Job Instruction

At our Oral Health collaborative last month in Chicago, teams and faculty continued to discuss ways to reliably place sealants on kids’ permanent molars.

Variation in technique and no agreement on steps prevent reliable practice. 

A method from the 1940’s can help.

How to instruct people to do a job according to your organization’s definition

The Training Within Industry (TWI) approach was developed during World War II in the United States.  TWI aimed to help people new to factory work safely and correctly build vehicles and bombs. Toyota and other companies in Japan learned TWI methods in the 1950s.  TWI job instruction is a core part of the way many Lean organizations teach staff specific tasks.

The Job Instruction outline has three parts:

  • Know What:  the important steps of the job

  • Know How to do the important steps:  make or break function, safety items, special tricks

  • Know Why: reasons for the know how items

More on Job Instruction

The Job Instruction outline is referred to as a Job Breakdown sheet by Graupp and Spurrier in their useful book Getting to Standard Work in Health Care:  Using TWI to Create a Foundation for Quality Care. Boca Raton: CRC Press; 2013.

The Job Instruction outline is not a replacement for a detailed policy, procedure manual or technical bulletin; it is a tool to help teachers teach a key job to learners, preferably one on one!

Graupp and Spurrier summarize Job Instruction as “the way to get a person to quickly remember to do a job correctly, safely and conscientiously.” (p. 73)

Steps to Application of Job Instruction

(1) Team and leaders identify key jobs;

(2)    Teacher (ideally, the supervisor) breaks down the job and documents in the Job Instruction Sheet, “Know what”, “Know how”, “Know why”;

(3)    Teacher teaches one-on-one using the Job Instruction four-step method; see pocket card image below.

The guiding rule for job instruction according to TWI: “If the student hasn’t learned, the teacher hasn’t taught.”

For Further Study

TWI produced a series of pocket cards for supervisors. Here’s an image of the Job Instruction card; good advice for trainers!


A 1946 summary of the TWI program, which extended beyond Job Instruction, may be found here.  The set of pocket cards on p. 169-170 gives you sound guidance in operations management.

The official government history of TWI may be found here.  And video illustrations of the Job Instruction method are here (4:10) and here (9:13).

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