Wai Chiong Loke
Global Center of Excellence for Healthcare
Partner, KPMG in Singapore
Standard work is often confused with policies and procedures. Although organizational policies do have an important role to play in ensuring clinical, risk, legal and financial best practices, they are of less use when defining how a given task should be completed. Consequently nurses, physicians and other staff all too often have to work it out for themselves, which leads to wide variations.
For example, different nurses may prepare patients for discharge in widely differing ways in terms of procedures, communication and advice.
With no common approach, those trying to improve processes lack a base from which to start their efforts. Standard work on the other hand creates a foundation by defining the ‘current best way,’ with very clear expectations that these steps will be followed, backed up by audits and observations.
Such a structure enables managers to understand when and why standard work is not being followed, and take appropriate action. In addition, managers and staff can together or individually eliminate any unnecessary steps in the standard work, continually questioning anything that does not add value to the patient journey. These improvements may be something as simple as improving communication between members of the care team, or ensuring that certain equipment or materials are readily available on the ward to speed up the daily routine.
Partner, KPMG in Canada
As individuals identify a potential improvement, they will be expected to raise their ideas at forums such as the daily improvement huddle, after which the standard work will be adjusted, people trained on the new approach (where necessary), with staff and patients quickly benefiting from new ways of working. These modest, incremental improvements keep staff engaged and motivated, as they can immediately see the impact of their work.
Standard work should always be easy to understand and if possible owned by those doing the work. A strong Lean ethos impacts every staff member’s mindset by setting an expectation that improvement is one’s personal responsibility, which in turn helps to avoid over-reliance on specific individuals, making the organization more resilient when a key manager or informal leader moves on.