Getting to Standard Work in Health Care Using TWI to Create a Foundation for Quality Care.

Cover
Half Title
Title Page
Copyright Page
Table of Contents
Foreword to Second Edition
Foreword to First Edition
Preface
Acknowledgments
About the Authors
Section I Case for Standard Work in Health Care
	Chapter 1 When Clinical Best Practice Is Not Actual Practice
		Introduction
		Human Nature and System Design
		Engineering Safety into Our Care
		More Effective Training for New Caregivers
		Training Veteran Employees in Clinical Best Practices
		Where We Go from Here
		Conclusion
	Chapter 2 The Challenge of Designing Standard Work
		Introduction
		PDSA Cycles—Forming and Testing Your Hypothesis
			PLAN
			DO
			STUDY
			ACT
			Clinical Practice Guidelines—the Place to Start
			Review of Current Supply Chain
			Assessment of the Physical Layout
			Assuring the Worker Can Do the Job
		Rising to the Challenges of a Global Pandemic
			Clinical Practice Guidelines—the Place to Start
			Review of Current Supply Chain
			Assessment of the Physical Layout
				PHASES OF SPACE ALLOCATION
			Assuring the Worker Can Do the Job
		Summary
	Chapter 3 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”
		Continued Application of Hand Hygiene Training
		Conclusion
	Chapter 4 Need for Good Instruction Skill
		Introduction
		TWI Application in Health Care
		Implementation of New Equipment: Everyone Does It the Right Way
		From Manufacturing to Health Care
		Good Leadership Skill
Section II Job Instruction Training
	Chapter 5 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 Person 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
	Chapter 6 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 & Dry
		Summary of Breakdown Procedure
		Structure of a Good Breakdown: Simple Words and Few
		Teaching “Feel”
		Common Key Points
		How Big Should a Breakdown Be?
		Observing and Involving Experienced Workers in the Breakdown Process
		Breakdown Sheets and Standardized Work
		Training Soft Skills: Hourly Rounding to Prevent Patient Falls
			Getting Patients to Ask for Help
			“We’re Too Busy to Do This”
				Communication
				Teamwork
				Leadership
				Positive Attitude
				Critical Thinking
				Work Ethic
			Patient Falls Were Reduced
	Chapter 7 How to Organize and Plan Training
		Introduction
		Get Ready Point 1: Make a Timetable for Training
		Application of Training Timetables
		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
Section III Job Relations Training
	Chapter 8 Four Steps of Job Relations
		Introduction
		What Is “Good Supervision?”
		What Is a Problem and How Do You Solve It?
			Handling a Problem
		Get the Objective
		Step 1: Get the Facts
			Item 1: Review the Record
			Item 2: Find Out What Rules and Customs Apply
			Item 3: Talk with Individuals Concerned
			Item 4: Get Opinions and Feelings
			Caution Point: Be sure you have the whole story
		Step 2: Weigh and Decide
			Item 1: Fit the Facts Together
			Item 2: Consider Their Bearings on Each Other
			Item 3: What Possible Actions Are There?
			Item 4: Check Practices and Policies
			Item 5: Consider Objective and Effect on Individual, Group, and Patient Care
			Caution Point: Don’t jump to conclusions
		Step 3: Take Action
			Item 1: Are You Going to Handle This Yourself?
			Item 2: Do You Need Help in Handling?
			Item 3: Should You Refer This to Your Supervisor?
			Item 4: Watch the Timing of Your Action
			Caution Point: Don’t pass the buck
		Step 4: Check Results
			Item 1: How Soon Will You Follow Up?
			Item 2: How Often Will You Need to Check?
			Item 3: Watch for Changes in Output, Attitudes, and Relationships
			Caution Point: Did your action help patient care?
		Did You Accomplish Your Objective?
		Applying the JR Four-Step Method to the Barbara Problem
			The Barbara Problem
			Determine Objective on the Barbara Problem
			Step 1: Get the Facts on the Barbara Problem
				Item 1: Review the Record
				Item 2: Find Out What Rules and Customs Apply
				Items 3 and 4: Talk with Individuals Concerned and Get Opinions and Feelings
			Step 2: Weigh and Decide on the Barbara Problem
				Items 1 and 2: Fit the Facts Together and Consider Their Bearings on Each Other
				Item 3: What Possible Actions Are There?
				Item 4: Check Practices and Policies
				Item 5: Consider Objective and Effect on Individual, Group, and Patient Care
			Step 3: Take Action on the Barbara Problem
			Step 4: Check Results on the Barbara Problem
	Chapter 9 JR’s Foundations for Good Relations
		Introduction
		How to See Problems Coming
		The Mike Problem
			Step 1: Get the Facts on the Mike Problem
			Step 2: Weigh and Decide on the Mike Problem
			Steps 3 and 4: Take Action and Check Results on the Mike Problem
		The Four Ways the Mike Problem Came Up
		Foundations for Good Relations
			Let Each Worker Know How He or She Is Doing
				Figure Out What You Expect of the Person
				Point Out Ways to Improve
			Give Credit When Due
				Look for Extra or Unusual Performance
				Tell the Person While “It’s Hot”
			Tell People in Advance about Changes That Will Affect Them
				Tell Them Why If Possible
				Work with Them to Accept the Change
			Make Best Use of Each Person’s Ability
				Look for Ability Not Now Being Used
				Never Stand in a Person’s Way
		People Must Be Treated as Individuals
		Conclusion
Section IV Implementing TWI into the Culture
	Chapter 10 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
			Introduce JR and, Later, JM
		Conclusion
	Chapter 11 Four Steps of Job Methods Improvement
		Introduction
		Example of TWI Job Methods Practice
		Step 1: Break Down the Job
			Applying Step 1 to Date of Surgery (DOS) Blood Draw
		Step 2: Question Every Detail
			Asking the Five W’s and One H
			Questioning Other Important Items Regarding the Overall Job
			Applying Step 2 to DOS Blood Draw
				Details 3 and 4: Lab receives orders and Lab tech walks back to lab
				Detail 5: Print labels
				Detail 6: Lab tech walks to pre-op
				Detail 7: Check white board at nurses’ station
				Detail 8: Walk to holding area
				Detail 9: Verify pt’s name and DOB
				Detail 10: Draw blood
				Details 11 and 12: Label specimens and Transport to lab
		Step 3: Develop the New Method
			Four Improvement Elements
				Improvement Element 1: Eliminate Unnecessary Details
				Improvement Element 2: Combine Details When Practical
				Improvement Element 3: Rearrange Details for Better Sequence
				Improvement Element 4: Simplify All Necessary Details
			Work Out Your Ideas with Others
			Write Up the Proposed New Method
		STEP 4: Apply the New Method
			Item 1: Sell Your Proposal to the Boss
			Item 2: Sell the New Method to the Staff
			Item 3: Get Final Approval of All Concerned on Safety, Quality, Quantity, and Cost
			Item 4: Put the New Method to Work—Use It until a Better Way Is Developed
			Item 5: Give Credit Where Credit Is Due
		Closing
	Chapter 12 Integrating TWI into the Culture to Sustain Results
		Introduction
		TWI as a Common Language
		Using the Tools of Lean with TWI
			PDSA (Plan–Do–Study–Act) Cycles
			Value Stream Maps
			Standard Work Sheet
			Standard Work
			Target Progress Reports
			Cycle Time
			Takt Time
			Root Cause Analysis (RCA)
		Sustaining Improvement by Engineering TWI into Leader Standard Work
		Conclusion
Conclusion: A Call to Action
Index