Standard Operations Module

Mod 11 – Standard Ops
GPS
MUDA MUDA
Cost Reduction Profit =

By Eliminating Waste Just-in-Time Price - Cost
Standard
GPS Depth Study Quality Cost Delivery
TAKT Time Map
NVA/VA- Measures Capacity Tables
Functions/Mgrs Safety Morale
Jidoka Standard Total Visual

R Productive
(human Control
Operations
Operations
e Maintenance
d automation)
e
p
l Setup Reduction Heijunka Poka-yoke
o Changeover (mistake
y
(Leveling) proofing)
m
Module 11
e
n Multi-process Continuous
t
Operations Flow Kanban Andon
3P
RPIW Kaizen Kaikuku Prod
Prep
7 Flows 7 Flows
Factory Product/Patient Quantity Analysis Medicine
• Sweeping
• Sorting 7
4 No’s
• Simplifying 5S • Standardizing
• Self Discipline Wastes
Value Stream Mapping
ONE PIECE FLOW TAKT TIME PULL PRODUCTION

Global Production System
© 1996-2013, John Black and Associates LLC
(modified from Hiroyuki Hirano, Productivity Press).
11 Standard Ops v20140606 1 ©1996-2013, John Black and Associates LLC

Committed Leaders Licensed Materials – USA Copyright Laws Apply
“Without Standards, There

Can Be No Improvement”
--Taiichi Ohno
 Considered to be the father of the Toyota Production System.

He was transferred to Toyota Motor Company in 1943, named
as the machine shop manager in 1949, promoted at Toyota to
director in 1954, managing director in 1964, senior managing
director in 1970, and executive vice president in 1975.
 Devised the seven wastes (or Muda in Japanese) as part of this
system.
 "Having no problems is the biggest problem of all." Ohno saw a
problem not as a negative, but in fact as "a kaizen opportunity in
disguise.“
Licensed Materials – USA Copyright Laws Apply
Standards are not New to Healthcare
We already know
patients are safer
when:
• We adhere to best practices
• Staff are consistently trained
• Clinical protocols are followed

Standards: Rounding
Mayo Clinic/Used with permission

Standard of Care

Standard Hand Cleaning

Standard Operations: Key Points

 The three elements of standard operations are standard
work, Takt Time, and standard work in process.
 The three methods of time measurement are lead time,
cycle time, and Takt Time.
 Standard work is a prescribed, repeatable sequence of
operations, balancing manual and automatic work
assigned to a single team member (operator), balanced
to the Takt Time.
 Establishing standard work is a four-step process:
1. Observe and understand the work.
2. Analyze the work and identify the waste.
3. Eliminate the waste.
4. Standardize the new work cycle.
The Three Elements of Standard

Operations
A 3-legged stool is always stable,

but falls over if one leg is missing.
Global
Production System
To Make things in the Right Way
JUST IN TIME Jidoka

People Standard Takt Time
Operate with the Work Production
One-by-one confirmation
minimum resources to detect abnormalities.
required to consistently One Piece
deliver Stop and respond to
Standard Work Flow
• Just what is needed. every abnormality.
Materials in Process Production
• In just the required Kanban Supermark Separate machine work
amount. et System from human work.
• Just where it is Enable machines to
needed. Pull detect abnormalities and
Machine Andon System
• Just when it is needed. Operational stop autonomously.
s Producti
Availability on
Leveled Production (Heijunka)
Cost Reduction Through The Elimination of Muda (Waste or Non-Value Added)
Standard operations is a fundamental tool to:

 See and eliminate waste.
 Help establish continuous flow production.
 Hold the gains realized in RPIW’s.
 Meet Takt Time.
 Drive further continuous improvements.
 Communicate between all providers.
 Improve management and better utilize resources.
Standard Operations in Healthcare

 Embed evidence-based standards into the practice of medicine.
 Enable cross coverage by making the process of care consistent.
 Ensure the consistent, high quality and safe treatment of patients.

The Importance of Time

The primary difference between Standard Operations and what
we traditionally think of as a standardized process is the role of
time.
 Timing is how we balance & coordinate efforts.
 A known standard time is key to ensuring the new standards
can be maintained.
Time Measurement:
 Allows for an instantaneous measurement of process health.
 Allows for real time, quantitative measurement of improvement
efforts.
 Assists in training of new personnel.
 Is how we manage our ability to meet customer
demand (Takt Time).

The Measurement of Time

Standard Operations requires we understand
three methods of time measurement.
1. Lead Time (L/T)
2. Cycle Time (C/T)
3. Takt Time (T/T)


1. Lead Time
Day of service lead time
Patient Requests Service
Pt Pt Pt has Pt has Pt is
Schedules Checks BP, Wt Exam Discharged
In
48:00:00 0:30 5:30 2:00
2:00 2:00 3:00 20:00 5:00
Wait Wait/ Walk Walk
Cycle Cycle Walk Cycle Cycle Cycle
Time Time Time Time Time
Total Lead Time of the Patient’s Experience

= all cycle times and all waits and walks in between cycle time
Lead Time is observed and can be improved!


2. Cycle Time
• Cycle Time is measured with a Stop Watch.
Team Member (Operator) Cycle Time
Time required for a single team member to complete one cycle of work
(e.g., room patient, check vitals, complete exam, give injections, complete
surgery, turnover room, etc.).
Examining
the patient
can be a
Exam cycle time
20:00


3. Takt Time
• A German musical term meaning “Beat.”
• The measure of the rate of customer demand.
Takt Time = Time Available
Output Required
• A key element to establishing continuous flow production.
• Is calculated, not measured.
• Is independent of capacity, number of providers, process capability, etc.
• Must be known before standard operations can begin.
• Can change suddenly as market conditions change.
Takt Time is market driven and must be met to

improve patient satisfaction!


Calculating Takt Time
Takt Time = Time Available

Output Required
Example: Market requires 40 patient visits in (1) 8 hour day.

8 hours x 60 minutes = 480 minutes
Break, start-up meeting,
productivity losses etc. - 60 minutes = net available time
planned time when people 420 minutes for patient care
are not available.
Takt Time = 420 minutes = 10.5 minutes Takt Time is always

40 patient visits expressed as time
This means that one patient must complete the process every 10.5 minutes (regardless of lead
time or cycle times) in order to meet the market requirement of 40 patients a day/8 hours.
It does not mean that any given process takes 10.5 min.

Calculating Takt Time
Available Time In Shift

Takt Time =
Output Required In Shift
Exercise:
• 48 patient visits per day must be completed.
• One 8 hour shift per day
What is the Takt Time?

Demand vs. Capacity

Customer demand is not the same thing as your current capacity.
Customer demand is the number of customers who want your product
today, not how many you can see today.
• Capacity - I’m open 8 hours, and each appointment takes

about 30 minutes, so I can see only 16 people.
• Demand – I’m open 8 hours, and each appointment takes
about 30 minutes.
I also have calls from 4 additional people who want to be seen today
but who cannot get in because there are no more appointments left -
therefore my real demand is 20 people.
Available Time
Takt Time =
Demand

Summary
1. Lead Time
• Total time to completely process a patient.
Lead Time = Cycle 1 + Wait + Cycle 2 + Wait...
2. Cycle Time
• Time required for single team member to complete one cycle of work.
• Includes value added time and waste.
• Is measured with a stop watch.
3. Takt Time
• Measure of market demand.
• Is market driven and calculated.
• Takt Time = Time Available
Output Required
• Is not a measure of process capability or capacity.


The Takt Time Dilemma
Typically: Takt Time <<<Cycle Time<<<Lead Time
How do we manage this dilemma?

• Multiple lines.
• Multiple providers/multi-tasking.
• Many patients in the process pipeline - the number of patients in the
process at any one time is called Work In Process (WIP).
These conditions lead to

• Long waits.
• Waste.
• Confusion, backflow and rework.
• Patient dissatisfaction.
The purpose of standard operations is to:

• Define number of providers required.
• Define and control number of patients in process (WIP).
• Provide tools to better balance Takt Time with Cycle and Lead Times.


How can we use our new knowledge of time to
manage the Takt Time dilemma?
The relationships of Takt Time, Lead Time, and Cycle Time
to each other can:
 Define the minimum number of team members
required to meet market demand.
 Define the minimum number of patients
required to keep the process flowing
(Standard Work In Process or SWIP).

The Measurements of Time

Standard Operations defines the minimum number
of team members required
# Team members = Sum of Team member cycle times

Takt Time
Example:
Cycle 1 + Cycle 2 + Cycle 3… = 80 min = 8 team members
Takt Time 10.5 min
8 providers are required to keep the process flowing.
< 8 team members - process will stop at some point,
increasing lead time.
> 8 team members - opportunity to re-deploy resources
after Kaizen.


Standard Operations defines the number of patients
required to keep the process flowing (SWIP).
SWIP = Lead Time
Takt Time
Example using day of service lead time

Lead Time = 200 min = 19 patients
Takt Time 10.5 min
At any given moment:
 If = 19 patients: process is performing as expected.
 If <19 patients: process will “starve” at some point and market demand
will not be met.
 If >19 patients: overscheduled or process has stopped somewhere -
take action now, lead time is increasing!
If we need 19 patients to keep the process flowing, but only 8 team members, what are
the other 11 patients doing?

Using Standard Operations SWIP = Lead Time

Takt Time
Standard Work in Process (SWIP)
If Standard Operations in place, the number of patients in the process at any
given time is an instantaneous measure of process health
No. of patients = SWIP Process is performing as expected.
No. of patients > SWIP There is a bottleneck somewhere that is stopping

Standard Work - go find it and fix it.
No. of patients < SWIP

 Process is performing better than expected, lead time is being
reduced. If consistent, re-adjust Standard Operations.
 Insufficient patients scheduled to meet market demand or

market demand has changed. If consistent, find root cause and
adjust Standard Operations.
Either of these cases may be defined as an opportunity to re-deploy resources.
Balancing cycle times to Takt Time

created the great efficiencies of
Boeing and Toyota’s moving
assembly lines.
In health care we tend to deny that
our processes can be standardized
because of the variability of
patients and services.
This line moves

2 inches per
minute
See - http://www.flixxy.com/boeing-737-time-lapse.htm

Standard Work
 Purpose:
• To ensure work and expectations are safe and
reasonable.
• To define and standardize normal conditions in
order to see abnormal conditions as soon as they
occur.
The objective is to minimize and control inconsistencies

(variation) in Quality, Inventory, Output, and Cost.
If you don’t know where you started,

how can you tell if you are getting anywhere?

Standard Work is a set of specific instructions that allow processes

to be completed in a consistent, timely, and repeatable manner.
To create new standard work:
• Determine the Takt Time
• Remove the waste from the process
• Time the steps for the cycle of work
• Balance the work among team members
Try it, get feedback, try it again – in a continual PDCA.

The Definition of Standard Work

Process Step 4
Process Step 6 Process Step 5
3
3 2
4
Process Step 3
2
1
1
Process Process Step 2

Step
1
A prescribed, repeatable sequence of operations,

balancing manual and automatic work:
Assigned to a single team member,
Balanced to the Takt Time.
The Prerequisites of Standard Work

• Takt Time must be known.
• The operation is centered around human work.
• The tasks are carried out repetitively.
• Quality and Safety items have been addressed.
Don’t get caught waiting “until you are ready.”

• Work balance need not be perfect before you start.
• Don’t worry too much about efficiency when you start.
• Focus on just getting consistent.
If you wait until you are ready, you will never begin!

Developing Standard Work

Standard Work can only
be learned by doing!
Go to the source of the work and

observe with all your senses.
Development of Standard Work

Just like any process, there is a well-defined standard
method for developing Standard Work.
The most important tools to develop Standard Work are:
 Keen eyes.
 An inquisitive mind.
Other tools include a stopwatch.
A video camera can be very helpful for analysis.
Remember: Standard Work is always observed where it is

done, not developed in the office!
Observing Standard Work is a key step in learning to see waste.
Standard forms and instructions are included in the Appendix.
Standard Work Improvement Cycle

Establish a
Starting point standard work Run the process Identify barriers
to consistently
that defines
following the
normal
standard.
conditions.
Identify waste and
opportunities for
improvement.
Which results in a process
with more consistency and
less variation.
Improve the
process. Eliminate
Re-set the
standard to the barriers, put
new improved in counter-
process.
Change and improve the measures
process

Standard Work
Tools for Documentation
Forms Purpose
• To record actual layout & flow.

Standard Worksheet
• To train new team members.
• To observe operations & break into small parts.

Time Observation Form • To establish best/repeatable elapsed time per
element.
Standard Work • To demonstrate best combination of manual

Combination Sheet work and machine work for one team member.
• To determine level of staffing in the cell.

Percent Load Chart
• To determine machine/equipment capacity.


Standard Work Forms
P rocess Name:
Model Number:
Model Name:
Mini Saw-Punch
xx30
Scissor Lift
S cope of
From:
Operati ons To:
Punch
Wash
Standard Wor k Sheet Date:
Dept. Head S upervisor Standard Worksheet

DEBUR • Used to document work area layout and flow.
WASH
PUNCH
1 5
• Shows placement of equipment/work tables, sequence of work, team
SA
W
1
2
3
4
NO
TC
H
member.
2
• Shows supplies/material movement and the location (with standard quantity)

W
SA
Quali ty
Check
S afet y
P recaut ion
S tandard Work
I n-P rocess
# of pieces of st d
work in-process
Takt
Tim e
Operator
Number
of WIP.
5
• Notes quality assurance checks and safety items that are standard for the
area.
Process Name:
Step
Time Observation Sheet
Observation Cycle Number
Observation
Date:
Observation
Time:
Component
Analysis
Number:
Observer:
Observation Points
Time Observation Form
• Used to document the steps in a process and time it takes to complete each
No. Component Task 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Task Time
step.
• Creates data that are used for other standard work forms.
Time for 1 cycle
• Combined with the Standard Work Sheet is the basis for decision making.
Production System B Time Observation Sheet.ppt
Standard Work Combination Sheet

Product number
or family
Standard Work
Sequence Description
Step
No. Work Element
Operator
___ of ___
Man. Auto. Walk

Standard Work
Combination Sheet
Operation Time
Date
Prepared
Dept.
Units
per shift
Takt
time
Manual
Automatic
Walking
Waiting • Used to describe the best combination of manual work with
Punch
Saw # 1
Saw # 2
Wash
t/t = 630
equipment/machine work in relation to Takt Time.
• Reflects the current work sequence and the expected time for completion of
Notch
Debur/Clean
Move to FG
each task.
Waiting
• Includes the automatic time of any equipment in the process and the relation
of the manual work to the automatic work.
Totals
Production System Standard Work Combination Sheet.ppt


Standard Work Forms
Percent Load (Bar Chart)

• Used to visually contrast team member and/or process cycle time
Process Name: Sample Percent Load Chart (Bar Chart) Date:
Product Line:
Lifting Stuff Scope of
From: Department Supervisor
GXV-2000
Model Name or Part: Operations To:
=  T.T.
Sum Total of Operator Takt Time:
O.C.T.
3.5
Sum of Operator Cycle Times
Cycle Times:
2205 sec 630 sec Takt Time
= Team Members Required
t/t = 630 sec

with Takt Time for a specific line or cell.
• Assists in understanding the proper number of team members that
en
n
Time
kaiz
e
kaiz
kaizen = 435 sec

should be staffing a line and the balance of the work from person to
Operator
Operator
Cycle Time
A
625 sec
B
620 sec 615 sec
C D
345 sec
person.
• Indicates where Kaizen must take place with the specific
Production System Percent Load Chart.ppt
requirement for improvement to achieve line balance.
Work Instructions: Standard Work and Work Standard

• How to perform the step by step tasks to complete the SWCS.
• The primary tool used for training team members in the standard
way to do a particular process.
• Photos and sketches can be very helpful here.

Developing Standard Work Establish a

standard work
that defines
normal
Run the process
Identify barriers
to consistently
following the
standard.
conditions.
Identify waste and
Observe and Understand the Work

opportunities for
improvement.
Which results in a process with
more consistency and less
variation.
Improve the
process.
Re-set the Eliminate
process.
measures
Change and improve the
process
Standard Worksheet (Raw Data)

Time Observation (Raw Data)
6
Process Name: Observation
1
Analysis
7
Date: Number:
Time Observation Sheet Observation
Observer:
Time:
Step Observation Cycle Number Component Observation Points

No. Component Task 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Task Time
3
2
Time for 1 cycle
B
= People Flow
Production System
= Team members
Time Observation Sheet.ppt
= Material Flow


standard work
that defines
normal
Run the process
Identify barriers
to consistently
following the
standard.
conditions.
Standard Work –
Identify waste and
opportunities for
improvement.
variation.
Analyze Work and identify Waste Improve the

process.
process.
measures
process
Product Line:
GXV-2000
=  T.T.
O.C.T.
4.2
Cycle Times:
Product number Date Units Manual

or family Prepared per shift
Standard Work Automatic
Operator
Standard Work Combination Sheet Dept.
Takt Walking
Sequence Description ___ of ___ time Waiting
Step Operation Time

Work Element Man. Auto. Walk
No.
Sample
t/t = 630 sec
Process Name: Percent Load Chart (Bar Chart) Date:
Punch t/t = 630 Product Line:

GXV-2000
Operations To:
Saw # 1 Model Name or Part:
=  T.T.
O.C.T.
3.5
Saw # 2
Cycle Times:
Time
Wash
Product number Date Units Manual
Notch or family
Standard Work Prepared per shift Automatic
Operator
Debur
Standard Work Combination Sheet Dept.
Takt Walking
Sequence Description ___ of ___ time Waiting
Step Operation Time

Move to F.G. Work Element Man. Auto. Walk
t/t = 630 sec

No.
Punch t/t = 630
Saw # 1
en
Saw # 2
en
Time
kaiz
Wash
kaiz
Notch Operator
A B C D E
Operator
540 sec 660 sec 490 sec 400 sec 540 sec
kaizen = 435 sec
Debur Cycle Time
Move to F.G.
Waiting
Totals

Operator
A B C D
Operator
Cycle Time 625 sec 620 sec 615 sec 345 sec
Waiting
Totals

Standard Work Establish a

standard work
that defines
normal
Run the process
Identify barriers
to consistently
following the
standard.
conditions.
Drives Improvements Identify waste and

opportunities for
improvement.
variation.
Standard Work - Eliminates Waste Re-set the

Improve the
process.
Eliminate
process.
measures
process
Quick And
Crude Is
Better
Than
Slow And
Elegant!
Taiichi Ohno’s Seven Wastes

Overproduction
Defective Time on Hand

Products (Waiting)
Movement
MUDA Transportation
Stock on Hand
(Inventory) Processing


standard
work that
defines
Run the process
Identify barriers
to consistently
following the
standard.
normal
Standard Work –
conditions.
Identify waste and
opportunities for
improvement.
Standardize the New Work Cycle: more consistency and less

variation.
Improve the
process.
P rocess Name:
Time Observation Sheet

Observat ion
Date:
A nalysis
Number: standard to the barriers, put
Observat ion
Tim e: Observer: new improved in counter-
Step Observation Cycle Number Component process.
Observation Points
No. Component Task 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Task Time measures
process
P roduct number Date Unit s Manual

or f amil y P repared per shif t
Sta ndard Work A utom atic
Operator Walking
S tandard Work Com bination S he et Dept.
Takt
S equence Descripti on ___ of ___ t ime Wait ing
Step Operati on Ti me
No.
Just sit back t/t = 630
And I’ll tell you
A tale
1 2
A tale of a fateful
Trip that started

3
From this tropic port
Abroad thisFrom:
tiny ship
Product Line:
Department Supervisor
GXV-2000
=  T.T.
Sum Total of Operator Takt Time: O.C.T.
3.5
Cycle Times:
Time for 1 cycle
Production System B Tim e O bservation Sheet .ppt
t/t = 630 sec

4
en
7
en
Waiting
Time
kaiz
Totals
6
kaiz
Pro duction System

kaizen = 435 sec
S tandard Work Com bination Sheet .ppt
5
Operator
A B C D
Operator
Cycle Time 625 sec 620 sec 615 sec 345 sec

Standard Work Drives Improvements

Standard Work - PDCA Cycle:
Step Tools
PLAN - Observe & •Time Observation Sheet.

1. •Standard Worksheet.
understand the work.
•Video.
•Value Stream Map
DO – Don’t •Time Observation Sheet.
Then do it again
2.
Lather, Rinse, Repeat!
discuss it - try it. •Standard Worksheet.

•Video.
CHECK - Did it • Percent Load (Bar

3. Chart).
work?
• Standard Work
Combination Sheet.
ACT - Standardize • Standard Work or
4.
the new work cycle. Work Standard
Repeat these steps as many times as possible.
How Do Standard
Operations Help Drive
Improvements?

Standard Operations Are Used in all Phases of

Continuous Improvement
Before Kaizen
 Documents current situation as a baseline.
 Develops observation skills to see 7 wastes.
 Provides data to quantify and focus improvement targets.
 “Jump starts” the actual Kaizen event.
During Kaizen
 Helps teammates see the 7 wastes.
 Allows real time, quantitative assessment of improvement ideas.
 Helps focus improvement ideas on workshop targets.
 Provides daily assessment of progress towards workshop targets.
 Trains all participants in “Standard Operations for Daily Management.”
After Kaizen
 Documents, quantifies and controls new standards.
 Provides measurement and training for all personnel.
 Provides “roadmap” back to new standard when disruption occurs.
 Provides baseline for next improvement cycle.

Using Standard Operations

Standard Work
• When provider actions are standardized to a repeatable cycle time:
– Abnormal conditions become more visual.
– Cross Training + Task Sharing are greatly simplified.
– Waste becomes more visual.
– Drives the thinking “Attack the Process, Support the People.”
– Everybody knows this is the standard until everybody agrees to a new
standard.


When Standard Operations are in place we can use the Standard
Operations tools to help define improvement targets:
Example: Standard Operations define the current situation for a 4 step
process with 4 team members.
Current Situation:
• 4 team members required
12 • Team member C cannot meet Takt Time
10
Team member
Cycle Time 8
Takt Time is
(minutes) always shown
6 in red
4
2
A B C D
Team members
RPIW Targets:
Using Standard Process performs to Takt Time.
Improve and re-balance the line to 3
Operations team members
• Use Standard Work and Time Observation sheets to develop Standard Work
Combination Sheets for all 4 team members.
• Find and eliminate waste.
10 Takt Time
Under-utilized Time
Team member
8
Cycle Time
(minutes)
6 Waste eliminated
2
Team member
A B C D
In this example we eliminate 2 minutes of waste in team member C and 1 minute for team member A.


Next re-balance the line to shift tasks from team member D to fill the
under-utilized time of team member A and B.
12
10 Takt Time
8
Team member
Cycle Time
(minutes)
2
Team member
A B C D
We now only have to find and eliminate 2 minutes of waste to allow us to re-deploy team member D.

Standard Operations
Example

Process Name Standard Worksheet

Spaghetti Diagram
Date prepared or revised / /
Operator Dept. Supervisor Shift

Operation From:
Location sequence
To:
(1)
1. Label Process
2. Draw physical layout
3. Number sequence of
(2)
operations (3)
4. Standard Work-In-Process
5. WIP
6. Quality Inspections
7. Safety Precautions
8. Takt Time
9. Cycle Time
Quality Check Safety Standard WIP # of pieces of WIP TAKT time Cycle time Operator Number
(6) Ops v20140606(7)

11 Standard (4) 49 (5) (8) (9)
©1996-2013, John Black and Associates LLC
Filling out a Standard Worksheet

1. Scope of operations: Fill in the first and last tasks for the process.
2. Draw a physical layout of the area.
• Equipment or process layout: Draw the physical layout of the work
area, and indicate the operation, machine, or process number.
Reduce the size and distance between equipment/processes to
scale and draw them on the sheet.
3. Order of operations
• Number the operations on the layout diagram in the order
performed and connect the operations with solid line. Show the
return from the last operation to the first with a dotted line.
4. Standard Work-In-Process
• Absolutely necessary WIP to facilitate the flow production must be
indicated with a @ at the operation, machine, or process involved.
Do not include materials and finished products. Draw a ● to
indicate standard work-in-process at the step, machine, or
process involved. Materials and finished products are not
included.
Filling out a Standard Worksheet

5. Indicate the Work In Process (WIP, such as patients waiting) for the cell or
work area in the indicated box.
6. Quality Checks: Draw a on each process requiring a quality check.
7. Safety Precautions: Draw a on each process requiring special caution.
8. TAKT Time: In the lower right box, clearly show the TAKT time as calculated
9. Cycle Time: Fill in the total cycle time when tasks proceed according to the
established sequence of operations.
10. Track the 7 flows of medicine, using a different color line for each flow.
Create a legend to identify the color of each flow.
(3) Drape (4) Anesthetize (5) Begin
patient patient surgery
(2) Set Up
anesthesia Verify Procedural Patient under
setup Pause anesthesia check
Check instruments
(1) Set Up (7) Put away
instruments instruments

Date prepared or revised 2 / 20 / 99

Process Name Acute Injury Exam Spaghetti
Standard Diagram
Worksheet
Dept. Head Supervisor Shift
Operator Nurse Practitioner From: Pick Up Patient
Operation
sequence Smith Jones AM
Location GIM To: Discharge Patient
Exam Biometrics
X Ray ③ ②
Reception
①
B A
④
C
F
Discharge
⑤ D ⑥ E ⑦
Air Cast
Results
Quality Check Safety Precaution Standard WIP # of pieces of WIP TAKT time Cycle time Operator Number
4 40' 40' 1/1


Process Observation Time Observer Observation Date:
Step Description of Operation 1 2 3 4 5 6 7 8 9 10 11 12 Shortest Remarks

# Task Time
Time for 1 Cycle

How to Measure the Operation Time

Measure manual work, machine work and walking time
within the operation
1. Observe the operation carefully in order to understand the sequence of tasks
and work methods and to determine component tasks.
• Stand where operations and hand motions are visible.
• Observe operations until you have a clear picture in your mind.
2. Enter component tasks on the Time Observation Form and, while watching the
operation, remember each observation point. An observation point is when
time is entered from the stopwatch.
• Observations can be made of component tasks 2 or 3 seconds long, or that
take days – it depends what you are timing and the type of work you are
observing.
• Keep observing a movement from the start until the end of its cycle.
• The observation point should be in the instant when a cycle is begun and
when it ends – the time in between is likely waiting or walking.
3. Measure the total time for one cycle (5 or 6 times).

How to Measure the Operation Time

4. Measure the time for the component tasks.
• Without stopping the stopwatch, take a reading at the end of each component task
and enter that value in the Time Observation Sheet. Enter in the upper half of square
provided.
• Stand in a position where the team member, the stopwatch and the Observation
Sheet are aligned on the same height. Minimize the scope of the observer’s eye
movement.
• Observation must be repeated roughly 10 times.
• Note any exceptional tasks or times observed.
5. Calculate the time for each component task. Run Time (n) = Stop (n) - Stop (n-1)
• Do not include abnormal values.
6. Record the time per component task.
• Enter the time in the lower half of the Time Observation Sheet.
7. Determine the cycle time for each component task.
• Choose the best value of 10 observations. (These are times that allow continuous
operations: do not include abnormal values.)
8. Determine the total cycle time.
• The best total cycle time is the sum of the best times determined in step 7.

Date Nov.1 / Operator No. 1/1

Process Writing on whiteboard Time Observation Worksheet
Time PM 2:00 ~ Observer Yamada
№ Elementary work 1 Component Task
2 3 4 5 6 7 8 9 10 11 12 13 14 15 Time Points observed
1 Get up from a chair
6 54 41 29 14 4 03 50
×
６ 7
6 7 7 8 8 9 7
18 1 05 52 39 25 13 5 00
2 Walk to a whiteboard 10
12 11 11 10 11 10 10
×
21 07 55 41 28 16 03
3 Pick up a pen ２ 3
3 2 3 2 3 3 3
×
17 2 05 50 39 27 14
4 Write on the whiteboard M
10 10 9 11 11 11 ９ 10
35 21 08 53 43 30 18
5 Put down the pen 3
4 3 3 4 3 4
44 31 18 3 04 52 40 27
6 Walk back to the chair 9
9 10 10 9 9 10 9
38 1 22 2 08 2 56 3 40 47 34 21 06 54 43 29
7 Sit down in the chair 2
3 3 3 2 2 3 2
Step 5+
Step 6 Step 7
Step 4
Steps 1,2 calculate
measure Determine,
best times
Determine (47”-44”=3”)
Determine
Step 3 measure Step 8
Time of one cycle (38) 44 46 48 44 44

(8)
P roduct number Date Unit s Manual
or f amil y
(9) (12)
Operator
Sta ndard Work P repared
(13) per shif t
(1) A utom atic
Walking
S tandard Work Com bination S he et Dept.
Takt
S equence Descripti on
(10) ___ of ___
Operati on Ti me
(11) t ime
(2) Wait ing
Step
No.
(7) (4) (6)
(3) Indicate TAKT time

with a red line
Waiting
Totals
(5) ©2002 John Black & Associates LLC

Filling out a
Enter the steps of work for a single team member spanning multiple process
steps, including walking and waiting in between steps.
Do not forget to pay attention to equipment/machine work. A sample completed
Standard Work Combination Sheet is shown on the following page.
1. State if time is in minutes or seconds.

2. Enter Takt Time
3. Red line: Corresponds to Takt Time in the operation working time.
4. Description of operation
• Enter in detail the actual tasks performed by the team member and
waits and walks in between in the appropriate column.
• Use expressions that combine a present-tense verb and its direct object
(e.g., “press button”).
• Enter equipment/machine time if applicable.
5. TOTALS
• Enter totals of manual work and walking times at bottom.
• Enter total waiting time in space provided.

Filling out a
6. Operation Working Time.
• Indicate manual work time by a solid line.
• Indicate automatic equipment time by a dotted line.
• Indicate walking time by a wavy line.
• Indicate waiting time by a double line.
7. Enter step number.
8. Enter if before or after kaizen.
9. Enter value stream name such as maternal registration.
10. Enter process name such as Emergency department registration of
mothers.
11. Enter area where observation occurs such as emergency room.
12. Enter which operator out of how many such as #2 of 4.
13. Enter the date of observation.


Operator
Date
MA
Manual
Process Patient Rooming Standard Work Prepared 2/20 WIP 48 Patients
Automati
Area Primary Care Clinic Combination Sheet Dept. GIM TAKT time 44 sec Walking
Time Operation Time (in seconds)

Step Operation Name
№ Man Auto Walk 5" 10" 15" 20" 25" 30" 35" 40" 45" 50" 55" BEFORE
60" 65" KAIZEN
70" 75" 80" 85" 90"
1 Greet Patient 2 2
2 Weigh Patient 4 3
3 Enter Exam Room 5 2
4 Check Medications 4 2
5 Ask Reason for Visit 3 2
6 Take Blood Pressure 6 2

Takt Time
Call Physician, Get Next
7
Patient
2 3 2
Wa it ing
Totals 26 3 15

Using the Standard Work Combination Sheet Mod 11 – Standard Ops
with Standard Worksheet

● Doctor Movement
Standard Worksheet
Exam Room
T.T. = 660
C.T. = 30 min per
min/30patients ⑩ ⑦ ④ ②
patient
=22 min per patient
③
Nurse
⑤
Station
⑧
⑨ ⑥ ①
Doctor’s Room


● Ordinary pattern
No Work Content M A W 5’ 10’ 15’ 20’ 25’ 30’

Check a patient
1 1’ 1’
schedule
0.5
2 Exam 1’
’
3 Check a chart 1’
0.5 Why is it
’ over T.T
0.5
4 Exam 5’
’
5 Communicate with nurse 3’ 1’
6 Confirm lab data 3’ 1’

0.5
7 Exam 2’
’
8 Test order 2’ 1’
9 Dictation 2’ 1’
Communicate with
2’ 1’
10
patient Looks good!?
Good
sequence!?
22’ 8’


●Applied pattern
No Work Content M A W 5’ 10’ 15’ 20’ 25’ 30’
1 Check a patient schedule 1’ 1’ Doctor’s room

6 Confirm lab data 3’ 1’ Exam room operation
operation
9 Dictation 2’ 1’
2 Exam 1’ 0.5’
4 Exam 5’ 0.5’
7 Exam 2’ 0.5’
10 Communicate with patient 2’ 1’
3 Check a chart 1’ 0.5’
5 Communicate with nurse 3’ 1’
8 Test order 2’ 1’
Nurse station
operation Bad work
22’ 8’ sequence!


Product Line: From: Department Supervisor
Scope of
=  T.T.
Sum Total of Takt Time: Sum of Operator Cycle Times O.C.T. Team Members
Operator Cycle
Times: Takt Time
= = Required
Time
Operator
Operator
Cycle
Time

Completing the Percent Load Chart

1. Indicate if by process or by team member.
2. Determine if in minutes or seconds
3. Draw a horizontal Takt Time line to appropriate time
scale (in red).
4. Calculate sum of cycle times.
5. Calculate team members required from formula (sum of
cycle times over Takt Time).
6. Indicate team member (or process steps) and fill in
cycle times from the standard work combination sheets.
7. Plot the individual team member or process step cycle
times against the vertical time axis.
8. Indicate if chart is before or after kaizen.
8
Area: 1 2 From: Department Supervisor
Operator:
Scope of
Operations To: 1
=  T.T.
Sum Total of Takt Time: O.C.T.
Operator Cycle
Times: 4 3
Takt Time
5= = Team Members
Required
Before Kaizen
8
3 Red Line
(minutes)
7
Takt Time
6
Time
5 7
4
3
2
1
Operator A B C D
Operator 6
Cycle
Time
3’30” 4’15” 8’00” 5’45”
Medical Example
Standard Work

Before Improvement
Standard Worksheet

Before Improvement
Tech Room Turnover 8/2/01
# Task Time
Wait for tower 25
1 25
25”
2 Remove scope 1:16
51
51”
3 Wipe tower 1:56
40”
40
4 Get stretcher 2:32
36
36”
5 Wait for room 4:24
1:52
1:52”
6 Setup tower 4:54 30”
30
7 Setup scope 5:15 21”
21
8 Test scope 6:01 46”
46
Time for 1 Cycle

6:01
6:01
Before Improvement
Before

After Improvement
Standard Worksheet

After Improvement Mod 11 – Standard Ops

Tech Room Turnover 8/2/01
# Task Time
1 Remove scope 26 26”

26
2 Wipe tower 1:06
40
40”
3 Get stretcher 1:42
36
36”
4 Setup tower 2:12 30”
30
5 Setup scope 2:33 21”
21
6 Test scope 3:21 49”
49
Time for 1 Cycle
3:21
3:21
After Improvement

Standard Operations Summary

In this module we have:
 Defined the 3 elements of Standard Operations and their
role in a continuous improvement environment.
 Shown the importance of timing and how time is measured
and utilized (Takt Time, Lead Time and Cycle Time).
 Given examples of how to develop and use Standard
Operations tools.
Standard Operations are not an end unto themselves.
It is a defined team member agreement of ways to perform tasks
safely, consistently with high quality at a lower cost.
Standard Operations are not written in stone. They are just the
starting point for another turn of the continuous improvement
wheel.

Appendix
 Examples of appropriate and
inappropriate use of Takt Time.
 Examples of the 3 types of Standard
Work in Healthcare with calculations.
 How to calculate a weighted average
cycle time.
 How to calculate productivity.
 How to calculate capacity.

How to use Takt Time?
① “Department” Takt Time & Cycle Time / patient (job)
Department available time : Open time Open time (No break time)
Demand : No. of patients (or Jobs) T.T =
No. of patients
Example
720min
Department available time : 12H (720min) T.T = = 12min per
Demand : 60 patients 60patients patient
Percent Load Chart

25min
21min Cycle time per patient!
20min
18min Repeatable work per patient!
A B T.T
C 12min
21 min
No. of provider = = 2 providers
12 min
Nurse Nurse Nurse Weighted average

Provider Cycle time

②－１ “Provider” Takt Time & Cycle Time / patient (job)
Provider available time : Shift time－Break time Net available time
Demand : No. of patients (or Jobs) T.T =
No. of patients
Example
660 min
Provider available Time : 12H (720min)-60min T.T = =22 min per
Demand : 30 Patients 2Nurses:30Patients/each) 30 patients patient
Percent Load Chart

24min T.T
22min
Cycle time per patient!
20min Repeatable work per patient!
Weighted average
Cycle time
Nurse Y
Nurse X Y Kaizen needed!

②－２ “Provider” Takt Time & Total Task Time (Each task)
Provider available time:
T.T = Net available time
Shift time－Break time
Example
Provider available time : 480 min－60 min T.T = 480 min－60 min=
420 min
YAMAZUMI Chart Overtime!

440mi
n T.T
420mi 420mi Cycle time = 440 min
n n
Task e
Not repeatable work per
Task e shift!
Task d
Task d
Task c
Total task time C =
Task c
100min Task time × No. of tasks
(Big
Task b
Task b
portion)
Task a Task a Task B

Clerk X Y Kaizen needed!

③ “Task” Takt Time（ “Task” Target Time）
Task available time Task available time
T.T =
Demand : No. of tasks No. of tasks
Example
80 min
Task available time : 100 min ⇒ 80 min T.T = =20 min per
Demand : 4 times 4 times task
YAMAZUMI Chart Percent Load Chart

440mi
T.T 25min
n
420mi T.T
Task e n
20min 20min
Task d
Task c Pre
Post
Task b No overtime!
Kaizen Task b
100min⇒80min
Task a
Clerk Y Task b b

Inappropriate Example ①
●Discharge process（Inpatient unit）
Patient A Patient B Patient C Patient D
1. Assessment 1. Assessment 1. Assessment 1. Assessment
2. Care 2. Care 2. Care 2. Care
3. Medication 3. Medication 3. Medication 3. Medication
Inpatient 4. Charting 4. Charting 4. Charting 4. Charting
unit 5. Telephone 5. Telephone 5. Telephone 5. Telephone
6. Discharge 6. Discharge 6. ・ 6. ・
・・・・
・・・・
Example
720 min
Department available time : 720min (Open time) T.T = = 360 min per patient
Demand : 2 patients (Discharge) 2 patients
Percent Load Chart T.T Standard Work Combination Sheet

360mi
n N
Work Content M A W
？
o
1 1
1 Check a patient schedule
’ ’
0
1 .
2 Exam
’ 5
0
’
1 .
3 Check a chart
’ 5
0
’
5 .
4 Exam
’ 5
’
3 1
5 Communicate with nurse
’ ’
？
3 1
6 Confirm lab data
’ ’
0
2 .
7 Exam
’ 5
30min × 1patient 8 Test order

2
’
’
1
’
30min 9
1
Dictation
Communicate with patient

2
’
2
1
’
1
0 ’ ’
2
8
2
Task Discharge ’
’

Inappropriate Example ②
●Nursing Process（Inpatient Unit）⇒ Not repeatable work
4. Charting 4. Charting 4. Charting 4. Charting
Nurse tasks 5. Telephone 5. Telephone 5. Telephone 5. Telephone
6. Discharge 6. Discharge 6. Discharge 6. Discharge
・・・・
・・・・
Example 660 min

Provider available time : 720 min－60 min T.T = = 165 min per
Demand : 4 patients patient
4 patients
Percent Load Chart T.T Standard Work Combination Sheet

165mi
n N
Work Content M A W
？
o
1 1
1 Check a patient schedule
’ ’
0
1 .
2 Exam
’ 5
0
’
1 .
3 Check a chart
’ 5
0
’
5 .
4 Exam
’ 5
’
3 1
5 Communicate with nurse
’ ’
？
3 1
6 Confirm lab data
’ ’
30min 7 Exam
2
’
0
.
5
30min × 1patient 8 Test order

2
’
2
’
1
’
1
9 Dictation
’ ’
1 2 1
Communicate with patient
0 ’ ’
2
8
2
Task Discharge ’
’

Appropriate Example
●Nursing Process（Inpatient Unit）⇒ Not repeatable work
Nurse tasks 4. Charting 4. Charting 4. Charting 4. Charting
5. Telephone 5. Telephone 5. Telephone 5. Telephone
6. Discharge 6. Discharge 6. Discharge 6. Discharge
・・・・
・・・・
Example 660 min

Provider available time : 720min－60min T.T = = 165 min per
Demand : 4 patients patient
4 patients
YAMAZUMI Chart T.T 30min T.T Percent Load Chart
165 min 20 min &
Discharge S. W. C. S.
Telephone
charting N
Work Content M A W
o Check a
1 1
1 patient
Medication 2
schedule
Exam
’
1
’
’
0
.
0
5
1 .’
3 Check a chart
’ 0
5
5 .’
4 Exam
’ 5
Communicate 3 ’
1
Care 5
with nurse ’ ’
Task time per 6

Confirm lab
data
3
’
2
1
’
0
.
Discharg 7 Exam
’ 5
patient ’
2 1
Task 8 Test order

’
2
’
1
Assessment e 9
1
0
Dictation
Communicate
with patient
’
2
’
’
1
’
2
8
Provider Nurse x 2
’
’

Standardized Work & Takt Time:
Types I, II, and III
Healthcare industry presents a workplace where there is a
mix of various job types.
 Patients with the same illness do not always have the same
symptoms. One patient’s abdominal pain does not necessarily
have the same cause as the next patient with abdominal pain.
 Due to the increased diversity, each job entails different tasks
and therefore different cycle times.
 Similarly, office workers, housekeepers, HR reps, assistants,
nurses, and clinicians must all perform multiple tasks in order
to meet the needs of the patients.
 There are many jobs with no repeatability, and repeatable jobs
which require a long cycle time.

Standardized Work & Takt Time:
Types I, II, and III
The diverse mix of job types in the workplace and the fact
that each person performs multiple tasks presents
challenges in identifying and understanding the problems
and implementing standardization based solely on the
conventional concept of Takt Time.
We must:
• Define the process to perform each task.
• Utilize Takt Time as a tool for Kaizen.
We need ingenuity, ideas, and

innovations to help us achieve the
purpose of Standard Work

Three Types of Standardized Work

Standardized Work Type I
The routine standardized work is called Type I, involving only one type of
patient, such as patients coming for flu shots or urinary tract infections.
Standardized Work Type II

The amount of work (exam and/or treatment time) varies depending on the
patient types and symptoms. Stratify patients by type and create a bar chart
with Cycle Time for each patient type. Calculate the weighted average
Cycle.
Standardized Work Type III
Various tasks are performed for multiple patients, but with not much
repeatability for each patient. Repeatable tasks, if any, have a long cycle
time. In this case, create a percent load chart of multiple tasks within a fixed
time period.

Illustration of Standardized Work Type I

• Set of three documents for Standardized Work（Standardized Production Capacity
Chart, Standard Work Combination Sheet, and Standard Work Sheet).
Determine Takt Time on the basis of required numbers.
Operating Time per Day (Fixed Amount of Time - breaks)

Takt Time ＝
# of Patients Required to See Each Day
 Modify Takt Time according to the production volume, i.e., if there are more
patients to see (demand) on a particular day.
 Use the Percent Load Chart to figure out how many people we need.
For example, in order to meet the increased

demand, we need to equalize the work load
46″ Takt Time (Heijunka) of team members A, B, C, and D.
To do this, all four team members must be

multi-skilled. This is applicable in a scenario
A B C D where a patient type does not change the
A, B, C, and D’s time required to perform tasks.
working time
Illustration of
Standardized Work Type II
Stratify patients by type and create a bar chart with Cycle
Time for each patient type. Also calculate the weighted
average Cycle Time.
The worker is taking a
Takt Time
50″ different amount of time
for each patient type.
T.T.=46″ 45″
Weighted average cycle
4０″ time helps identify
Weighted problem areas and helps
Man-hour
Average C.T.
with allocation of work
and more efficient
scheduling.
Patient types a b c
grouped per
time
requirements Worker A

Calculation Method for
Standardized Work Type I-II
Calculation for TAKT Time
Baseline Volume Target volume
# Shifts/Day
(×) # of Hours/Shift
(＝) # of Hours/Day
(×) 60 Minutes/Hour
(＝) # of Minutes/Day
(－) Breaks (Minutes)
(－) Wash Time (Minutes)
(－) Tool Change (Minutes)
(＝) Total Minutes Available/Day
(÷) Unit Sales/Day
TAKT TIME : (＝) Minutes Per Unit
OR : (×) 60 Seconds/Minute
TAKT TIME : (＝) Seconds per Unit

Weighted Average Calculation Method of Workload

for Standardized Work Type II
Working Time by
Worker Work Details Daily Workload Daily Working Time
Task
(a) （80） (×) （150″） (＝) （12,000″）
(b) （80） (×) （120″） (＝) （9,600″）
(c) （40） (×) （100″） (＝) （4,000″）
Total Sum（A）(200） Total Sum(B)

（25,600″）
Total Sum of Daily Working Time（B）

Weighted Average of Workload =
Total Sum of Daily Workload（A）
Daily Operating Time ： 460 min.（27,600″）

27,600″ 25,600″
T.T. ＝＝ 138″ C.T. Weighted Average ＝＝ 128″
200 150″ 200
T.T. ＝ 138″
Weighted Average
120″ 100″ CT 128”
(a) (b) (c)

Illustration of
Percent Load Chart of multiple tasks within
a fixed amount of time.
Time to do task ⑩each time
⑩ Calculation of required multiplied by the number of
working time for a task times the task is done per day
T.T.=460′
① ⑨
④ Check to see if the
⑥ operating time is
Operating
taken up by different
②
Time
Stack up the tasks. If not, start

⑦ required time Kaizen with the task
⑩ for each task which is taking longer
⑤ time.
③ ⑧
Workers ィ
A
ィィ
B
ィィ
C
ィィ
D
ィ
Calculation Method for
Calculation of Available Time ＜Hours in a day (Fixed Amount of Time）＞
※Correspond to Takt Time for Types I and II
Baseline Volume Target volume
# Shifts/Day
(×) # of Hours/Shift
(＝) # of Hours/Day
(×) 60 Minutes/Hour
(＝) # of Minutes/Day
(－) Breaks (Minutes)
(－) Wash Time (Minutes)
(－) Tool Change (Minutes)
(＝) Total Minutes Available/Day

Calculation Method of Workload in

Standardized Work III
Working Time by
Worker Work Details No. of Tasks/day Daily Working Time
Task
（250 min.）
(a) （5 times） (×) （50 min.） (＝)
（90 min.）
(b) （3 times） (×) （30 min.） (＝)
（150 min.）
(c) （5 times） (×) （30 min.） (＝)
(＝) Total Sum（490 min.）
Daily Operating Time ： 460 min.

Daily Working Time ： 490 min.
490
min. Operating Time ＝ 460 min.
(c)
(b)
(a)

7 Steps to Calculate a Weighted Average Cycle Time (WACT)
1) Determine task groups by PQA and/or stick tallies 2) Determine task group percentage of whole
X 38 patient exams X Y 38
exams = 27%
= a% = b% 137
Y 99 patient calls Z Z 99
+ calls = 73%
Z 137
137 daily tasks
4) Determine average cycle time for each task group
3) Calculate takt time of combined task groups based on time observations
Time available -60 min break 3.06 or 184 takt exams = 636 seconds cycle time
= 420 =
# total daily tasks 137 min sec time calls = 228 seconds cycle time
5) Calculate weighted average cycle time for each task group using percentages from step 2 and cycle times
from step 4
a% x exam cycle time = X 27% x 636 = 172 seconds
b% x call cycle time = Y 73% x 228 = 166 seconds

Total weighted average Z 338 seconds weighted average cycle time
cycle time (WACT)
6) Graph percent load chart 7) Perform Kaizen to meet takt time
338
Exam 172
Σ O.C.T
= 338
= 1.8 people · Eliminate waste in process
takt time 184 required · Eliminate process
184 sec takt time · Redistribute workload
· Add value
Call 166 · Add quality
· PDCA
338 sec
WACT Copyright 2009 John Black and Associates LLC

How to calculate Productivity?
Current
Patient (Output) Provider (Input)
A type: 10 patients per day 1 doctor: 10 hours per day
B type: 20 patients per day 2 nurses: 11 hours per day
C type: 10 patients per day 1 clerk: 8 hours per day
Total: 40 patients per day Total: 40 hours per day
Output 40 patients 1.0 patient / provider･
Productivity = =
Input 40 hours hour
No
Up Demand
Kaizen ① “ Increase Output “ Kaizen ② “ Decrease Input “
Patient (Output) Provider (Input) Patient (Output) Provider (Input)
A type : 11patients 1 doctor : 10hours A type : 10patients 1 doctor : 9hours
B type : 21patients 2 nurses : 11hours B type : 20patients 2 nurses : 10hours
C type : 12patients 1 clerk : 8hours C type : 10patients 1 clerk : 7hours
total : 44patients total : 40hours total : 40patients total : 36hours
44 patients 40 patients
Productivity = = 1.1 patient /provider Productivity = = 1.11 patient /provider
40 hours hour 36 hours hour
Productivity = (1.1-1.0) × 100 =10%up Productivity = (1.11-1.0) × 100 =11%up

How to calculate Capacity?
●Spot KAIZEN (Process)
Department open time Demand
8 hours (480 min)/day 40 patients (or Jobs) /day
Pre－Kaizen Weighted 400 min
Average = = 10 min / patient
Patient (Output) Cycle time 40 patients
A type : 10 patients × Cycle time 15 min = 150 min
B type : 20 patients × Cycle time 10 min = 200 min
C type : 10 patients × Cycle time 5 min = 50 min
480 min
Capacity = = 48 patients / day
total : 40 patients 400 min 10 min
※ Same patient ratio
Post－Kaizen Weighted 320 min

Average = = 8 min / patient
Patient (Output) Cycle time 40 patients
A type : 10 patients × Cycle time 14 min = 140 min
B type : 20 patients × Cycle time 7 min = 140 min
480 min
C type : 10 patients × Cycle time 4 min = 40 min
Capacity = = 60 patients / day
total : 40 patients 320 min 8 min
※ Capacity 25%up

How to calculate Capacity?
●Line KAIZEN (Flow)
480 min
Department open time Demand T.T= = 12 min /patient
8 hours (480 min)/day 40 patients (or Jobs) /day 40 patients
Process map
Check－In Nurse Doctor
Percent Load Chart

T.T 14min 14min T.T T.T
12min 12min 12min 12min 12min
10min
8min
Pos
Pre Bottle
t Pos
Pre
Pre Neck t No
post
Kaizen? No Change
Change! !
Capacity
up?
Clerk Nurse Doctor


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Mod 11 – Standard Ops

Cost Reduction Profit =

Jidoka Standard Total Visual

Value Stream Mapping

ONE PIECE FLOW TAKT TIME PULL PRODUCTION

11 Standard Ops v20140606 1 ©1996-2013, John Black and Associates LLC

“Without Standards, There

 Considered to be the father of the Toyota Production System.

Standards are not New to Healthcare

11 Standard Ops v20130530 3 ©1996-2013, John Black and Associates LLC

Mayo Clinic/Used with permission

11 Standard Ops v20140606 4 ©1996-2013, John Black and Associates LLC

Mayo Clinic/Used with permission

11 Standard Ops v20140606 5 ©1996-2013, John Black and Associates LLC

Mayo Clinic/Used with permission

11 Standard Ops v20140606 6 ©1996-2013, John Black and Associates LLC

Standard Operations: Key Points

The Three Elements of Standard

A 3-legged stool is always stable,

JUST IN TIME Jidoka

Leveled Production (Heijunka)

Cost Reduction Through The Elimination of Muda (Waste or Non-Value Added)

Standard operations is a fundamental tool to:

Standard Operations in Healthcare

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The Importance of Time

11 Standard Ops v20130530 11 ©1996-2013, John Black and Associates LLC

The Measurement of Time

11 Standard Ops v20130530 12 ©1996-2013, John Black and Associates LLC

The Measurement of Time

Total Lead Time of the Patient’s Experience

Lead Time is observed and can be improved!

11 Standard Ops v20130530 13 ©1996-2013, John Black and Associates LLC

The Measurement of Time

11 Standard Ops v20130530 14 ©1996-2013, John Black and Associates LLC

The Measurement of Time

Takt Time is market driven and must be met to

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The Measurement of Time

Takt Time = Time Available

Example: Market requires 40 patient visits in (1) 8 hour day.

Takt Time = 420 minutes = 10.5 minutes Takt Time is always

The Measurement of Time

Available Time In Shift

What is the Takt Time?

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Demand vs. Capacity

• Capacity - I’m open 8 hours, and each appointment takes

The Measurement of Time

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The Measurement of Time

Typically: Takt Time <<<Cycle Time<<<Lead Time

How do we manage this dilemma?

These conditions lead to

The purpose of standard operations is to:

11 Standard Ops v20130530 20 ©1996-2013, John Black and Associates LLC

The Measurement of Time

11 Standard Ops v20130530 21 ©1996-2013, John Black and Associates LLC

The Measurements of Time