Learning How to Improve: Start with Work Standards
Lean Frontiers is presenting series of webinars devoted to standardization. The webinars outline the perspective of Isao Kato, who spent his career at Toyota at the side of Taiichi Ohno and as liaison to Toyota consultant Shigeo Shingo.
While Toyota produces cars and trucks, Toyota’s approach applies to any system that cycles repeatedly to build a product or deliver a service.
Kato summarizes the Toyota approach as five ‘step ups’ in standardizing the cycle of work:
Establish expected performance and conditions. In other words, define ‘normal’.
Make ‘abnormal’ easy to see.
Solve the problems that will naturally arise. Problems are the gaps between the desired ‘normal’ conditions and actual ‘abnormal’ conditions.
Refine the workflow to drive out waste and develop skills of people.
Assure the continued health of the first four step ups.
Kato observed:
“Not every organization can and needs to get to Step up 5. But substantial benefit will be gained by adopting the philosophies of standardized work to take you as far as is (commercially) needed.” (Oscar Roche, “Standardizing Work: ‘Execution brings up organizational problems; this is just normal!’”, TWI Institute, Aug 12, 2020).]
More on Step Up 1
Step Up 1 consists of three parts:
define normal performance of the product or service as experienced by the customer
define normal operating conditions for equipment and process steps, and
define normal actions by people doing the work.
The Step Up 1 definitions form a work standard for the output, for the equipment/process and for the people.
In the Toyota tradition, a work standard is treated as a hypothesis or prediction: If you achieve “100% normal”, you and your customer will get the desired outcome.
Once the hypothesis is stated, you are set to act as a detective, a scientific investigator who studies the work. An organization filled with skilled scientific detectives is well-placed to innovate and thrive.
Link to Model for Improvement
The Model for Improvement (MFI) developed by Associates in Process Improvement is a guide to scientific investigation.
The first question in MFI aligns with Kato’s Step Up 1: What are you trying to accomplish?
Kato’s Step Up 2 implies measurement, which is the intent of MFI’s second question: How will we know that a change is an improvement?
The key insight in Step Up 2: Make it easy to contrast normal with abnormal through guides, templates, status indicators, checklists all local to where the work gets done.
MFI’s Question 3 and the Plan-Do-Study-Cycle link to Kato’s Step Up 3: What can we change to reduce or eliminate the abnormal state? What happens when we test that change? The PDSA test cycle is the means to refine the hypothesis documented in the work standard.
In the context of daily work, we can integrate problem-solving via PDSA into daily huddles and regular ‘Go See’ activity.
Viewpoint for teaching and learning
Supervisors and managers responsible for production processes can help their people develop PDSA skills in two ways. They can develop a special project or they can focus on the core work of their unit. The fundamentals of observation and testing are the same, either way. Nonetheless, special projects require project management skills and integration of changes into the regular work at the end of the project. If the regular work is not clearly defined and studied, changes from special projects will not stick, so it makes sense to start with the unit’s core work.
At Toyota, the engineers and managers focused on the core production processes as the context for PDSA applications. This seems a natural consequence of their responsibility for production: their work consisted of repeated cycles to build cars and trucks.
Over the past 20 years, most of the PDSA teaching and coaching I’ve done has focused on special projects. This may be a natural consequence of my experience as a consultant: my work has consisted of project after project! As I reflect on this history, many of the special projects did not sufficiently connect to core work.
I resolve to do better in my new assignments!
Brent James’ Insight: Standard work in clinical care processes
It’s easy to argue that treatment and care of people is not the same as building a car in a factory.
Growing out of work begun almost 30 years ago at Intermountain Healthcare, Brent James developed an approach that knits the concept of work standard to the clinical complexity of health care. He recognized that no clinician today can keep in mind all the relevant choices, evidence, and implications to provide reliable care.
James worked to develop standard care pathways, for example for treatment of lower back pain. The pathways represent agreements among clinicians on effective care, informed by research, professional society best practices, and collective clinical agreement. Their approach is usefully referred to as “mass customization”.
James and his colleagues integrated a core value. Clinicians must apply professional judgment as they care for individual patients and not blindly follow the current pathway, a current hypothesis subject to change.
The clinical work standard in James’ mass customization includes a statement of the care pathway, agreement by the clinicians to use the care pathway, and a commitment to document deviations from the care pathway so that the care pathway may be refined.
Deviations from the care pathway may arise from specific inadequacies in the pathway, steps in the pathway that conflict with clinical judgment or breakdowns in supporting process steps. While clinicians may deviate from the pathway, a deviation and reasons must be documented as part of a regular feedback loop to refine the pathway.
A refined care pathway will accommodate more variation in patient presentation. Over time, more and more patients will receive care according to the pathway. Nevertheless, the care pathway will never exactly match the care required by every patient. You can’t reach 100% because of inherent variability in cases and nuances of clinical judgement.
The stated care pathway defines ‘normal’ care; use of the pathway and feedback on deviations defines ‘normal’ practice. In the James’ framework, we need to make it easy to see ‘abnormal’ in both the clinical pathway and the commitment to documentation and study of deviations.
Here’s a link to an overview of the pathway method, which is taught at the Intermountain Healthcare Delivery Institute.
