QUERI – Quality Enhancement Research Initiative

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Quality Improvement Methods

3. Andon

a. Definition: The term "Andon" comes from the Toyota Production System and refers to a clear prompt message regarding the status of production. Often it is used to highlight problems or delays and is used to provide the worker with the opportunity of stopping production for quality issues or when assistance is needed. In healthcare, this would be the idea that a clear sign is generated when work is not proceeding correctly. All staff should be in position to alert others to a problem and stop a procedure when necessary. In a research setting an Andon could be used to alert staff to the existence of a new procedure or as a way to flag the occasion where an intervention is not happening as planned.

When a healthcare worker determines a patient needs something, particularly from a safety standpoint, there needs to be a way to communicate the requirement directly to someone who can provide it. Similarly, in Lean terminology, "Jikoda" refers to the idea that a worker should have the opportunity to halt work when a defect or quality problem might occur.

b. Literature:

  • Furman, Cathie, and Robert Caplan. "Applying the Toyota Production System: using a patient safety alert system to reduce error." Joint Commission Journal on Quality and Patient Safety 33.7 (2007): 376-386.
  • Farahmand, K., Khiabani, V., Ma, Y. (2014). Implementing Andon in Healthcare Deliver. 2014 Healthcare Systems Process Improvement Conference. ID # 130, Orlando, Florida, USA. February 21-24, 2014.
  • Wysocki, B. "To fix health care, hospitals take tips from factory floor." Wall Street Journal (2004): A1.

c. Example: At the Toyota Motor Company any worker who spots a defect occurring can pull a cord called an "Andon" that stops the assembly line until the problem is fixed. Similarly a nurse who spots a need for a new intravenous line but cannot get the appropriate department to do the replacement should have a procedure to get the change made to prevent a possibly serious infection. Thus the hospital should have a procedure, an Andon, to facilitate anyone, no matter their position, who notices a quality problem to force the corrective action.

d. Steps: A nurse brought a medical "production line" to a halt. The nurse thought a 76-year-old patient needed a new intravenous line but couldn't get the radiology department to install one immediately. Fearing the patient would develop an infection, the nurse phoned clinical director to take action overriding the decision of the radiology department. Implementing a policy to support this sort of independent authority to stop normal ongoing practices, when warranted, is an example of an Andon.