QUERI – Quality Enhancement Research Initiative

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Quality Improvement Methods

47. Standard Work

a. Definition: Good quality (and good productivity) requires that work be done in a consistent way. Interventions to develop a better way will only have an impact if the new practice results in a change that is consistently and reliably implemented. Lean improvement practitioners have found that documenting a new way is absolutely critical for sustaining the change. Standard Work includes a written description which is communicated and followed by the staff involved. It describes in a clear manner what activities should occur, their sequence, and the approximate amount of time required. Standard Work is useful for audits, assures consistency, supports safety, is useful for training and is a starting point for future improvements. The lack of Standard Work often results in lower quality and productivity. However, the Standard Work documents are not intended to constrain efforts or limit future improvements.

b. Literature: Standard Work is explained in most books on the Toyota or Lean Approach (see Section 24). Standard work is included in many articles about implementing Lean in healthcare, such as:

  • Laing, Karen, and Katherine Baumgartner. "Implementing 'Lean' Principles to Improve the Efficiency of the Endoscopy Department of a Community Hospital: A Case Study." Gastroenterology Nursing 28.3 (2005): 210-215.
  • Ng, David, et al. "Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department." CJEM 12.1 (2010): 50-57.

c. Example: Standard work is always documented as a narrative often with graphic and in a standardized format for the institution where it will be used. Such as:

Standard Worksheet

Graphics in the standard work documents are often helpful such as pictures of computer screens or the layout of workspace with the flow of work shown on it. When research develops a new or changed procedure it should be documented as a Standard Work. This becomes the basis for the new procedure's training and verification that it is being followed. It is also used for ongoing audits and as a reference if there is a question as to how something should be done.

d. Steps: The improvement intervention first determines the proper way for a particular type of work to be done. Or, if there is no intervention or change involved, the best way to do certain work is determined and selected as the standard. The work is then documented and approved. The standard work document generally includes:

  • Description
  • Responsibilities, such as the steps or tasks involved
  • Documents (if any) or forms
  • Time, such as Takt time (see Section 49), and volume expectations (if any)
  • Approvals required

The document may include process maps, templates, worksheets and checklists. Detailed versions are sometimes referred to as a Standard Operating Procedure (SOP). The completed document is made available to all who are affected by it, are given necessary training and informed how to access it when needed.