About The Course

Understand the difference between standard work and job rigidity. Complete basic calculations for determining proper staffing levels.

Standard Work is the act of defining the current work sequence and making sure that it functions in accordance to patient demand. Standard work also involves making sure that, operationally, you are staffed in accordance to patient demand and that you have the appropriate mix of beds and providers (nurses, physicians, techs, etc.). Finally, the application of standard work ensures that you have enough work in process (clinically this means patients) in order to maintain productivity, minimizing idle time, while maintaining reasonable throughput times. As we will see in later chapters, this is actually quite complex. In essence, standard work is the most effective combination of activities that will provide the most efficient care known to be possible at that time.

Unlike manufacturing where production is set based on a projected schedule, in healthcare, this involves carefully quantifying the rate, variation and patterns of arrivals. Because of the complex nature of the very specialized service industry we work in, these patterns often must be studied seasonally, monthly, daily, and even hourly. Once these arrival patterns are clearly characterized, we can then use this information to estimate the amount of time we have to perform each operation in order to meet the pace of arrivals, a concept called “takt time.”

After characterizing arrival patterns and takt times, standard work then focuses on the capacity or ability to provide care. Again, using a systematic approach, we can begin to quantify the time it takes and the variation involved in caring for patients at every step in the process. Once this is clearly delineated, we can then determine the appropriate staffing and beds required to meet demand, or demand-capacity matching.

The final step is the calculation of the appropriate amount of work in process (essentially team size) that promotes the most efficient throughput, maximizing provider utilization and minimizing idle time (within reason).  As we will see in later chapters, due to the variation and randomness of the arrivals associated with emergency departments, this can be very difficult, but it is possible.

Why is standard work important? From a process flow perspective, it reduces variation which can affect efficiency and productivity, it reduces the likelihood for errors and deviation from the standard of care and it maximizes the value-added time from the patient’s perspective. In terms of sustainable gains and orienting new employees, it provides for process documentation, staff instructions, and training aids to describe the best known method.

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