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05/31/2012 04:31 PM
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Hi-
Our organization struggles with deploying standard work. Specifically, we are looking for good strategies to use when deploying standard work so that front line nurses, physicians, and clinical staff all receive the message and operate to the new standards.
PS--Our team will be at the HCVL Summit next week in Minneapolis if anyone would like to chat in person.
Thanks,
Chase Coffey, MD
Henry Ford West Bloomfield Hospital
Henry Ford Health System
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06/05/2012 09:23 AM
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Hi Chase,
You may find this thread about standard work useful, which I posted last fall.
http://www.lean.org/FuseTalk/f...id=6036&enterthread=y
I am still an improvement manager, although I have since moved to a different healthcare organization, and I empathize with trying to develop tools that are straightforward and helpful, communicate process steps and create consistency among what are often many disciplines. In other words, deploying standard work.
I've experimented with a few different strategies, from step by step guidelines with instructions, objectives, and photographs of what each step looks like (very detailed)... to color-coded workflows that convey process changes in a visual manner... to laminated flash cards that are carried by staff in their lab coats or circulated during rounds / huddles to structure communication.
As one contributer to the above string noted, adhering to any process for which there is a standard is facilitated by building in a method to discern when the standard is NOT being followed. In other words, use, mis-use or dis-use of the standard workflow should be evident to managers and this "evidence" acts as a control. This can sometimes be very challenging to integrate but the control will act as a management tool which will build in accountability and likely make the sustainability of the standard more successful.
I hope that you'll find some of this useful and that others with expertise can offer additional concrete strategies for deployment.
Best,
Amy
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06/05/2012 09:23 AM
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Hi Chase,
We just attended the Thedacare workshop and this is exactly what they teach you about in class. Since you are attending the summit that would be a great place to chat to some of the folks from Thedacare or those who have reach out to Shingo.
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06/05/2012 09:24 AM
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We have had similar issues in our ED with over 100 staff members & 16 physicians.
We have developed a coaching model, where each coach has approximately 6 people to coach on new standard work. within a given time frame & they are responsible for entering the date their people have been coached into an Excel Spread Sheet.
I am the Coaching resource to the two Coaching Leads who are clinical resource nurses (charge nurses) & we meet with the team of coaches on a regular basis to provide coaching training & coach them on new standard work. We also talk about coaching challenges & any issues with the standard work.
We also have an audit system to manage sustainability.
Although our model is not perfect - we have had much more success with this method than our previous methods.
Gayle Bohemier
Quality Facilitator
Emergency Department
St. Boniface Hospital
Winnipeg, Manitoba
Canada
e-mail: gbohemier@sbgh.mb.ca
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06/05/2012 09:24 AM
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Dr. Coffey,
I will also be at the HCVL Summit and would be more than happy to share our process in person. Please e-mail me direct at eric.rohrbacher@reliantmedicalgroup.org to setup a time/place.
Eric
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06/05/2012 09:24 AM
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We have found that implementing standard work begins with leadership being involved and that the nurses, physicians and clinical staff understand that implementation results can and will be measured and leadership will hold themselves and others accountable for the results. Get leadership engaged. Try Gembas. Get leaders out of their offices to "watch the work."
As important, is that front line nurses, physicians and clinical staff have been engaged in determining standard work. When they invent it, they own it and they do it. They also are the experts because they do the work every day.
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06/06/2012 11:48 AM
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Thank you all for these insightful comments. I'll certainly try to connect with some of you at the HCVL conference this week in MN.
Cheers!
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06/07/2012 12:15 PM
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Hi Dr Coffey
There are two very different issues at play in creating and making Standard Work actually work in any environment.
First is how Standard Work instructions are created, here we get a great deal of confusion with mandated work standards. Standard Work Instructions are and should be created with the active involvement of the work force, and they need to be a living set of instructions. When you get your front line workers involved in creating them and improving them over time it helps with the second issue of dealing with human change resistence. If the front line workers helped create and test and adjust them, than there is little reason they need proof that they are better (something mandated work standards always need). If they are living than overtime they will get improved as people test new ideas to improve them, and implement those changes that had a positive effect. After all Standard work is part of continuous improvement and if they do not change overtime there has been no improvement.
The second issue is change management related, whenever you mandate changes there will be far more resistence than when workers played a part in that change, and had an active sya in its development. Communication and involvement help improve adoption, deploy, and ownership (accountibility) to new Standard Work Instructions.
Robert Drescher
ELSE Inc.
Edited: 06/07/2012 at 12:14 PM by Lean Moderator
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