zero-defect work, the structure for contributing to change, the opportunity to communicate in effective customer-supplier relationships to solve their own problems, and the principles of waste-free, efficient work, then that is a management failure.

 

 

Learning by Doing

 

Unlike many businesses, in the Toyota culture on-the-job employee training in quality

improvement is built into the system such that the expectation embraced by all is that

of “learning by doing” first, with more formal training second. In this approach, staff are

placed in an everyday difficult circumstance and then allowed to problem solve by

doing.

 

Lean processes are designed to highlight problems in real time where the work is

performed by getting to the root cause and by the person doing the job at the time the

problem occurs. In short, feedback loops making use of indicators and metrics are

designed into the process to allow working staff to identify defects in real-time.

 

By comparison, the usual American manufacturing approach to training is that of an

undertaking that must be scheduled, presented by formal instruction, with a minimum

of hands-on instruction. In this latter view, training time is viewed as a detractor of

valuable production time.

 

The Toyota approach to work has been described by Mike Rother as the 'improvement

kata' (a method or routine of human behavior). Can we replicate it? We can certainly

try. It is a fact (proven in industry) that proper training reduces the time associated with

the learning curve and improves quality.

 

 

Applying Work Rule #4, Basis of the Improvement Kata

 

One of the opportunities that most impressed us as a means of moving toward the ideal

condition is Toyota’s Work Rule #4 as defined by Steven Spear, which states that any

improvement must be made in accordance with the scientific method, under the guidance of a teacher, at the lowest possible level in the organization.

 

That is to say that changes or pilot “experiments” are suggested and carried out by those actually doing the work. This approach also facilitates employee buy-in (empowerment) to change and increases compliance with the new work standard.

 

From our own experiences in the Henry Ford Production System, we know that when a

employee contributes to the change, they are more likely to experience ownership.

 

Change then, is not made by, but facilitated by the teacher who is defined as an internal

expert, knowledgeable and experienced in the area taught. This also promotes employee accountability.

 

By comparison, the American business culture often employs external consultants to analyze and suggest change. Yet many times these ‘experts’ have only minimal knowledge of actual work processes and outputs and must be informed and taught of details by the employees themselves.

 

Conversely, in the Toyota approach, empowered workers see their daily work in the context of continually making effective process improvement changes that are designed and tested by the scientific method.

 

To convert to and foster this latter culture, it is important to acknowledge that your employees are the ‘experts’ and hold the knowledge that can result in continually improving the work toward whatever goals are desired by themselves and defined by their leaders/managers.

 

 

Problem Resolution by Team Members

 

In a Lean management system, continuous problem resolution is dependent on a

worker-driven 'bottom up' approach rather than the conventional management driven

'top down' approach to problem solving. By leveraging the quality improvement

organizational structure defined previously that aligns team members with their team

leader and work stations into small teams, we can foster employee identification of the

nature and scope of defects, and stimulate and guide the discussion of possible

solutions that can be tested. This cooperative approach is predicated on a 'no blame but

all accountable' sense of process ownership.

 

Through an empowering structure that continually informs the workforce about the

quality of their work product and charges them with improving it, employees more

readily assimilate the mantra- "never pass a defect".

 

Transforming the culture of work, or more correctly the employees’ incentive to relate

to each other and work differently, must occur to obtain success in a Lean enterprise.

 

The role of leadership is to establish the shift in work expectations, structures and

realignment of incentives so that employees can relate to and interact with each other

horizontally across the path of workflow and contribute collaboratively toward work

process redesign across historical work silos. This takes collaboration of

supervisors/managers who control adjacent, dependent or connected work silos in

customer-supplier relationships.

 

To be effective in fostering change from the bottom-up, so to speak, the people-focused

strengths of Toyota's culture must be reproduced- namely:

 

• Employees in charge of their own jobs

• Employees designing standardized work

• Employees working to continually improve the work, with changes made by teams and effectiveness assessed by the customer focused PDCA cycle

 

 

Roles of Team Members

 

In this new Lean culture of work, the consistently engaged, learning, communicating and

contributing team member is expected to fulfill the following empowered roles so that

effective process improvements can be continually designed and tested by scientific

method (PDCA) in the workplace:

 

• Understand the work rules, principles and tools of process improvement

• Identify defects, daily, on whiteboards or deviation management forms

• Meet in team quality improvement huddles to regularly to share and brainstorm problems in the workplace

• Join teams charged with addressing interventions

• Assist in design of measurement tools and metrics

• Collect the data

• Assist in root cause analysis

• Communicate to other teams, customers-suppliers

• Communicate to managers/leaders

• Keep track of process improvements

• Continually seek better ways of performing the work

• Present results of successes

• Learn from previously proposed interventions that did not work (the failures)

 

As you can see from these activities described above, all focused on improving the work,

such that teamwork and participation in the process forms the foundation of Lean process improvement.



Required Core Lean Activities

 

But there is more. There are 4 core activities required of your employees to engage in teams so that continuous improvement occurs.





We commonly entertain the following questions from managers and employees in Lean training that get to the heart of Dr. Deming’s caution that-

 

"It is not enough to do your best; you must know what to do, and then do your best."

 

Question from manager: How do I get Lean to be more than a sporadic crisis-driven project but rather a continuous improvement initiative owned by all employees?

 

Question from employee: What’s my role in Lean and what do you want me to do?

 

Answer: From our 15 years of Lean experience, we have been able to distill our basic employee training in Lean to address 4 new and expected Lean behaviors. These are core educational modules in Lean Bronze Certification Training that define required employee knowledge and engagement in the Lean continuous improvement process.

 

The 4 activities are:

 

5S (Sort-Set in order-Shine-Standardize-Sustain)ustain)

 

Lean culture requires creating a visual, organized, standardized workplace (workcell) that is organized by employees who do the actual work. 5S is a structured approach to workplace organization that begins the process of standardization and creation of the visual work. 


Ironically, we here at Henry Ford Health are the rightful heirs of 5S which originated with the 5C workplace organization of Ford Motor Company - Clear-Configure-Clean-Conform-Custom.

 

PDCA Problem Solving (Plan-Do-Check-Act)

 

This is a structured approach to problem solving that requires data to define the current condition, understanding the problem more deeply at the level of root cause by involving the customer or supplier, a best guess as to the process change that would improve toward the target condition, an action plan to test the proposed intervention, and data collection to re-evaluate the condition for improvement. Repeated PDCA cycles of process change improvements are implemented until the target condition is achieved consistently.

 

The desired output of problem solving is Standard Work is created by consensus of those who actually do the work. This is the basis of standardization. Written and practiced standard work is continually improved based on knowledge of defective work yet received or produced in order to reduce variability and waste to achieve higher levels of quality, consistency, throughput, productivity and cost.

 

Deviation Management

 

All employees identify and document all defective work encountered to understand what to improve, document corrective actions taken, and contribute to planned process changes to eliminate the most common or severe deviations from expected work outcomes.

 

Daily Management

 

All employees attend Daily Management board huddles to identify, track and resolve the most critical defective work processes by contributing to root cause analysis and proposing interventions within 24 hours of occurrence.

 

The knowledge and skill sets described above define the basic Lean Bronze Certification for beginners in the Henry Ford Production System. Self-directed learning of these basic Lean competencies is available for Henry Ford Health employees and as modules that managers and supervisors may review with their team members.

 

 

 

References:

1. Spear S and Bowen KH: Decoding the DNA of the Toyota Production System. Harvard Business Review, Sept-Oct, 97-106, 1999

2. Zarbo RJ, Copeland JR, Varney RC: Deviation Management: Key Management Subsystem Driver of Knowledge-Based Continuous Improvement in the Henry Ford Production System. AJCP 148:354-367, 2017

3. Zarbo RJ, Varney RC, Copeland JR, et al: Daily Management System of The Henry Ford Production System: QTIPS to Focus Continuous Improvements at the Level of the Work. AJCP 144:1-15, 2015

 

 

Wednesday's Words of Quality, Lesson #7: Role of the Team Leader for Quality

 Wednesday's Words of Quality, 

Lesson #7: Role of the Team Leader for Quality 

 Richard Zarbo, MD  © 2022 Wednesday’s Words of Quality


Lesson #7 of 13



As in biologic systems, structure (organizational) begets function. If the desired outcome is individuals charged with accountability for the quality of their own work, then this requires us as leaders to redefine that expectation of workers themselves.

 

"It’s the work, not the man that manages." -Henry Ford

 

Just saying that work is to be delivered in continuous flow, according to next customer

specification, without defects, in a timely, accurate, cost-effectively and safe manner, won’t make it so. This Lean expectation must be structured to occur consistently. Here we discuss the all-important role of the team leader for quality in work areas or workstations.

 

It is extremely important when training in Lean tools and principles of work improvement to train teams and their leaders along the path of workflow not just individuals to work effectively together.

 

 

Team Leader for Process Improvement

 

The concept of the workstation team leader for process improvement is a novel adaption to the work of healthcare that we borrowed from the Toyota Production System in creating the sustaining work structure of the Henry Ford Production System. This team leader for process improvement is the equivalent of the quarterback in football and is responsible for the functional health of the team toward continuous improvement. This individual is responsible for encouraging team members to identify workplace non-value added work or waste, for instance

using whiteboards, to mine the type and nature of in-process defects that plague us every day, so that teams can generate and test solutions leading to new work design.

 

 

Worker Empowerment & Structure

 

This structure of teams with their designated team leaders for process improvement requires identification of workstations along the path of workflow in order to foster individual worker and team empowerment and accountability for continuous improvement.

 

Juran's definition of empowerment is pertinent here as one who “has knowledge, skills, authority & desire to decide and act within prescribed limits and takes responsibility for the consequences of their actions and for contribution to the success of the enterprise.”

 

To obtain the consistently engaged worker requires us to transform our approach to work from just showing up for work on time and doing as directed, to workers invited to think about and learn from doing their work and to contribute thoughtfully and creatively to doing the work better. In this manner we cultivate empowered workers who now see their daily work in the context of continually learning, constantly communicating with their team members and team leaders in a structured approach to making effective process improvements that are designed and tested by scientific method (PDCA).

 

We should think of work as something that is supplied to or done or created for someone else's use (the customer). To ensure that the work of the workstation is defect free, continually improving for its customer and aligned with the work received from the supplier, requires designation of workstation team leaders to assist the team members with their newly expected focus on continual improvement.

 

This is the effective structure that allows teams to consistently understand improvement opportunities presented by the work itself, for instance from white boards or deviation management, and to employ the tools of improvement in a sustained fashion. If you have multiple shifts, consider appointing a team leader for process improvement on the workstation of each shift so that they can coordinate quality initiatives from workers on all shifts as the in-process defects are encountered. This structures communication between shifts and with the next level leader, the supervisor or manager.

 

 

The Workstations

 

Our definition of workstations are semi-autonomous and multi-skilled work teams along the path of workflow that contribute to a task, service or product that is used by or serves another group in the workplace. You may ask yourself several questions to identify what constitutes a workstation:

 

Who does what for whom? (Customer-Supplier) 

Who passes you your work? (Supplier) 

Who requests work from you? (Customer) 

Are they inside or outside your department? (Internal or External Suppliers and Customers)

 

Work may be seen as accomplished in stages.


-----> Stage 1 -----> Stage 2 -----> Stage 3 ----->


According to Deming- " Work comes into any stage, changes state, and moves on into the next stage. Any stage has a customer, the next stage. The final stage will send product or service to the ultimate customer, he that buys the product or the service."

 

What are the stages of your work?

 

Do you have someone who is specifically designated as a team leader for process improvement in that stage? How have you structured oversight for quality in that stage so that we can achieve Deming's vision that-

 

"Each stage works with the next stage and with the preceding stage toward

optimum accommodation, all stages working together toward quality that the

ultimate customer will boast about."

 

 

Role of the Team Leader for Process Improvement

 

We all have job descriptions sanctioned by leaders, managers and job descriptions. But in a Lean culture where we continually seek work improvements, the most important job expectation of the often ill-defined "OTHER duties as defined" option. 


In a Lean managed culture this "OTHER duties" option becomes larger as we ask employees to act creatively within the prescribed limits of the Lean culture and structure to contribute to continual work improvement.

 

Recognition of team leaders for process improvement along interconnected workstations in the path of workflow to foster this transformed approach to work is an opportunity gifted to leaders and managers that should not be squandered.

 

But how do we identify one of the team to serve in the important role of team

leader?

 

We have numerous options and we should chose very well as this individual's passion and commitment to continual improvement and change are key to success of the Lean culture. Typically, this individual is already defined by an existing leadership or workstation role. If no workstation leader exists then you can appoint by ability, by passion or by vote of the workstation members. Of course, as leaders we may occasionally need to side-step an existing but dysfunctional leader by appointing a co-leader to ensure success. This has many advantages over removing a leader who, despite coaching, for some reason is not capable of leading in this fashion or is not supportive of the changed manner of working with empowered, communicating workers.

 

The team leader choice is critical as this individual must never be complacent with the status quo but rather must continually and proactively push for continual improvement. The advantage of these workstation leaders is that they are located closest to the level of the work where the defects are apparent often only to the workers who do the actual work.

 

 

Quality Related Expectations of the Team Leader for Process Improvement

 

The work-related expectations of the team leader for quality include the following:

 

• Project identification, selection, and prioritization

• Focus on problems and process, not personalities (neutralize the personality blame game)

• Knowledge of and adherence to the Lean work rules and principles, and use of appropriate          tools

• Team member selection

• Project definition, study, and identification of sound measures for PDCA based improvements

• Customer-supplier connections

• Reality test proposed interventions

• Project tracking

• Assure effective Daily Management Board of metrics and interventions

• Push for continual problem identification through Deviation Management

• Seek ideas for change from the team members

• Communication and recognition

• Coach, develop and encourage team members

• Deal with failures

• Celebrate the team’s success

 

This team leader role is a growth and development opportunity that leverages workplace learnings to continually develop people to solve problems in a defined manner. This will come to define your new work culture. You will find soon enough after months of team successes that the Lean culture provides fertile ground for self-growth and breeds our next generation of leaders.

 

Did someone just say Employee Engagement scores?

 

 

Next WWQ: Lesson #8 – Role of the Team Member

Wednesday's Words of Quality, Lesson #6: The Business Case for Change

 Wednesday's Words of Quality, 

Lesson #6: The Business Case for Change 

Richard Zarbo, MD  © 2022 Wednesday’s Words of Quality


Lesson #6 of 13


 

Lean is a Business Management System

 


"If you don't like change, you will like irrelevance even less." 

                                                                            - General Eric Shinseki

 


Our business case for change lies in the sensitivity that “Learning is not compulsory, and neither is survival” as Dr. Deming was fond of saying.

 

Key to our survival strategy is Deming’s Quality Chain Reaction where pursuit of

quality leads to designing work systems so that people are capable of consistently doing things right the first time. The result is a business with increased productivity (not doing it twice with rework) and decreased costs of doing the work. This in turn, enables a business to offer lower prices to customers which attract increased business volumes resulting in increased profits and higher customer satisfaction. This is the basis for creating a business culture of continuous improvement and change that sees quality as more than a desirable outcome but as the foundation of a business strategy to remain competitive.



The term Continual Improvement connotes the ongoing nature of the strategy.

According to Deming, Quality is not a state to be achieved but rather an ongoing

company-wide effort at continual improvement. This is THE PROCESS- the way everyone thinks, talks, works and acts every day. This is the definition of culture- the way we all behave.

 

But don’t just listen to Deming's rationale for continual change. Henry Ford got it right

almost 100 years ago:

 

"Our own attitude is that we are charged with discovering the best way of doing

everything, and that we must regard every process employed in manufacturing as purely experimental. If we reach a stage in production which seems remarkable as compared with what has gone before, then that is just a stage of production and nothing more."

 

The success of this strategy is obvious in comparing organizations in which Continuous Improvement is at the core of their DNA. The Lean 20 is a list of Lean companies suggested by readers of Evolving Excellence and Superfactory. The Lean

20 average business return of 12.71% is a simple average of the year to date

performance of each company, which can be compared to the S&P 500. The 10 top

performers returned 16- 32% more than the non-Lean practicing businesses comprising the S&P 500 over time. I take this as evidence of superior business performance.

 

 

Constancy of Purpose

 

Creating constancy of purpose towards improving work product and service levels is the basis of continual improvement. This enables us to be competitive and to grow in a very tough healthcare market where patients and reimbursements are declining. Ultimately, this allows us to stay in business and to provide jobs.

 

This constancy of purpose is focused on the customer. Who are your customers?

Internal as well as external? What do they want? What specifically are their needs and expectations? How well are you serving them? Are you just meeting minimum

expectations and someone else's benchmarks or are you thrilling them?

 

Constancy of purpose requires leaders to address:

• philosophy and policy

• core values

• long term strategic course

 

In Lean lesson #1, I discussed the philosophy at the core of people development,

supported by an appropriate management system that empowers the workforce to

effectively employ technical tools of work efficiency and process improvement. It is our role as leaders to reinforce this cultural transformation in the workers perception of their work roles, to create structures for empowered workers to be accountable and

successful, to communicate, support, reward and model this culture of engaged

workers, helping to identify and resolve defects and eliminate waste. Leaders must be

engaged and lead from "the shop floor" to use the manufacturing analogy. It is from this perspective that opportunities for improvement become evident daily, at a very

granular level.

 

 What to Do

 

"Doing your best is not good enough. You have to know what to do. Then do your best."

                                                                               -W. Edwards Deming

 

As a leader, knowing what to do is the part each of you and your workers own in your

area of expertise. That requires constant attention to refining what you do to be better,

continually. For that you need a structure that provides accountability by defined teams for continual identification and correction of defective work and work processes in the workplace and at individual workstations where this occurs with on-going measures of how well you are performing. We will address these topics subsequently in this series.

 

You Must Lead the Change

 

What is your role in leading change and assuring successful transformation to a Lean

working culture? What is expected of you? What is the difference between leadership

and management?

 

John Kotter, a voice of the Western management style, would say "Leadership is the

development of vision and strategies, the alignment of relevant people behind those strategies, and the empowerment of individuals to make the vision happen, despite obstacles. This stands in contrast with management, which involves keeping the current system operating through planning, budgeting, organizing, staffing, controlling, and problem solving."

 

Both roles are very important to business success and we often wear both hats.

 

But Deming would call us to a different understanding for business success in the Lean culture, notably his Principle #7- Adopt and Institute Leadership.

 

By leadership he means, "The job of management is not supervision, but leadership. Management must work on sources of improvement, the intent of quality of product and of service, and on the translation of the intent into design and actual product."

 

In other words, your primary focus is overseeing the continuous development of a

better system of work in which employees can be more effective in achieving the goals that you have assigned them. Otherwise, you're not doing the job. And they can’t be expected to do their jobs to your level of expectation in a flawed system of work.

 

To quote Deming again, "The required transformation of Western style of management requires that managers be leaders."

 

 

Kotter's 8 Steps of Change

 

Change, especially significant change of the status quo is not easy. Everyone loves the idea of change for the better, until it’s his or her time to change. Kotter describes a

number of managerial behaviors that are critical to succeed in producing change. When managers produce successful change of any significance in organizations, the effort is usually a time-consuming and highly complex 8-step process, never a 1-2-3, hit-and-run affair. According to Kotter, managers who opportunistically skip steps or proceed in the wrong order rarely achieve their aspirations.

 

In the most successful change efforts, leaders must move through 8 complicated stages in which they (1) create a sense of urgency, (2) put together a strong enough team to direct the process, (3) create an appropriate vision, (4) communicate that new vision broadly, (5) empower employees to act on the vision, (6) produce sufficient short-term results to give their efforts credibility and to disempower the cynics, (7) build momentum and use that momentum to tackle the tougher change problems, and (8) anchor the new behavior in organizational culture.





Practical Tips in Producing Change in Ways People Work

 

The structures we create and the support we provide to sustain worker-involved change is critical to its success. Dr. Jeffrey Liker has nicely framed the key issues for leaders who are intent on truly changing culture that will result in “a business transformation that puts customers first and does this through developing people. People who do the work have to improve the work.”

 

“As we are progressing on the ‘Lean journey’, companies are maturing from process improvement toolkits to lean value-stream management, to employee engagement in problem solving, to aligned culture focused by self-aware leadership on the right business problems. The companies I teach are begging for guidance on leadership. They have had enough discussion of tools. They understand that path is a dead end. It is the right time for this discussion, but how do you have the discussion?”

 

"There are tools, but they are not tools for 'improving the process.' They are tools for making problems visible and for helping people think about how to solve those problems. Whether it is a kanban or standardized work or 5S, these are tools to set a standard and make the deviation from the standard visible to the work group. Then the work group must develop problem-solving skills to identify the root cause and solve the real problem."

 

"Any solution is an experiment that is 'right half the time.' If the tools do not change the way people who do the work think about their own processes, the tools are a failure. If leaders do not understand how to use the tools to unleash the creativity and motivation of people, they are not leaders-they are just administering a bureaucratic process."

-Jeffrey Liker

 

 

The Bottom Line

 

"You get what you accept and what you accept sets the standard." 

                                                                        -Joseph Bujak, MD

 

It is common to for leaders to speak of change in the same sentence with changing

culture. But our own experience with culture change these past 15 years in the Henry

Ford Production System across all laboratories of 800 employees across the Henry Ford Health System has taught us repeatedly that culture is a desirable but secondary outcome to changing structure and process that enables and expects employees to work differently.

 

 

References:

1. W. Edwards Deming: Out of the Crisis. MIT Press 2000.

2. John P. Kotter: On What Leaders Really Do. Harvard Business School Press, 1999.

3. Jeffrey K. Liker: Personal communication and book review at Lean Enterprise Institute of The Lean Manager: A Novel of Lean Transformation (2009, Balle and Balle)

Wednesday's Words of Quality, Lesson #5: Standard Work

 Wednesday's Words of Quality, 

Lesson #5: Standard Work 

Richard Zarbo, MD  © 2022 Wednesday’s Words of Quality



Lesson #5 of 13



Let me begin this week’s Lean lesson with the conclusion:

 

Achieving Standard Work is hard work but the necessary 1st step in achieving high quality and reliability.

 

There are 2 main enemies of quality- lack of work standardization and poor communication. We will focus on the first one here.

 

Start with Standard Work for High Quality and Reliability

 

Achieving Standard Work is the first step to achieve work standardization by ridding work variation to obtain highly consistent and reliable work products and services. As an example, don’t you just hate it when shopping for a new pair of slacks requires trying on 4 pairs of the “same size” before one fits correctly on your perfect form?

 

You just experienced human work variation from lack of Standard Work.

 

As leaders, many see standardization from the macro level of fixing something on a grand scale. That can be effective. But I see it differently now. My many years of following the management principles of Deming as practiced in the Lean culture of Toyota tell me that another approach must be undertaken by leaders to be truly effective in creating and sustaining standardization.

 

That approach is at the micro level, or at the level of the worker, where the work actually takes place and true value to the patient is created. In manufacturing this is known as the “shop floor”. For us in healthcare this is where we work with each other in service to each other and to the patient. This is also known as the gemba.

 

Standards

 

Standardization is the practice of setting, communicating, following and improving standards.

 

A standard is defined as the current one best way to safely complete an activity with the proper outcome and the highest quality.

 

A standard is not static but can be viewed as a milestone on the path to a target or goal. Mike Rother has depicted this misconception of a standard as a stop that prevents backsliding of current processes in the following figure (adapted from Rother M: Toyota Kata. New York:McGraw Hill, 2010).




Standardization

 

Standardization relies on Standard Work - a defined activity that secures improvement and is a never ending process of review and improvement. This also requires standardizing connections (the hand-off) and pathways (steps in the process flow). These are the key elements of work design standardization that reduce variation that in turn leads to poor quality.

 

Standard Work must be created by consensus of those who actually do that work. 

This is standardization at the micro level where the defects are received, made and passed on by the workforce.

 

Standard work is more granular than a written standard operating procedure.

 

In order to be effective, Standard Work must be defined at the level of:

 

• CONTENT- Define the task and the details of the task

• SEQUENCE- What order do the tasks happen?

• TIMING- How long does it take to process?

• LOCATION- Where are the tasks taking place?

• OUTCOME- What result is clearly expected?

 

In this manner Standard Work is the foundation of consistent quality so that it-

1. Becomes a baseline for all improvement activities

2. Is the initial step to controlling variation and enhancing quality

3. Is agreed-upon work procedure that meets requirements

4. Is each process step defined & performed repeatedly in the same manner

5. Removes variability; the enemy of quality, maximizing performance

6. Minimizes waste; requiring costly rework, wasted time and resources

7. Must be adhered to, documented and communicated

8. Must be audited for compliance

9. Is only good as it satisfies the current need

10. Is not static but must be revisited and improved as conditions require

11. Also entails defining standard connections and pathways

12. Is hard work!

 

Although standard work is the basis of standardization, it is not a very easy thing to obtain or adhere to as a consistent practice of all workers doing the same task. Despite the presence of a standard operating procedure (SOP), workers can get quite creative when carrying out the steps of work defined in a SOP.

 

Therefore, this requires you to periodically audit your workers to ensure compliance with the standard work, especially steps that are critical to quality or safety.

 

Standard work also requires a work process with predefined connections between "customers" and "suppliers" and a predefined pathway that the product or service travels. These latter aspects of the work connections and the work pathway are additional opportunities for standardization of work in order to minimize variation.

 

When performing root cause, our own experience with inefficient and defective work is that there is often a violation of these work rules, defined by Spear and Bowen as the DNA of the Toyota Production System. (Spear and Bowen 1999) We often find that we either don’t have, could refine better or lack compliance with existing standard work, connections or pathways.


 

Standard Work and PDCA Culture

 

To be effective in using standardization as an opportunity for continuous improvement, leaders must create for workers a means to discuss a no-blame defective handoff by meeting with their “customer” to discuss processes not people at fault.

 

Essentially, you need to foster a culture that drives the 4th work rule defined by Spear and Bowen in order to obtain PDCA based continuous improvement by the empowered worker, at the level of the work, with their leader, based on scientific data. Each employee is a “customer” who receives a derivative of the specimen, and in turn, a “supplier” who processes the received derivative and forwards the product or service for the next step in the process.

 

Communication within customer teams is encouraged to document defects and then to communicate these during customer-supplier meetings called to address a problem. In this setting, the “supplier” team is expected to understand the “customer’s” expectation then re-evaluate and improve their own process steps to satisfy that requirement.

 

This approach to standard work adapts PDCA (Plan, Do, Check, Act) to the standardization process itself in pursuit of the perfect process. Standardization then, is dynamic, not static, and looks like this in the figure below.


Most importantly, standard work is sustained by managerial support of a culture designed to:

 

• Create structure for process improvement to take place by workers, aligned by work cell with their designated Team Leader for quality (appoint one)

• Create opportunity for horizontal communication between work cells to take place based on requirements that drive work standardization (customer-supplier meetings)

• Support teamwork and ownership of the process by every worker

• Reward workers who suggest and make improvements

• Allow (don’t punish) mistakes and encourage experimentation

• Create a system for capturing and implementing employee suggestions

• Offer training to every worker on improvement methods and optimal work design

• Hold regular meetings to drive and sustain quality initiatives

 


Protean Benefits of Standardization

 

The outcomes of standardization can have wide ranging effects.

 

For the Health System this translates to:

• Reduced variability

• Reduced waste

• Enhanced consistency, throughput, productivity

• Reduced costs $$ and rework

• Increased profit margins

 

For our Patients this translates to:

• Improved quality and clinical outcomes

• Shorter, more predictable lead and wait times

• Improved satisfaction and retention

 

For our Employees at all levels this translates to:

• Easier to learn new operations

• Easier to shift to different operations within a cell or operations in other cells or work areas

• Easier to see problems and contribute improvement ideas

• Accountability and higher engagement

• Standardization is hard work, and even harder when it must involve all employees engaged in the processes.

 

But that's the rub. As Thomas Edison said- "Opportunity is missed by most people because it comes dressed in overalls and looks like work." 


This is very important hard work for you and your team. We are all involved and accountable for making our system of work better. Our patients are counting on us for that.

 

References:

1. Rother Mike: Toyota Kata. Managing People for Improvement, Adaptiveness, and Superior Results. New York:McGraw Hill, 2010).

2. Spear Steven and Bowen Kent H: Decoding the DNA of the Toyota Production System. Harvard Business Review, Sept-Oct, 97- 106, 1999

 

 

Next WWQ: Lesson #6 – The Business Case for Change

 


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