CASE FOR STANDARD WORK IN HEALTH CARE
When Clinical Best Practice Is Not Actual Practice
Introduction
Engineering Safety into Our Care
More Effective Training for New Caregivers
Training Veteran Employees in Clinical Best Practices
Conclusion
Art of Medicine: It's the People
Introduction
Pit Crews, Not Cowboys
Where Things Go Wrong
Where We Go from Here
Hand Hygiene Training Case Study
Introduction
Initial Training and Insights
Hand Hygiene: The Right Place to Start
Training Rollout
Results of the Initial Rollout
Handwashing Pilot Created Pull
Conclusion
Need for Good Instruction Skill
Introduction
TWI Application in Health Care
From Manufacturing to Health Care
Good Job Instruction Technique
JOB INSTRUCTION TRAINING
Four Steps of Job Instruction
Introduction
Showing Alone
Telling Alone
A Sure and Effective Method of Instruction
Teaching Hand Hygiene
Step 1: Prepare the Worker
Detail 1: Put the Person at Ease
Detail 2: State the Job
Detail 3: Find Out What the Person Already Knows
Detail 4: Get the Person Interested in Learning the Job
Detail 5: Place the Person in the Correct Position
Step 2: Present the Operation
Detail 1: Tell, Show, and Illustrate One Important Step at a Time
Detail 2: Do It Again Stressing Key Points
Detail 3: Do It Again Stating Reasons for Key Points
Caution Point: Instruct Clearly, Completely, and Patiently, but Don't Give Them More Information Than They Can Master at One Time
Step 3: Tryout Performance
Detail 1: Have the Person Do the Job, Correct Errors
Detail 2: Have the Person Explain Each Important Step to You as They Do the Job Again
Detail 3: Have the Person Explain Each Key Point to You as They Do the Job Again
Detail 4: Have the Person Explain Reasons for Key Points to You as They Do the Job Again
Caution Point: Make Sure the Person Understands
Caution Point: Continue Until You Know They Know
Step 4: Follow-Up
Detail 1: Put the Person on Their Own
Detail 2: Designate Who the Person Goes to for Help
Detail 3: Check on the Learner Frequently
Detail 4: Encourage Questions
Detail 5: Taper Off Extra Coaching and Close Follow-Up
If the Worker Hasn't Learned, the Instructor Hasn't Taught
Breaking Down a Job for Training
Introduction
Get Ready Point 2: Break Down the Job
What Is an Important Step?
What Is a Key Point?
Important Step 1: Wet Hands
Important Step 2: Apply Soap
Important Step 3: Rub Hands
Important Step 4: Rub Fingers
Important Step 5: Rinse
Important Step 6: Dry
Summary and Sample Breakdowns
Breakdown Sheets and Standardized Work
Finding the Key Points: The Key to Good Instruction
Introduction
What to Include and What Not to Include
Simple Words and Few
Teaching Feel
How Many Key Points in a Single Step?
Common Key Points
Observing and Involving Experienced Workers in the Breakdown Process
Training Soft Skills: Hourly Rounding to Prevent Patient Falls
Getting Patients to Ask for Help
We're Too Busy to Do This
Patient Falls Were Reduced
How to Organize and Plan Training
Introduction
Get Ready Point 1: Make a Timetable for Training
Get Ready Points 3 and 4:
Get Everything Ready and Arrange the Worksite
Training Large Jobs: Divide Them into Teaching Units
When, and When Not, to Use Job Instruction
Implementation of New Equipment: Everyone Does It the Right Way
IMPLEMENTING THE JI PROGRAM
Starting Out Strong with a Pilot Project
Introduction
A Plan for Continuing Results
Getting Started on the Right Foot
Form a TWI Working Group Responsible to Lead the Way
Select a Pilot Project to Show the Need for Standard Work
Initial Delivery of TWI Training
Create In-House Trainers
Create a Rollout Plan and Spread the Training
Integrating JI into the Culture to Sustain Results
Introduction
TWI as a Common Language
Using the Tools of Lean with TWI
Standard Work Sheet
PDSA (Plan-Do-Study-Act) Cycles
Standard Work
Target Progress Reports
Cycle Time
Takt Time
Root Cause Analysis (RCA)
Sustaining Improvement
Conclusion: A Call to Action
Index
