Standard Operations Module 11

Transcription

1 GPS Mod 11 Standard Ops MUDA MUDA Cost Reduction By Eliminating Waste Just-in-Time Profit = Price - Cost GPS Depth Study NVA/VA- Functions/Mgrs R e d e p l o y m e n t RPIW Jidoka (human automation) Setup Reduction Changeover Multi-process Operations Kaizen Quality Cost Delivery Safety Measures Standard Operations Heijunka (Leveling) Continuous Flow Morale Kaikuku TAKT Time Map Capacity Tables Total Productive Maintenance Poka-yoke (mistake proofing) Kanban 3P Prod Prep Visual Control Andon Standard Operations Module 11 7 Flows Factory Product/Patient Quantity Analysis 7 Flows Medicine 4 Nos Sorting Simplifying 5S Sweeping Standardizing Self Discipline 7 Wastes Value Stream Mapping ONE PIECE FLOW TAKT TIME PULL PRODUCTION Global Production System , John Black and Associates LLC (modified from Hiroyuki Hirano, Productivity Press). Committed Leaders 1

2 Without Standards, There Can Be No Improvement --Taiichi Ohno Considered to be the father of the Toyota Production System. He was transferred to Toyota Motor Company in 1943, named as the machine shop manager in 1949, promoted at Toyota to director in 1954, managing director in 1964, senior managing director in 1970, and executive vice president in Devised the seven wastes (or Muda in Japanese) as part of this system. "Having no problems is the biggest problem of all." Ohno saw a problem not as a negative, but in fact as "a kaizen opportunity in disguise. 2

3 Standards are not New to Healthcare We already know patients are safer when: We adhere to best practices Staff are consistently trained Clinical protocols are followed 11 Standard Ops v

4 Standards: Rounding Mod 11 Standard Ops 4 Mayo Clinic/Used with permission

5 Standard of Care Mod 11 Standard Ops 5 Mayo Clinic/Used with permission

6 Standard Hand Cleaning Mod 11 Standard Ops 6 Mayo Clinic/Used with permission

7 Standard Operations: Key Points The three elements of standard operations are standard work, Takt Time, and standard work in process. The three methods of time measurement are lead time, cycle time, and Takt Time. Standard work is a prescribed, repeatable sequence of operations, balancing manual and automatic work assigned to a single team member (operator), balanced to the Takt Time. Establishing standard work is a four-step process: 1. Observe and understand the work. 2. Analyze the work and identify the waste. 3. Eliminate the waste. 4. Standardize the new work cycle. 11 Standard Ops v

8 The Three Elements of Standard Operations A 3-legged stool is always stable, but falls over if one leg is missing. 8

9 Global Production System To Make things in the Right Way JUST IN TIME Operate with the minimum resources required to consistently deliver Just what is needed. In just the required amount. Just where it is needed. Just when it is needed. People Materials Machine s Standard Work Standard Work in Process Kanban Andon Operational Availability Takt Time Production One Piece Flow Production Supermark et System Pull System Producti on Jidoka One-by-one confirmation to detect abnormalities. Stop and respond to every abnormality. Separate machine work from human work. Enable machines to detect abnormalities and stop autonomously. Leveled Production (Heijunka) Standard operations is a fundamental tool to: Cost Reduction Through The Elimination of Muda (Waste or Non-Value Added) See and eliminate waste. Help establish continuous flow production. Hold the gains realized in RPIWs. Meet Takt Time. Drive further continuous improvements. Communicate between all providers. Improve management and better utilize resources. 9

10 Standard Operations in Healthcare Embed evidence-based standards into the practice of medicine. Enable cross coverage by making the process of care consistent. Ensure the consistent, high quality and safe treatment of patients. 11 Standard Ops v

11 The Importance of Time The primary difference between Standard Operations and what we traditionally think of as a standardized process is the role of time. Timing is how we balance & coordinate efforts. A known standard time is key to ensuring the new standards can be maintained. Time Measurement: Allows for an instantaneous measurement of process health. Allows for real time, quantitative measurement of improvement efforts. Assists in training of new personnel. Is how we manage our ability to meet customer demand (Takt Time). 11 Standard Ops v

12 The Measurement of Time Standard Operations requires we understand three methods of time measurement. 1. Lead Time (L/T) 2. Cycle Time (C/T) 3. Takt Time (T/T) 11 Standard Ops v

13 1. Lead Time The Measurement of Time Patient Requests Service Pt Schedules Wait Pt Checks In Day of service lead time Pt has BP, Wt Pt has Exam Pt is Discharged 48:00:00 0:30 5:30 2:00 2:00 2:00 3:00 20:00 5:00 Cycle Time Cycle Time Wait/ Walk Cycle Time Walk Cycle Time Walk Cycle Time Total Lead Time of the Patients Experience = all cycle times and all waits and walks in between cycle time Lead Time is observed and can be improved! 11 Standard Ops v

14 2. Cycle Time The Measurement of Time Cycle Time is measured with a Stop Watch. Team Member (Operator) Cycle Time Time required for a single team member to complete one cycle of work (e.g., room patient, check vitals, complete exam, give injections, complete surgery, turnover room, etc.). Exam Examining the patient can be a cycle time 20:00 11 Standard Ops v

15 3. Takt Time The Measurement of Time A German musical term meaning Beat. The measure of the rate of customer demand. Takt Time = Time Available Output Required A key element to establishing continuous flow production. Is calculated, not measured. Is independent of capacity, number of providers, process capability, etc. Must be known before standard operations can begin. Can change suddenly as market conditions change. Takt Time is market driven and must be met to improve patient satisfaction! 11 Standard Ops v

16 The Measurement of Time Takt Time = Time Available Output Required Calculating Takt Time Example: Market requires 40 patient visits in (1) 8 hour day. 8 hours x 60 minutes = 480 minutes Break, start-up meeting, productivity losses etc. planned time when people are not available minutes 420 minutes = net available time for patient care Takt Time = 420 minutes 40 patient visits = 10.5 minutes Takt Time is always expressed as time This means that one patient must complete the process every 10.5 minutes (regardless of lead time or cycle times) in order to meet the market requirement of 40 patients a day/8 hours. It does not mean that any given process takes 10.5 min. 11 Standard Ops v

17 The Measurement of Time Calculating Takt Time Takt Time = Available Time In Shift Output Required In Shift Exercise: 48 patient visits per day must be completed. One 8 hour shift per day What is the Takt Time? 11 Standard Ops v

18 Demand vs. Capacity Customer demand is not the same thing as your current capacity. Customer demand is the number of customers who want your product today, not how many you can see today. Capacity - Im open 8 hours, and each appointment takes about 30 minutes, so I can see only 16 people. Demand Im open 8 hours, and each appointment takes about 30 minutes. I also have calls from 4 additional people who want to be seen today but who cannot get in because there are no more appointments left - therefore my real demand is 20 people. Takt Time = Available Time Demand 11 Standard Ops v

19 Summary The Measurement of Time 1. Lead Time Total time to completely process a patient. Lead Time = Cycle 1 + Wait + Cycle 2 + Wait Cycle Time Time required for single team member to complete one cycle of work. Includes value added time and waste. Is measured with a stop watch. 3. Takt Time Measure of market demand. Is market driven and calculated. Takt Time = Time Available Output Required Is not a measure of process capability or capacity. 11 Standard Ops v

20 The Measurement of Time The Takt Time Dilemma Typically: Takt Time <<<Cycle Time<<<Lead Time How do we manage this dilemma? Multiple lines. Multiple providers/multi-tasking. Many patients in the process pipeline - the number of patients in the process at any one time is called Work In Process (WIP). These conditions lead to Long waits. Waste. Confusion, backflow and rework. Patient dissatisfaction. The purpose of standard operations is to: Define number of providers required. Define and control number of patients in process (WIP). Provide tools to better balance Takt Time with Cycle and Lead Times. 11 Standard Ops v

21 The Measurement of Time How can we use our new knowledge of time to manage the Takt Time dilemma? The relationships of Takt Time, Lead Time, and Cycle Time to each other can: Define the minimum number of team members required to meet market demand. Define the minimum number of patients required to keep the process flowing (Standard Work In Process or SWIP). 11 Standard Ops v

22 Example: The Measurements of Time Standard Operations defines the minimum number of team members required # Team members = Sum of Team member cycle times Cycle 1 + Cycle 2 + Cycle 3 Takt Time Takt Time = 80 min = 8 team members 10.5 min 8 providers are required to keep the process flowing. < 8 team members - process will stop at some point, increasing lead time. > 8 team members - opportunity to re-deploy resources after Kaizen. 11 Standard Ops v

23 The Measurement of Time Standard Operations defines the number of patients required to keep the process flowing (SWIP). SWIP = Lead Time Takt Time Example using day of service lead time At any given moment: Lead Time = 200 min = 19 patients Takt Time 10.5 min If = 19 patients: process is performing as expected. If <19 patients: process will starve at some point and market demand will not be met. If >19 patients: overscheduled or process has stopped somewhere - take action now, lead time is increasing! If we need 19 patients to keep the process flowing, but only 8 team members, what are the other 11 patients doing? 11 Standard Ops v

24 Using Standard Operations Standard Work in Process (SWIP) SWIP = Lead Time Takt Time If Standard Operations in place, the number of patients in the process at any given time is an instantaneous measure of process health No. of patients = SWIP Process is performing as expected. No. of patients > SWIP There is a bottleneck somewhere that is stopping Standard Work - go find it and fix it. No. of patients < SWIP Process is performing better than expected, lead time is being reduced. If consistent, re-adjust Standard Operations. Insufficient patients scheduled to meet market demand or market demand has changed. If consistent, find root cause and adjust Standard Operations. Either of these cases may be defined as an opportunity to re-deploy resources. 24

25 Balancing cycle times to Takt Time created the great efficiencies of Boeing and Toyotas moving assembly lines. In health care we tend to deny that our processes can be standardized because of the variability of patients and services. This line moves 2 inches per minute See

26 Purpose: Standard Work To ensure work and expectations are safe and reasonable. To define and standardize normal conditions in order to see abnormal conditions as soon as they occur. The objective is to minimize and control inconsistencies (variation) in Quality, Inventory, Output, and Cost. If you dont know where you started, how can you tell if you are getting anywhere? 11 Standard Ops v

27 Standard Work is a set of specific instructions that allow processes to be completed in a consistent, timely, and repeatable manner. To create new standard work: Determine the Takt Time Remove the waste from the process Time the steps for the cycle of work Balance the work among team members Try it, get feedback, try it again in a continual PDCA. 27

28 The Definition of Standard Work Process Step 6 Process Step 5 Process Step Process Step Process Step 1 Process Step 2 A prescribed, repeatable sequence of operations, balancing manual and automatic work: Assigned to a single team member, Balanced to the Takt Time. 11 Standard Ops v

29 The Prerequisites of Standard Work Takt Time must be known. The operation is centered around human work. The tasks are carried out repetitively. Quality and Safety items have been addressed. Dont get caught waiting until you are ready. Work balance need not be perfect before you start. Dont worry too much about efficiency when you start. Focus on just getting consistent. If you wait until you are ready, you will never begin! 11 Standard Ops v

30 Developing Standard Work Standard Work can only be learned by doing! Go to the source of the work and observe with all your senses. 11 Standard Ops v

31 Development of Standard Work Just like any process, there is a well-defined standard method for developing Standard Work. The most important tools to develop Standard Work are: Keen eyes. An inquisitive mind. Other tools include a stopwatch. A video camera can be very helpful for analysis. Remember: Standard Work is always observed where it is done, not developed in the office! Observing Standard Work is a key step in learning to see waste. Standard forms and instructions are included in the Appendix. 11 Standard Ops v

32 Standard Work Improvement Cycle Starting point Establish a standard work that defines normal conditions. Which results in a process with more consistency and less variation. Re-set the standard to the new improved process. Run the process Identify waste and opportunities for improvement. Improve the process. Change and improve the process Identify barriers to consistently following the standard. Eliminate barriers, put in countermeasures 11 Standard Ops v

33 Standard Work Tools for Documentation Forms Standard Worksheet Time Observation Form Standard Work Combination Sheet Percent Load Chart Purpose To record actual layout & flow. To train new team members. To observe operations & break into small parts. To establish best/repeatable elapsed time per element. To demonstrate best combination of manual work and machine work for one team member. To determine level of staffing in the cell. To determine machine/equipment capacity. 11 Standard Ops v

34 Process Name: Model Number: Model Name: Process Name: Product number or family Standard Work Sequence Description Scope of Operati ons Operator of Waiting From: To: Observation Cycle Number Operation Time Quali ty Check Date Prepared Dept. S afety P recaution Observation Date: Observation Time: S tandard Work In-P rocess Units per shift Takt time Date: Dept. Head # of pieces of std work in-process Analysis Number: Observer: S upervisor Takt Tim e Time Observation Sheet.ppt Manual Automatic Walking Waiting Operator Number Standard Work Combination Sheet.ppt Mini Saw-Punch xx30 Scissor Lift PUNCH SAW 1 Punch Wash Standard Work Sheet DEBUR WASH 4 SAW 2 NOTCH Developing Standard Work 5 Standard Work Forms Mod 11 Standard Ops Standard Worksheet Used to document work area layout and flow. Shows placement of equipment/work tables, sequence of work, team member. Shows supplies/material movement and the location (with standard quantity) of WIP. Notes quality assurance checks and safety items that are standard for the area. Step No. Component Task Time for 1 cycle Time Observation Sheet Component Observation Points Task Time Time Observation Form Used to document the steps in a process and time it takes to complete each step. Creates data that are used for other standard work forms. Combined with the Standard Work Sheet is the basis for decision making. Production System B Step No. Punch Saw # 1 Saw # 2 Wash Notch Debur/Clean Move to FG Work Element Totals Production System Man. Auto. Walk Standard Work Combination Sheet t/t = 630 Standard Work Combination Sheet Used to describe the best combination of manual work with equipment/machine work in relation to Takt Time. Reflects the current work sequence and the expected time for completion of each task. Includes the automatic time of any equipment in the process and the relation of the manual work to the automatic work. 34

35 Process Name: Product Line: Model Name or Part: Sum Total of Operator Cycle Times: Time Takt Time: Scope of Operations From: To: Sum of Operator Cycle Times Takt Time Date: Department Supervisor Percent Load Chart.ppt Mod 11 Standard Ops Developing Standard Work Standard Work Forms Sample Percent Load Chart (Bar Chart) Lifting Stuff GXV-2000 O.C.T. = = Team Members Required 2205 sec 630 sec 3.5 T.T. kaizen Operator A B C D Operator Cycle Time 625 sec 620 sec 615 sec 345 sec Production System kaizen t/t = 630 sec kaizen = 435 sec Percent Load (Bar Chart) Used to visually contrast team member and/or process cycle time with Takt Time for a specific line or cell. Assists in understanding the proper number of team members that should be staffing a line and the balance of the work from person to person. Indicates where Kaizen must take place with the specific requirement for improvement to achieve line balance. Work Instructions: Standard Work and Work Standard How to perform the step by step tasks to complete the SWCS. The primary tool used for training team members in the standard way to do a particular process. Photos and sketches can be very helpful here. 35

36 Developing Standard Work Establish a standard work that defines normal conditions. Run the process Identify barriers to consistently following the standard. Observe and Understand the Work Which results in a process with more consistency and less variation. Identify waste and opportunities for improvement. Standard Worksheet (Raw Data) Process Name: Step No. Component Task Re-set the standard to the new improved process. Time Observation Sheet Observation Cycle Number Improve the process. Change and improve the process Observation Date: Observation Time: Component Task Time Analysis Number: Observer: Eliminate barriers, put in countermeasures Time Observation (Raw Data) Observation Points Time for 1 cycle = Material Flow = Team members = People Flow Production System B Time Observation Sheet.ppt 36

37 Mod 11 Standard Ops Developing Standard Work Establish a standard work that defines normal conditions. Standard Work Analyze Work and identify Waste Identify barriers to consistently following the standard. Run the process Identify waste and opportunities for improvement. Which results in a process with more consistency and less variation. Improve the process. Re-set the standard to the new improved process. Eliminate barriers, put in countermeasures Change and improve the process Sample Process Name: Product Line: Percent Load Chart (Bar Chart) Lifting Stuff GXV-2000 Sum Total of Operator Cycle Times: Takt Time: Standard Work Combination Sheet Operator Standard Work Sequence Description of Date Prepared Units per shift Manual Automatic Dept. Takt time Walking Waiting Department Sum of Operator Cycle Times 630 sec 2630 sec Product number or family Date: From: Scope of Operations To: Model Name or Part: Takt Time O.C.T. = T.T. = 4.2 Supervisor Team Members Required Operation Time Step No. Man. Auto. Walk Work Element Product Line: Saw # 1 Percent Load Chart (Bar Chart) Lifting Stuff GXV-2000 From: Scope of Operations To: Model Name or Part: Sum Total of Operator Cycle Times: Wash Product number or family Notch Debur Standard Work Sequence Description Move to F.G. Step No. Operator Standard Work Combination Sheet of Date Prepared Units per shift Dept. Takt time Takt Time: 2205 sec Time Saw # 2 t/t = 630 sec Sample Process Name: t/t = 630 Punch Sum of Operator Cycle Times 630 sec Takt Time O.C.T. = T.T. Date: Department = 3.5 Supervisor Team Members Required Manual Automatic Walking Waiting Operation Time Work Element Man. Auto. Walk t/t = 630 sec t/t = 630 Punch Notch Operator Debur Operator Cycle Time Move to F.G. A B C D E 540 sec 660 sec 490 sec 400 sec 540 sec Production System en kaiz Wash kaiz Time Saw # 2 en Saw # 1 kaizen = 435 sec Percent Load Chart.ppt Waiting Totals Production System Standard Work Combination Sheet.ppt Operator A Operator Cycle Time 625 sec B C 620 sec 615 sec Production System D 345 sec Percent Load Chart.ppt Waiting Totals Production System Standard Work Combination Sheet.ppt 37

38 Standard Work Drives Improvements Standard Work - Eliminates Waste Establish a standard work that defines normal conditions. Which results in a process with more consistency and less variation. Re-set the standard to the new improved process. Mod 11 Standard Ops Run the process Identify waste and opportunities for improvement. Improve the process. Change and improve the process Identify barriers to consistently following the standard. Eliminate barriers, put in countermeasures Quick And Crude Is Better Than Slow And Elegant! 38

39 Taiichi Ohnos Seven Wastes Mod 11 Standard Ops Overproduction Defective Products Time on Hand (Waiting) Movement MUDA Transportation Stock on Hand (Inventory) Processing 39

40 Time Developing Standard Work Standard Work Standardize the New Work Cycle: Process Name: Step No. Component Task Time Observation Sheet Observation Cycle Number Observation Date: Observation Tim e: Component Task Time A nalysis Number: Observer: Observation Points Establish a standard work that defines normal conditions. Which results in a process with more consistency and less variation. Re-set the standard to the new improved process. Mod 11 Standard Ops Run the process Identify waste and opportunities for improvement. Improve the process. Change and improve the process Identify barriers to consistently following the standard. Eliminate barriers, put in countermeasures Product number or famil y S tandard Work Sequence Description Operator of Standard Work Combination Sheet Date P repared Dept. Units per shift Takt time Manual A utom atic Walking Waiting Step No. Work Element Just sit back And Ill tell you A tale A tale of a fateful Trip that started Man. Auto. Walk Operati on Ti me t/t = From this tropic port Process Name: Sample Percent Load Chart (Bar Chart) Product Line: Abroad this tiny ship Lifting Stuff From: Scope of Model Name or Part: Operations GXV-2000 To: Sum Total of Operator Takt Time: Sum of Operator Cycle Times Cycle Times: O.C.T sec 630 sec 3.5 Takt Time T.T. Time for 1 cycle Date: Department Supervisor = = Team Members Required Production System B Time Observation Sheet.ppt Totals kaizen Production System Waiting kaizen t/t = 630 sec kaizen = 435 sec Standard Work Com bination Sheet.ppt Operator Operator Cycle Time A B C D 625 sec 620 sec 615 sec 345 sec Production System Percent Load Chart.ppt 40

41 Then do it again Lather, Rinse, Repeat! Mod 11 Standard Ops Standard Work Drives Improvements Standard Work - PDCA Cycle: 1. Step PLAN - Observe & understand the work. Tools Time Observation Sheet. Standard Worksheet. Video. Value Stream Map 2. DO Dont discuss it - try it. Time Observation Sheet. Standard Worksheet. Video CHECK - Did it work? ACT - Standardize the new work cycle. Percent Load (Bar Chart). Standard Work Combination Sheet. Standard Work or Work Standard Repeat these steps as many times as possible. 41

42 How Do Standard Operations Help Drive Improvements? 42

43 Standard Operations Are Used in all Phases of Continuous Improvement Before Kaizen Documents current situation as a baseline. Develops observation skills to see 7 wastes. Provides data to quantify and focus improvement targets. Jump starts the actual Kaizen event. Mod 11 Standard Ops During Kaizen Helps teammates see the 7 wastes. Allows real time, quantitative assessment of improvement ideas. Helps focus improvement ideas on workshop targets. Provides daily assessment of progress towards workshop targets. Trains all participants in Standard Operations for Daily Management. After Kaizen Documents, quantifies and controls new standards. Provides measurement and training for all personnel. Provides roadmap back to new standard when disruption occurs. Provides baseline for next improvement cycle. 11 Standard Ops v

44 Standard Work Using Standard Operations When provider actions are standardized to a repeatable cycle time: Abnormal conditions become more visual. Cross Training + Task Sharing are greatly simplified. Waste becomes more visual. Drives the thinking Attack the Process, Support the People. Everybody knows this is the standard until everybody agrees to a new standard. 11 Standard Ops v

45 When Standard Operations are in place we can use the Standard Operations tools to help define improvement targets: Example: Standard Operations define the current situation for a 4 step process with 4 team members. Team member Cycle Time (minutes) Using Standard Operations Current Situation: 4 team members required Team member C cannot meet Takt Time Takt Time is always shown in red 11 Standard Ops v A B C D Team members 45

46 Team member Cycle Time (minutes) Using Standard Operations RPIW Targets: Process performs to Takt Time. Improve and re-balance the line to 3 team members Use Standard Work and Time Observation sheets to develop Standard Work Combination Sheets for all 4 team members. Find and eliminate waste. Mod 11 Standard Ops 10 8 Takt Time Under-utilized Time Waste eliminated A B C D Team member In this example we eliminate 2 minutes of waste in team member C and 1 minute for team member A. 46

47 Team member Cycle Time (minutes) Mod 11 Standard Ops Next re-balance the line to shift tasks from team member D to fill the under-utilized time of team member A and B. 12 Using Standard Operations 10 Takt Time A B C D Team member We now only have to find and eliminate 2 minutes of waste to allow us to re-deploy team member D. 47

48 Standard Operations Example 11 Standard Ops v

49 Process Name Spaghetti Diagram Operator Location Standard Worksheet Operation sequence From: To: (1) Date prepared or revised / / Dept. Supervisor Shift (2) 1. Label Process 2. Draw physical layout 3. Number sequence of operations 4. Standard Work-In-Process 5. WIP 6. Quality Inspections 7. Safety Precautions 8. Takt Time 9. Cycle Time (3) Quality Check Safety Standard WIP # of pieces of WIP TAKT time Cycle time Operator Number (6) (7) (4) 49 (5) (8) (9)

50 Filling out a Standard Worksheet 1. Scope of operations: Fill in the first and last tasks for the process. 2. Draw a physical layout of the area. Equipment or process layout: Draw the physical layout of the work area, and indicate the operation, machine, or process number. Reduce the size and distance between equipment/processes to scale and draw them on the sheet. 3. Order of operations Number the operations on the layout diagram in the order performed and connect the operations with solid line. Show the return from the last operation to the first with a dotted line. 4. Standard Work-In-Process Absolutely necessary WIP to facilitate the flow production must be indicated with at the operation, machine, or process involved. Do not include materials and finished products. Draw a to indicate standard work-in-process at the step, machine, or process involved. Materials and finished products are not included. 11 Standard Ops v

51 Filling out a Standard Worksheet 5. Indicate the Work In Process (WIP, such as patients waiting) for the cell or work area in the indicated box. 6. Quality Checks: Draw a on each process requiring a quality check. 7. Safety Precautions: Draw a on each process requiring special caution. 8. TAKT Time: In the lower right box, clearly show the TAKT time as calculated 9. Cycle Time: Fill in the total cycle time when tasks proceed according to the established sequence of operations. 10. Track the 7 flows of medicine, using a different color line for each flow. Create a legend to identify the color of each flow. (3) Drape patient (4) Anesthetize patient (5) Begin surgery (2) Set Up anesthesia Verify setup Procedural Pause Patient under anesthesia check (1) Set Up instruments Check instruments (7) Put away instruments 11 Standard Ops v

52 Process Name Acute Injury Exam Standard Spaghetti Worksheet Diagram Operator Location Nurse Practitioner GIM Operation sequence From: Pick Up Patient To: Discharge Patient Date prepared or revised 2 / 20 / 99 Dept. Head Supervisor Shift Smith Jones AM Exam Biometrics X Ray 4 3 C 2 B A D E Reception F Discharge Air Cast Results Quality Check Safety Precaution Standard WIP # of pieces of WIP TAKT time Cycle time Operator Number 4 40' 40' 1/1 52

53 Time Observation Form Mod 11 Standard Ops Process Observation Time Observer Observation Date: Step # Description of Operation Shortest Task Time Remarks Time for 1 Cycle 53

54 How to Measure the Operation Time Measure manual work, machine work and walking time within the operation 1. Observe the operation carefully in order to understand the sequence of tasks and work methods and to determine component tasks. Stand where operations and hand motions are visible. Observe operations until you have a clear picture in your mind. 2. Enter component tasks on the Time Observation Form and, while watching the operation, remember each observation point. An observation point is when time is entered from the stopwatch. Observations can be made of component tasks 2 or 3 seconds long, or that take days it depends what you are timing and the type of work you are observing. Keep observing a movement from the start until the end of its cycle. The observation point should be in the instant when a cycle is begun and when it ends the time in between is likely waiting or walking. 3. Measure the total time for one cycle (5 or 6 times). 11 Standard Ops v

55 How to Measure the Operation Time 4. Measure the time for the component tasks. Without stopping the stopwatch, take a reading at the end of each component task and enter that value in the Time Observation Sheet. Enter in the upper half of square provided. Stand in a position where the team member, the stopwatch and the Observation Sheet are aligned on the same height. Minimize the scope of the observers eye movement. Observation must be repeated roughly 10 times. Note any exceptional tasks or times observed. 5. Calculate the time for each component task. Run Time (n) = Stop (n) - Stop (n-1) Do not include abnormal values. 6. Record the time per component task. Enter the time in the lower half of the Time Observation Sheet. 7. Determine the cycle time for each component task. Choose the best value of 10 observations. (These are times that allow continuous operations: do not include abnormal values.) 8. Determine the total cycle time. The best total cycle time is the sum of the best times determined in step Standard Ops v

56 Process Writing on whiteboard Time Observation Worksheet Date Time Elementary work Steps 1,2 Get up from a chair Walk to a whiteboard Pick up a pen Write on the whiteboard Put down the pen Walk back to the chair Sit down in the chair Determine Step 4 measure M Step 5+ Step 6 calculate (47-44 =3 ) Step 7 Nov.1 / PM 2:00 ~ Component Task Time Determine, best times Operator No. 1 / 1 Observer Yamada Points observed Step 3 measure Determine Step 8 Time of one cycle (38)

57 Product number or famil y S tandard Work Sequence Descripti on Step No. (8) Work Element Man. Auto. Walk Operati on Ti me Date P repared (9) (12) Sta ndard Work (13) Operator Combination Sheet Dept. of (10) (11) Units per shift Takt time (1) (2) Manual Autom atic Walking Waiting (7) (4) (6) (3) Indicate TAKT time with a red line (5) Totals Waiting 2002 John Black & Associates LLC 57

58 Filling out a Standard Work Combination Sheet Mod 11 Standard Ops Enter the steps of work for a single team member spanning multiple process steps, including walking and waiting in between steps. Do not forget to pay attention to equipment/machine work. A sample completed Standard Work Combination Sheet is shown on the following page. 1. State if time is in minutes or seconds. 2. Enter Takt Time 3. Red line: Corresponds to Takt Time in the operation working time. 4. Description of operation Enter in detail the actual tasks performed by the team member and waits and walks in between in the appropriate column. Use expressions that combine a present-tense verb and its direct object (e.g., press button ). Enter equipment/machine time if applicable. 5. TOTALS Enter totals of manual work and walking times at bottom. Enter total waiting time in space provided. 11 Standard Ops v

59 6. Operation Working Time. Indicate manual work time by a solid line. Indicate automatic equipment time by a dotted line. Indicate walking time by a wavy line. Indicate waiting time by a double line. 7. Enter step number. 8. Enter if before or after kaizen. 9. Enter value stream name such as maternal registration. Mod 11 Standard Ops 10. Enter process name such as Emergency department registration of mothers. 11. Enter area where observation occurs such as emergency room. 12. Enter which operator out of how many such as #2 of Enter the date of observation. Filling out a Standard Work Combination Sheet 11 Standard Ops v

60 Process Patient Rooming Date Prepared 2/20 WIP 48 Patients Area Primary Care Clinic Dept. GIM TAKT time 44 sec Operation Name Time Operation Time (in seconds) Mod 11 Standard Ops Step Man Auto Walk 5" 10" 15" 20" 25" 30" 35" 40" 45" 50" 55" 60" BEFORE 65" 70" KAIZEN 75" 80" 85" 90" 1 Greet Patient Weigh Patient Enter Exam Room Check Medications Ask Reason for Visit 3 2 Standard Work Combination Sheet Standard Work Combination Sheet Operator MA Manual Automati Walking 6 Take Blood Pressure Call Physician, Get Next Patient Takt Time Waiting Totals

61 Using the Standard Work Combination Sheet with Standard Worksheet Mod 11 Standard Ops Doctor Movement Standard Worksheet T.T. = 660 min/30patients =22 min per patient Exam Room C.T. = 30 min per patient Nurse Station Doctors Room 61

62 Ordinary pattern Using the Standard Work Combination Sheet with Standard Worksheet Standard Work Combination Sheet Mod 11 Standard Ops No Work Content M A W 1 Check a patient schedule 2 Exam 1 3 Check a chart 1 4 Exam Communicate with nurse Why is it over T.T 6 Confirm lab data Exam 2 8 Test order Dictation Communicate with patient Looks good!? Good sequence!? 62

63 Applied pattern Using the Standard Work Combination Sheet with Standard Worksheet Standard Work Combination Sheet Mod 11 Standard Ops No Work Content M A W 1 Check a patient schedule Confirm lab data Dictation Exam room operation Doctors room operation 2 Exam Exam Exam Communicate with patient Check a chart Communicate with nurse Test order 2 1 Nurse station operation 22 8 Bad work sequence! 63

64 Time Mod 11 Standard Ops Process Name: Product Line: Model Name or Part: Sum Total of Operator Cycle Times: Takt Time: From: Scope of Operations To: Sum of Operator Cycle Times Takt Time Percent Load Chart (Bar Chart) O.C.T. = = T.T. Date: Department Supervisor = Team Members Required Operator Operator Cycle Time 64

65 Completing the Percent Load Chart 1. Indicate if by process or by team member. 2. Determine if in minutes or seconds 3. Draw a horizontal Takt Time line to appropriate time scale (in red). 4. Calculate sum of cycle times. 5. Calculate team members required from formula (sum of cycle times over Takt Time). 6. Indicate team member (or process steps) and fill in cycle times from the standard work combination sheets. 7. Plot the individual team member or process step cycle times against the vertical time axis. 8. Indicate if chart is before or after kaizen. 11 Standard Ops v

66 Time (minutes) Process Name: Area: Operator: Sum Total of Operator Cycle Times: 1 4 Takt Time: From: Scope of Operations To: 3 1 Sum of Operator Cycle Times Takt Time Percent Load Chart (Bar Chart) = = O.C.T. T.T. 8 Date: Department = Mod 11 Standard Ops Supervisor Team Members Required 3 8 Red Line Takt Time Before Kaizen Operator Operator Cycle Time A B C D

67 Medical Example Standard Work 67

68 Before Improvement Standard Worksheet Mod 11 Standard Ops 68

69 Step # Mod 11 Standard Ops Process Observation Time Observer Observation Date: Tech Room Turnover Description of Operation Shortest Task Time Wait for tower Remove scope Wipe tower Get stretcher Wait for room Setup tower Setup scope Test scope : : : :24 1:52 4: : :01 46 Before Improvement : /2/01 Remarks Time for 1 Cycle 6:01 6:01 69

70 Before Improvement Mod 11 Standard Ops Before 70

71 After Improvement Standard Worksheet Mod 11 Standard Ops 71

72 Step # Mod 11 Standard Ops Process Observation Time Observer Observation Date: Tech Room Turnover Description of Operation Shortest Task Time Remove scope Wipe tower Get stretcher Setup tower Setup scope Test scope : : : : :21 49 After Improvement /2/01 Remarks Time for 1 Cycle 3:21 3:21 72

73 After Improvement Mod 11 Standard Ops 73

74 Standard Operations Summary In this module we have: Defined the 3 elements of Standard Operations and their role in a continuous improvement environment. Shown the importance of timing and how time is measured and utilized (Takt Time, Lead Time and Cycle Time). Given examples of how to develop and use Standard Operations tools. Standard Operations are not an end unto themselves. It is a defined team member agreement of ways to perform tasks safely, consistently with high quality at a lower cost. Standard Operations are not written in stone. They are just the starting point for another turn of the continuous improvement wheel. 11 Standard Ops v

75 Appendix Examples of appropriate and inappropriate use of Takt Time. Examples of the 3 types of Standard Work in Healthcare with calculations. How to calculate a weighted average cycle time. How to calculate productivity. How to calculate capacity. 11 Standard Ops v

76 How to use Takt Time? Mod 11 Standard Ops 1 Department Takt Time & Cycle Time / patient (job) Department available time : Open time Demand : No. of patients (or Jobs) T.T = Open time (No break time) No. of patients Example Department available time : 12H (720min) Demand : 60 patients T.T = 720min 60patients = 12min per patient Percent Load Chart 25min 20min 18min A B C 21min T.T 12min Cycle time per patient! Repeatable work per patient! No. of provider = 21 min 12 min = 2 providers Provider Nurse Nurse Nurse Weighted average Cycle time 76

77 How to use Takt Time? Mod 11 Standard Ops 2-1 Provider Takt Time & Cycle Time / patient (job) Provider available time : Shift time-break time Demand : No. of patients (or Jobs) Example Provider available Time : 12H (720min)-60min Demand : 30 Patients 2Nurses:30Patients/each) T.T = T.T = Net available time No. of patients 660 min =22 min per 30 patients patient Percent Load Chart 20min 24min T.T 22min Cycle time per patient! Repeatable work per patient! Weighted average Cycle time Nurse X Y Nurse Y Kaizen needed! 77

78 How to use Takt Time? Mod 11 Standard Ops 2-2 Provider Takt Time & Total Task Time (Each task) Provider available time: Shift time-break time Example Provider available time : 480 min-60 min T.T = Net available time T.T = 480 min-60 min= 420 min YAMAZUMI Chart 420mi n Task e 440mi n Task e Task d Overtime! T.T 420mi n Cycle time = 440 min Not repeatable work per shift! Task d Task c Task b Task c Task b 100min (Big portion) Total task time C = Task time No. of tasks Clerk Task a X Task a Y Task B Kaizen needed! 78

79 How to use Takt Time? 3 Task Takt Time( Task Target Time) Mod 11 Standard Ops Task available time Demand : No. of tasks Example Task available time : 100 min 80 min Demand : 4 times T.T = T.T = Task available time No. of tasks 80 min =20 min per 4 times task YAMAZUMI Chart 440mi n Task e T.T 420mi n Percent Load Chart 25min 20min T.T 20min Task d Task c Pre Post Task b Kaizen Task b 100min 80min No overtime! Task a Clerk Y Task b b 79

80 Discharge process(inpatient unit) Inpatient unit Patient A 1. Assessment 2. Care 3. Medication 4. Charting 5. Telephone 6. Discharge Example Inappropriate Example 1 Patient B 1. Assessment 2. Care 3. Medication 4. Charting 5. Telephone 6. Discharge Department available time : 720min (Open time) Demand : 2 patients (Discharge) Patient C 1. Assessment 2. Care 3. Medication 4. Charting 5. Telephone 6. Mod 11 Standard Ops Patient D 1. Assessment 2. Care 3. Medication 4. Charting 5. Telephone min T.T = = 360 min per patient 2 patients Percent Load Chart? 30min T.T 360mi n 30min 1patient Standard Work Combination Sheet N Work Content M A W o Check a patient schedule Exam Check a chart Exam Communicate with nurse? Confirm lab data Exam Test order Dictation Communicate with patient 0 Task Discharge

81 Inappropriate Example 2 Nursing Process(Inpatient Unit) Not repeatable work Nurse tasks Patient A 1. Assessment 2. Care 3. Medication 4. Charting 5. Telephone 6. Discharge Example Patient B 1. Assessment 2. Care 3. Medication 4. Charting 5. Telephone 6. Discharge Provider available time : 720 min-60 min Demand : 4 patients Percent Load Chart? 30min T.T 165mi n 30min 1patient N o Patient C 1. Assessment 2. Care 3. Medication 4. Charting 5. Telephone 6. Discharge 660 min T.T = patient 4 patients Mod 11 Standard Ops Patient D 1. Assessment 2. Care 3. Medication 4. Charting 5. Telephone 6. Discharge = 165 min per Standard Work Combination Sheet 1 Check a patient schedule 2 Exam 3 Check a chart 4 Exam 5 Communicate with nurse 6 Confirm lab data 7 Exam 8 Test order 9 Dictation 1 0 Work Content M A W Communicate with patient ? Task Discharge

82 Appropriate Example Nursing Process(Inpatient Unit) Not repeatable work Patient A Patient B Patient C Mod 11 Standard Ops Patient D Nurse tasks 1. Assessment 2. Care 3. Medication 4. Charting 5. Telephone 6. Discharge 1. Assessment 2. Care 3. Medication 4. Charting 5. Telephone 6. Discharge 1. Assessment 2. Care 3. Medication 4. Charting 5. Telephone 6. Discharge 1. Assessment 2. Care 3. Medication 4. Charting 5. Telephone 6. Discharge Example Provider available time : 720min-60min Demand : 4 patients YAMAZUMI Chart Discharge Telephone charting Medication Care Assessment T.T 165 min Task time per patient Task 30min Discharg e 660 min T.T = patient 4 patients T.T 20 min N Work Content M A W o Check a patient 0 schedule 1. 2 Exam Check a chart Exam. 5 Communicate with nurse Confirm lab data Exam Test order Dictation 1 Communicate with patient = 165 min per Percent Load Chart & S. W. C. S. Provider Nurse x

83 Mod 11 Standard Ops Healthcare industry presents a workplace where there is a mix of various job types. Patients with the same illness do not always have the same symptoms. One patients abdominal pain does not necessarily have the same cause as the next patient with abdominal pain. Due to the increased diversity, each job entails different tasks and therefore different cycle times. Standardized Work & Takt Time: Types I, II, and III Similarly, office workers, housekeepers, HR reps, assistants, nurses, and clinicians must all perform multiple tasks in order to meet the needs of the patients. There are many jobs with no repeatability, and repeatable jobs which require a long cycle time. 11 Standard Ops v

84 The diverse mix of job types in the workplace and the fact that each person performs multiple tasks presents challenges in identifying and understanding the problems and implementing standardization based solely on the conventional concept of Takt Time. We must: Standardized Work & Takt Time: Types I, II, and III Define the process to perform each task. Utilize Takt Time as a tool for Kaizen. We need ingenuity, ideas, and innovations to help us achieve the purpose of Standard Work 11 Standard Ops v

85 Three Types of Standardized Work Standardized Work Type I Mod 11 Standard Ops The routine standardized work is called Type I, involving only one type of patient, such as patients coming for flu shots or urinary tract infections. Standardized Work Type II The amount of work (exam and/or treatment time) varies depending on the patient types and symptoms. Stratify patients by type and create a bar chart with Cycle Time for each patient type. Calculate the weighted average Cycle. Standardized Work Type III Various tasks are performed for multiple patients, but with not much repeatability for each patient. Repeatable tasks, if any, have a long cycle time. In this case, create a percent load chart of multiple tasks within a fixed time period. 85

86 Illustration of Standardized Work Type I Set of three documents for Standardized Work(Standardized Production Capacity Chart, Standard Work Combination Sheet, and Standard Work Sheet). Determine Takt Time on the basis of required numbers. Takt Time = Operating Time per Day (Fixed Amount of Time - breaks) # of Patients Required to See Each Day Modify Takt Time according to the production volume, i.e., if there are more patients to see (demand) on a particular day. Use the Percent Load Chart to figure out how many people we need. 46 Takt Time For example, in order to meet the increased demand, we need to equalize the work load (Heijunka) of team members A, B, C, and D. A B C D 11 Standard Ops v A, B, C, and Ds working time To do this, all four team members must be multi-skilled. This is applicable in a scenario where a patient type does not change the time required to perform tasks. 86

87 Man-hour Illustration of Standardized Work Type II Mod 11 Standard Ops Stratify patients by type and create a bar chart with Cycle Time for each patient type. Also calculate the weighted average Cycle Time. T.T.=46 Patient types grouped per time requirements 50 Takt Time a b c Worker A Weighted Average C.T. The worker is taking a different amount of time for each patient type. Weighted average cycle time helps identify problem areas and helps with allocation of work and more efficient scheduling. 11 Standard Ops v

88 Calculation Method for Standardized Work Type I-II Calculation for TAKT Time Baseline Volume Target volume # Shifts/Day ( ) # of Hours/Shift Mod 11 Standard Ops (=) # of Hours/Day ( ) 60 Minutes/Hour (=) (-) (-) (-) (=) # of Minutes/Day Breaks (Minutes) Wash Time (Minutes) Tool Change (Minutes) Total Minutes Available/Day ( ) Unit Sales/Day TAKT TIME : (=) Minutes Per Unit OR : ( ) 60 Seconds/Minute TAKT TIME : (=) Seconds per Unit 11 Standard Ops v

89 Weighted Average Calculation Method of Workload for Standardized Work Type II Worker Work Details Daily Workload Working Time by Task Daily Working Time (a) (80) ( ) (150 ) (=) (12,000 ) (b) (80) ( ) (120 ) (=) (9,600 ) (c) (40) ( ) (100 ) (=) (4,000 ) Total Sum(A)(200) Total Sum of Daily Working Time(B) Weighted Average of Workload = Total Sum of Daily Workload(A) Total Sum(B) (25,600 ) Daily Operating Time : 460 min.(27,600 ) T.T. = 27, = 138 C.T. Weighted Average = 25, = T.T. = 138 Weighted Average CT 128 (a) (b) (c) 89

90 Operating Time Illustration of Standardized Work Type III Percent Load Chart of multiple tasks within a fixed amount of time. Mod 11 Standard Ops 10 Calculation of required working time for a task Time to do task 10each time multiplied by the number of times the task is done per day T.T.= Stack up the required time for each task Check to see if the operating time is taken up by different tasks. If not, start Kaizen with the task which is taking longer time. Workers A ィ B ィ C ィ D ィ 11 Standard Ops v

91 Calculation Method for Standardized Work Type III Calculation of Available Time <Hours in a day (Fixed Amount of Time)> Mod 11 Standard Ops Correspond to Takt Time for Types I and II Baseline Volume Target volume # Shifts/Day ( ) # of Hours/Shift (=) # of Hours/Day ( ) 60 Minutes/Hour (=) (-) (-) (-) (=) # of Minutes/Day Breaks (Minutes) Wash Time (Minutes) Tool Change (Minutes) Total Minutes Available/Day 11 Standard Ops v

92 Calculation Method of Workload in Standardized Work III Mod 11 Standard Ops Worker Work Details No. of Tasks/day Working Time by Task Daily Working Time (a) (5 times) ( ) (50 min.) (=) (b) (3 times) ( ) (30 min.) (=) (c) (5 times) ( ) (30 min.) (=) (=) (250 min.) (90 min.) (150 min.) Total Sum(490 min.) Daily Operating Time : 460 min. Daily Working Time : 490 min. 490 min. (c) Operating Time = 460 min. (b) (a) 11 Standard Ops v

93 7 Steps to Calculate a Weighted Average Cycle Time (WACT) 1) Determine task groups by PQA and/or stick tallies + X Y Z 38 patient exams 99 patient calls 137 daily tasks 3) Calculate takt time of combined task groups Time available -60 min break # total daily tasks 420 = = or 184 min sec takt time 2) Determine task group percentage of whole X Y 38 = a% = b% exams 137 = 27% Z Z 99 calls = 73% 137 4) Determine average cycle time for each task group based on time observations exams = 636 seconds cycle time calls = 228 seconds cycle time 5) Calculate weighted average cycle time for each task group using percentages from step 2 and cycle times from step 4 a% b% x x exam cycle time call cycle time Total weighted average cycle time (WACT) = = X Y Z 27% 73% x x = = 172 seconds 166 seconds 338 seconds weighted average cycle time 6) Graph percent load chart 338 Σ O.C.T Exam 172 takt time 184 sec takt time Call 166 = = 1.8 people required 7) Perform Kaizen to meet takt time Eliminate waste in process Eliminate process Redistribute workload Add value Add quality PDCA 338 sec WACT Copyright 2009 John Black and Associates LLC 93