by eliminating waste nva/va- standard · work, takt time, and standard work in process. the three...

©1996-2013, John Black and Associates LLC

Licensed Materials – USA Copyright Laws Apply 1

Mod 11 – Standard Ops

11 Standard Ops v20140606

Global Production System

Product/Patient Quantity Analysis

Kaizen Kaikuku

Just-in-Time

Measures

Standard

Operations

Heijunka

(Leveling)

Continuous

Flow

Total

Productive

Maintenance

Poka-yoke (mistake

proofing)

Kanban

Setup Reduction

Changeover

Multi-process

Operations

Jidoka (human

automation)

GPS

MUDA MUDA

Visual

Control

Andon

TAKT TIME ONE PIECE FLOW PULL PRODUCTION

R

e

d

e

p

l

o

y

m

e

n

t

Committed Leaders

Profit =

Price - Cost

TAKT Time Map

Capacity Tables

Cost Reduction By Eliminating Waste

GPS Depth Study

NVA/VA-

Functions/Mgrs

Quality Cost Delivery

Morale Safety

Value Stream Mapping

5S • Sorting

• Simplifying

• Sweeping

• Standardizing

• Self Discipline

3P Prod Prep

7 Flows Medicine

7

Wastes

RPIW

7 Flows

Factory

4 No’s

© 1996-2013, John Black and Associates LLC

(modified from Hiroyuki Hirano, Productivity Press).

Standard

Operations

Module 11





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.“

“Without Standards, There

Can Be No Improvement”

--Taiichi Ohno


3 ©1996-2013, John Black and Associates LLC

Licensed Materials – USA Copyright Laws Apply 11 Standard Ops v20130530

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.





A 3-legged stool is always stable,

but falls over if one leg is missing.

The Three Elements of Standard

Operations





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.

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

Leveled Production (Heijunka)

JUST IN TIME

Operate with the

minimum resources

required to consistently

deliver

• Just what is needed.

• In just the required

amount.

• Just where it is

needed.

• Just when it is needed.

Jidoka

One-by-one confirmation to detect abnormalities.

Stop and respond to every abnormality.

Separate machine work from human work.

Enable machines to detect abnormalities and stop autonomously.

Pull System

Production

One Piece Flow

Production Supermarket System

Takt Time

Production

Andon Operational

Availability

Standard Work in Process

Kanban

Standard

Work

Materials

Machine

s

People

Global

Production System

To Make things in the Right Way




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

Pt

Schedules


Total Lead Time of the Patient’s Experience

= all cycle times and all waits and walks in between cycle time

Patient Requests Service

Day of service lead time

Lead Time is observed and can be improved!

Pt

Checks

In

Wait

Pt has

BP, Wt Pt has

Exam

Pt is

Discharged

Walk Walk Wait/

Walk

2:00 2:00 3:00 20:00 5:00

48:00:00 0:30 5:30 2:00

Cycle

Time Cycle

Time

Cycle

Time

Cycle

Time

Cycle

Time





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.).

Exam

Examining

the patient

can be a

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!





Takt Time = 420 minutes

40 patient visits

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.

planned time when people

are not available.


- 60 minutes

420 minutes = net available time

for patient care

= 10.5 minutes Takt Time is always

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




Output Required In Shift


Calculating Takt Time

• 48 patient visits per day must be completed.

• One 8 hour shift per day

What is the Takt Time?

Exercise:

Takt Time = Available Time In Shift




Demand

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.

Takt Time = Available Time




The Measurement of Time 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).




# 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.

The Measurements of Time Standard Operations defines the minimum number

of team members required




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?

The Measurement of Time Standard Operations defines the number of patients

required to keep the process flowing (SWIP).





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.

SWIP = Lead Time

Takt Time

Using Standard Operations





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




Purpose:

Standard Work

• 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.




A prescribed, repeatable sequence of operations,

balancing manual and automatic work:

Assigned to a single team member,

Balanced to the Takt Time.

Process

Step

1

Process Step 2

Process Step 3

Process Step 4

Process Step 5 Process Step 6

1

2 3

3

2

1

4

The Definition 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.

If you wait until you are ready, you will never begin!

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.

The Prerequisites of Standard Work




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

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.

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.




Starting point Establish a

standard work

that defines

normal

conditions.

Identify barriers

to consistently

following the

standard.

Eliminate

barriers, put

in counter-

measures

Re-set the

standard to the

new improved

process.

Which results in a process

with more consistency and

less variation.

Run the process

Change and improve the

process

Identify waste and

opportunities for

improvement.

Improve the

process.

Standard Work Improvement Cycle




Standard Work

Tools for Documentation

Standard Worksheet

Time Observation Form

Standard Work

Combination Sheet

Percent Load Chart

Forms Purpose

• To record actual layout & flow.

• To train new team members.

• To observe operations & break into small parts.

• To establish best/repeatable elapsed time per

element.

• To demonstrate best combination of manual

work and machine work for one team member.

• To determine level of staffing in the cell.

• To determine machine/equipment capacity.





Production System Time Observation Sheet.ppt

Time Observation SheetProcess Name:

Step

No. Component TaskComponent

Task TimeObservation Points

Observation

Date:

Observer:

Observation Cycle Number

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Observation

Time:

Analysis

Number:

Time for 1 cycle

B


• Used to document the steps in a process and time it takes to complete each

step.

• Creates data that are used for other standard work forms.

• Combined with the Standard Work Sheet is the basis for decision making.

Standard WorkCombination Sheet

StepNo.

Work Element Man. Auto. WalkOperation Time

Product number or family

Dept.

Unitsper shift

Takttime

Standard Work Sequence Description

DatePrepared

Manual

Automatic

Walking

Waiting

Operator

Waiting

Totals

___ of ___

Production System Standard Work Combination Sheet.ppt

Punch

Saw # 1

Saw # 2

Wash

Notch

Debur/Clean

Move to FG

t/t = 630

Standard Work Combination Sheet

• Used to describe the best combination of manual work with

equipment/machine work in relation to Takt Time.

• Reflects the current work sequence and the expected time for completion of

each task.

• Includes the automatic time of any equipment in the process and the relation

of the manual work to the automatic work.

Standard Work Forms Standard Worksheet

• Used to document work area layout and flow.

• Shows placement of equipment/work tables, sequence of work, team

member.

• Shows supplies/material movement and the location (with standard quantity)

of WIP.

• Notes quality assurance checks and safety items that are standard for the

area.

Quali tyCheck

SafetyPrecaut ion

Standard WorkIn-Process

# of pieces of stdwork in-process

TaktTim e

OperatorNumber

Standard Work SheetProcess Name:

Model Number:

Model Name:

Scope of

Operati ons

From:

To:

Date:

Dept. Head Supervisor

Mini Saw-Punchxx30Scissor Lift

PunchWash

DEBUR

PUNCH

SAW 1

SAW 2

NOTCH

WASH

5

1

2

3

4

5






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.

Standard Work Forms

Percent Load (Bar Chart)

• Used to visually contrast team member and/or process cycle time

with Takt Time for a specific line or cell.

• Assists in understanding the proper number of team members that

should be staffing a line and the balance of the work from person to

person.

• Indicates where Kaizen must take place with the specific

requirement for improvement to achieve line balance.

Percent Load Chart (Bar Chart)Process Name:

Product Line:

Model Name or Part:

Scope of

Operations

From:

To:

Date:

Department Supervisor

Tim

e

Operator

Operator Cycle Time

Sum Total of Operator

Cycle Times:Takt Time: Sum of Operator Cycle Times

Takt Time

O.C.T.

T.T.= = Team Members Required

Production System Percent Load Chart.ppt

t/t = 630 sec

Sample

Lifting Stuff

GXV-2000

630 sec

625 sec 620 sec 615 sec 345 sec

2205 sec 3.5

A B C D

kaiz

en

kaiz

en

kaizen = 435 sec






Production System Time Observation Sheet.ppt


Step

No. Component TaskComponent

Task TimeObservation Points

Observation

Date:

Observer:


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Observation

Time:

Analysis

Number:

Time for 1 cycle

B

1

2 3

5

4

7

6

= Material Flow = Team members = People Flow

Standard Worksheet (Raw Data)

Observe and Understand the Work

Time Observation (Raw Data)

Establish a

standard work

that defines

normal

conditions.

Identify barriers

to consistently

following the

standard.

Eliminate

barriers, put

in counter-

measures

Re-set the

standard to the

new improved

process.

Which results in a process with

more consistency and less

variation.

Run the process


process

Identify waste and

opportunities for

improvement.

Improve the

process.







Product Line:

Model Name or Part:

Scope of

Operations

From:

To:

Date:


Tim

e

Operator

Operator Cycle Time



Takt Time

O.C.T.



t/t = 630 sec

Sample

Lifting Stuff

GXV-2000

630 sec

540 sec 660 sec 490 sec 400 sec 540 sec

2630 sec 4.2

A B C D E


Product Line:

Model Name or Part:

Scope of

Operations

From:

To:

Date:


Tim

e

Operator

Operator Cycle Time



Takt Time

O.C.T.



t/t = 630 sec

Sample

Lifting Stuff

GXV-2000

630 sec

625 sec 620 sec 615 sec 345 sec

2205 sec 3.5

A B C D

kaiz

en

kaiz

en

kaizen = 435 sec


StepNo.



Dept.

Unitsper shift

Takttime


DatePrepared

Manual

Automatic

Walking

Waiting

Operator

Waiting

Totals

___ of ___


Punch

Saw # 1

Saw # 2

Wash

Notch

Debur

Move to F.G.

t/t = 630


StepNo.



Dept.

Unitsper shift

Takttime


DatePrepared

Manual

Automatic

Walking

Waiting

Operator

Waiting

Totals

___ of ___


Punch

Saw # 1

Saw # 2

Wash

Notch

Debur

Move to F.G.

t/t = 630

Standard Work –

Analyze Work and identify Waste

Establish a

standard work

that defines

normal

conditions.

Identify barriers

to consistently

following the

standard.

Eliminate

barriers, put

in counter-

measures

Re-set the

standard to the

new improved

process.



variation.

Run the process


process

Identify waste and

opportunities for

improvement.

Improve the

process.






Quick And

Crude Is

Better

Than

Slow And

Elegant!

Standard Work

Drives Improvements

Standard Work - Eliminates Waste

Establish a

standard work

that defines

normal

conditions.

Identify barriers

to consistently

following the

standard.

Eliminate

barriers, put

in counter-

measures

Re-set the

standard to the

new improved

process.



variation.

Run the process


process

Identify waste and

opportunities for

improvement.

Improve the

process.





Taiichi Ohno’s Seven Wastes

MUDA

Time on Hand (Waiting)

Transportation

Defective Products

Processing

Movement

Stock on Hand

(Inventory)

Overproduction





1 2 3

5

4

7 6

Production System Tim e O bservation Sheet .ppt


Step

No. Component TaskComponentTask Time

Observation Points

Observat ion

Date:

Observer:


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Observat ion

Tim e:

Analysis

Number:

Time for 1 cycle

B


StepNo.

Work Element Man. Auto. WalkOperati on Ti me

Product numberor famil y

Dept.

Unitsper shif t

Takt

t ime

Standard Work

Sequence Descripti on

DatePrepared

Manual

Autom atic

Walking

Wait ing

Operator

Waiting

Totals

___ of ___

Production System Standard Work Com bination Sheet .ppt

Just sit back

And I’ll tell you

A tale

A tale of a fateful

Trip that started

From this tropic port

Abroad this tiny ship

t/t = 630


Product Line:

Model Name or Part:

Scope of

Operations

From:

To:

Date:


Tim

e

Operator

Operator Cycle Time



Takt Time

O.C.T.



t/t = 630 sec

Sample

Lifting Stuff

GXV-2000

630 sec

625 sec 620 sec 615 sec 345 sec

2205 sec 3.5

A B C D

kaiz

en

kaiz

en

kaizen = 435 sec

Standard Work – Standardize the New Work Cycle:

Establish a

standard

work that

defines

normal

conditions.

Identify barriers

to consistently

following the

standard.

Eliminate

barriers, put

in counter-

measures

Re-set the

standard to the

new improved

process.



variation.

Run the process


process

Identify waste and

opportunities for

improvement.

Improve the

process.






•Time Observation Sheet.

•Standard Worksheet.

•Video.

•Value Stream Map

PLAN - Observe & understand the work.

1.

• Percent Load (Bar

Chart).

• Standard Work

Combination Sheet.

CHECK - Did it

work?

2. DO – Don’t

discuss it - try it.

3.

ACT - Standardize the new work cycle.

4.

Step Tools

Repeat these steps as many times as possible.

Th

en

do

it

ag

ain

L

ath

er,

Rin

se, R

ep

eat!

Standard Work Drives Improvements

Standard Work - PDCA Cycle:

•Time Observation Sheet.

•Standard Worksheet.

•Video.

• Standard Work or

Work Standard





How Do Standard

Operations Help Drive

Improvements?




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.

Standard Operations Are Used in all Phases of

Continuous Improvement





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.

Team members

A B C D

Team member

Cycle Time

(minutes) Takt Time is

always shown in red

Current Situation:

• 4 team members required

• Team member C cannot meet Takt Time

2

4

6

8

10

12






Team member A B C D

Takt Time

Under-utilized Time

2

4

6

8

10

Te

am

me

mb

er

Cyc

le T

ime

(min

ute

s)

Waste eliminated

Using Standard

Operations • Use Standard Work and Time Observation sheets to develop Standard Work

Combination Sheets for all 4 team members.

• Find and eliminate waste.

RPIW Targets: Process performs to Takt Time. Improve and re-balance the line to 3 team members

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.

Team member

Takt Time

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.

2

4

6

8

10

12

Te

am

me

mb

er

Cyc

le T

ime

(min

ute

s)





Example

Standard Operations





Process Name Spaghetti Diagram

Operator

Location

Operation sequence

From:

To:

Date prepared or revised / /

Dept. Supervisor

Safety Quality Check Standard WIP # of pieces of WIP TAKT time Cycle time Operator Number

(1)

1. Label Process

2. Draw physical layout

3. Number sequence of

operations

4. Standard Work-In-Process

5. WIP

6. Quality Inspections

7. Safety Precautions

8. Takt Time

9. Cycle Time

(5) (8) (9)

Shift

(7) (6) (4)

(2) (3)

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.

Filling out a Standard Worksheet

(1) Set Up

instruments

(2) Set Up

anesthesia

(3) Drape

patient

(4) Anesthetize

patient

(5) Begin

surgery

(7) Put away

instruments

Check instruments

Verify

setup Procedural

Pause

Patient under

anesthesia check





Process Name Acute Injury Exam Spaghetti Diagram

Operator Nurse Practitioner

Location GIM

Operation sequence

From: Pick Up Patient

To: Discharge Patient

Date prepared or revised 2 / 20 / 99

Dept. Head Supervisor Shift

Smith Jones AM

Safety PrecautionQuality Check Standard WIP # of pieces of WIP

4

TAKT time

40'

Cycle time

40'

Operator Number

1/1

BiometricsExam

X Ray

Results

Air Cast

Discharge

Reception①

②③

④

⑤ ⑥ ⑦

A B

C

D E F

Standard Worksheet






Process Observation Time Observer Observation Date:

Step#

Description of Operation 1 2 3 4 5 6 7 8 9 10 11 12 ShortestTask Time

Remarks

Time for 1 Cycle





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.

How to Measure the Operation Time





Process Writing on whiteboard Time Observation Worksheet Date

Time

Nov.1 /

PM 2:00 ~

Operator No. 1 / 1

Observer Yamada

№ Elementary work 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1

2

3

4

5

6

7

Get up from a chair

Walk to a whiteboard

Pick up a pen

Write on the whiteboard

Put down the pen

Walk back to the chair

Sit down in the chair 38 1 22 2 08 2 56 3 40

(38) 44 46 48 44

6

6

18

12

21

3

M

35

44

9

47

3

54

7

1 05

11

07

2

17

10

21

4

31

10

34

3

41

7

52

11

55

3

2 05

10

08

3

18

10

21

3

29

8

39

10

41

2

50

9

53

3

3 04

9

06

2

14

8

25

11

28

3

39

11

43

4

52

9

54

2

4 03

9

13

10

16

3

27

11

30

3

40

10

43

3

50

7

5 00

10

03

3

14

11

18

4

27

9

29

2

7

10

3

10

3

9

2

44 Time of one cycle

６

２

９

×

×

×

Component Task Time Points observed

Steps 1,2

Step 4

measure

Determine

Step 8

Determine

Determine,

best times

Step 6

calculate

Step 5+

(47”-44”=3”)

Step 7

Step 3 measure






StepNo.

Work Element Man. Auto. WalkOperati on Ti me

Product numberor famil y

Dept.

Unitsper shif t

Takt

t ime

Standard Work

Sequence Descripti on

DatePrepared

Manual

Autom atic

Walking

Wait ing

Operator

Waiting

Totals

___ of ___

©2002 John Black & Associates LLC

(1)

(2)

(3) Indicate TAKT time

with a red line

(4) (6)

(5)

(7)

(10)

(9) (13)

(11)

(12)

(8)




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.

Filling out a






Operator

Process Patient RoomingDate

Prepared 2/20 WIP 48 Patients

Area Primary Care Clinic Dept. GIM TAKT time 44 sec

StepTime Operation Time (in seconds)

№ Man Auto Walk 5" 10" 15" 20" 25" 30" 35" 40" 45" 50" 55" 60" 65" 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

7Call Physician, Get Next

Patient2 3 2

Wait ing

Totals 26 3 15

Operation Name


Manual

Automati

Walking

Takt Time


MA

BEFORE KAIZEN





● Doctor Movement Standard Worksheet

Exam Room

Nurse

Station

Doctor’s Room

①

②

③

④

⑤

⑥

⑦ ⑩

⑧ ⑨

T.T. = 660

min/30patients

=22 min per patient

C.T. = 30 min per

patient

Using the Standard Work Combination Sheet with Standard Worksheet





● Ordinary pattern Standard Work Combination Sheet

No Work Content M A W

1 Check a patient

schedule 1’ 1’

2 Exam 1’ 0.5

’

3 Check a chart 1’ 0.5

’

4 Exam 5’ 0.5

’

5 Communicate with nurse 3’ 1’

6 Confirm lab data 3’ 1’

7 Exam 2’ 0.5

’

8 Test order 2’ 1’

9 Dictation 2’ 1’

10 Communicate with

patient 2’ 1’

22’ 8’

5’ 10’ 15’ 20’ 25’ 30’

Looks good!?

Good

sequence!?

Why is it

over T.T






●Applied pattern Standard Work Combination Sheet

No Work Content M A W

1 Check a patient schedule 1’ 1’

6 Confirm lab data 3’ 1’

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’

22’ 8’

5’ 10’ 15’ 20’ 25’ 30’

Doctor’s room

operation Exam room

operation

Nurse station

operation Bad work

sequence!






Percent Load Chart (Bar Chart) Process Name:

Product Line:

Model Name or Part:

Scope of

Operations

From:

To:

Date:

Department Supervisor T

ime

Operator

Operator Cycle Time

Sum Total of

Operator Cycle

Times:

Takt Time: Sum of Operator Cycle Times

Takt Time

O.C.T.

T.T. = = Team Members

Required =




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.





Percent Load Chart (Bar Chart) Process Name:

Area:

Operator:

Scope of

Operations

From:

To:

Date:


Tim

e

Operator

Operator Cycle Time

Sum Total of

Operator Cycle

Times:

Takt Time: Sum of Operator Cycle Times

Takt Time

O.C.T.

T.T. = = Team Members

Required =

8

1

3 4

1

6

3

5

7

(min

ute

s)

Before Kaizen

2

7

6

5

4

3

2

1

8 Red Line

Takt Time

A B C D

3’30” 4’15” 8’00” 5’45”





Medical Example

Standard Work





Standard Worksheet

Before Improvement





Process

Observation Time Observer Observation Date:

Step #

Description of Operation 1 2 3 4 5 6 7 8 9 10 11 12 Shortest Task Time

Remarks

Time for 1 Cycle

Tech Room Turnover 8/2/01

Wait for tower

Remove scope

Wipe tower

Get stretcher

Wait for room

Setup tower

Setup scope

Test scope

1

2

3

4

5

6

7 8

25

25 1:16

51

1:56

40 2:32

36 4:24

1:52 4:54

30 5:15

21 6:01

46

6:01 6:01

25”

51”

40”

36”

1:52”

30”

21”

46”

Before Improvement





Before

Before Improvement





After Improvement

Standard Worksheet





Process

Observation Time Observer Observation Date:

Step #

Description of Operation 1 2 3 4 5 6 7 8 9 10 11 12 Shortest Task Time

Remarks

Time for 1 Cycle

Tech Room Turnover 8/2/01

Remove scope

Wipe tower

Get stretcher

Setup tower

Setup scope

Test scope

1

2

3

4

5

6

26

26 1:06

40

1:42

36 2:12

30 2:33

21 3:21

49

3:21 3:21

26”

40”

36”

30”

21”

49”

After Improvement





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.




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.

Appendix





How to use Takt Time?

① “Department” Takt Time & Cycle Time / patient (job)

Department available time : Open time

Demand : No. of patients (or Jobs)

Open time (No break time)

T.T =

No. of patients

Department available time : 12H (720min)

Demand : 60 patients

720min

T.T = = 12min per

60patients patient

Percent Load Chart

T.T

Nurse

A

B

C

Nurse Nurse Provider

25min

18min 20min

12min

21min

Weighted average

Cycle time

Cycle time per patient!

Repeatable work per patient!

21 min

No. of provider = = 2 providers

12 min

Example





②－１ “Provider” Takt Time & Cycle Time / patient (job)

Provider available time : Shift time－Break time

Demand : No. of patients (or Jobs)

Net available time

T.T =

No. of patients

Provider available Time : 12H (720min)-60min

Demand : 30 Patients 2Nurses:30Patients/each)

660 min

T.T = =22 min per

30 patients patient

Percent Load Chart

T.T

X Y Nurse

20min

24min

22min Cycle time per patient!

Repeatable work per patient!

Nurse Y

Kaizen needed!

Weighted average

Cycle time

Example






②－２ “Provider” Takt Time & Total Task Time (Each task)

Provider available time:

Shift time－Break time T.T = Net available time

YAMAZUMI Chart

T.T

X Y Clerk

420mi

n

440mi

n 420mi

n

Cycle time = 440 min

Not repeatable work per

shift!

Task B

Kaizen needed!

Total task time C =

Task time × No. of tasks

Provider available time : 480 min－60 min T.T = 480 min－60 min=

420 min

Task a

Task b

Task c

Task d

Task e

Task a

Task b

Task c

Task d

Task e

100min

(Big

portion)

Overtime!

Example






③ “Task” Takt Time（ “Task” Target Time）

Task available time

Demand : No. of tasks

Task available time

T.T =

No. of tasks

Task available time : 100 min ⇒ 80 min

Demand : 4 times

80 min

T.T = =20 min per

4 times task

YAMAZUMI Chart

T.T

Y Clerk

440mi

n 420mi

n

Task a

Task b

Task c

Task d

Task e

Kaizen Task b

100min⇒80min

Percent Load Chart

T.T

b Task

25min

20min

Pre

Post

b

20min

No overtime!

Example






Inappropriate Example ①

●Discharge process（Inpatient unit）

1. Assessment

2. Care

3. Medication

4. Charting

5. Telephone

6. Discharge

・

・

Patient A

Inpatient

unit

1. Assessment

2. Care

3. Medication

4. Charting

5. Telephone

6. Discharge

・

・

Patient B

1. Assessment

2. Care

3. Medication

4. Charting

5. Telephone

6. ・

・

・

Patient C

1. Assessment

2. Care

3. Medication

4. Charting

5. Telephone

6. ・

・

・

Patient D

Department available time : 720min (Open time)

Demand : 2 patients (Discharge)

720 min

T.T = = 360 min per patient

2 patients

T.T

Task

360mi

n

30min

Discharge

Percent Load Chart Standard Work Combination Sheet

N

o Work Content M A W

1 Check a patient schedule 1

’

1

’

2 Exam 1

’

0

.

5

’

3 Check a chart 1

’

0

.

5

’

4 Exam 5

’

0

.

5

’

5 Communicate with nurse 3

’

1

’

6 Confirm lab data 3

’

1

’

7 Exam 2

’

0

.

5

’

8 Test order 2

’

1

’

9 Dictation 2

’

1

’

1

0 Communicate with patient

2

’

1

’

2

2

’

8

’

30min × 1patient

？

？

Example





Inappropriate Example ②

●Nursing Process（Inpatient Unit）⇒ Not repeatable work

1. Assessment

2. Care

3. Medication

4. Charting

5. Telephone

6. Discharge

・

・

Patient A

Nurse tasks

1. Assessment

2. Care

3. Medication

4. Charting

5. Telephone

6. Discharge

・

・

Patient B

1. Assessment

2. Care

3. Medication

4. Charting

5. Telephone

6. Discharge

・

・

Patient C

1. Assessment

2. Care

3. Medication

4. Charting

5. Telephone

6. Discharge

・

・

Patient D

Provider available time : 720 min－60 min

Demand : 4 patients

660 min

T.T = = 165 min per

patient

4 patients

T.T

Task

165mi

n

30min

Discharge

Percent Load Chart Standard Work Combination Sheet

N


1 Check a patient schedule 1

’

1

’

2 Exam 1

’

0

.

5

’

3 Check a chart 1

’

0

.

5

’

4 Exam 5

’

0

.

5

’

5 Communicate with nurse 3

’

1

’

6 Confirm lab data 3

’

1

’

7 Exam 2

’

0

.

5

’

8 Test order 2

’

1

’

9 Dictation 2

’

1

’

1

0 Communicate with patient

2

’

1

’

2

2

’

8

’

30min × 1patient

？

？

Example





Appropriate Example

●Nursing Process（Inpatient Unit）⇒ Not repeatable work

1. Assessment

2. Care

3. Medication

4. Charting

5. Telephone

6. Discharge

・

・

Patient A

Nurse tasks

1. Assessment

2. Care

3. Medication

4. Charting

5. Telephone

6. Discharge

・

・

Patient B

1. Assessment

2. Care

3. Medication

4. Charting

5. Telephone

6. Discharge

・

・

Patient C

1. Assessment

2. Care

3. Medication

4. Charting

5. Telephone

6. Discharge

・

・

Patient D

Provider available time : 720min－60min

Demand : 4 patients

660 min

T.T = = 165 min per

patient

4 patients

T.T

Provider

165 min

Assessment

Nurse x

YAMAZUMI Chart

Task time per

patient

Care

Medication

charting

Telephone

Discharge

Example

T.T 20 min

Task Discharg

e

30min

N


1

Check a

patient

schedule

1

’

1

’

2 Exam 1

’

0

.

5

’ 3 Check a chart 1

’

0

.

5

’ 4 Exam 5

’

0

.

5

’ 5 Communicate

with nurse

3

’

1

’

6 Confirm lab

data

3

’

1

’

7 Exam 2

’

0

.

5

’ 8 Test order 2

’

1

’

9 Dictation 2

’

1

’ 1

0

Communicate

with patient

2

’

1

’

2

2

’

8

’

Percent Load Chart &

S. W. C. S.




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

Standardized Work & Takt Time:

Types I, II, and III





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 I

Standardized Work Type II

Standardized Work Type III

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.

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.

Three Types of Standardized Work




• 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.

Takt Time ＝ Operating Time per Day (Fixed Amount of Time - breaks)

# 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.

A B C D

Takt Time 46″

A, B, C, and D’s

working time

For example, in order to meet the increased

demand, we need to equalize the work load

(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

where a patient type does not change the

time required to perform tasks.

Illustration of Standardized Work Type I




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

different amount of time

for each patient type.

Weighted average cycle

time helps identify

problem areas and helps

with allocation of work

and more efficient

scheduling.

a b c

Worker A

T.T.=46″

50″

4０″

45″

Takt Time

Weighted

Average C.T.

Ma

n-h

our

Patient types

grouped per

time

requirements

Illustration of

Standardized Work Type 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

(÷) Unit Sales/Day

TAKT TIME : (＝) Minutes Per Unit

OR : (×) 60 Seconds/Minute

TAKT TIME : (＝) Seconds per Unit

Calculation for TAKT Time

Calculation Method for

Standardized Work Type I-II





Worker Work Details Daily Workload Working Time by

Task Daily Working Time

(a) （80） (×) （150″） (＝) （12,000″）

(b) （80） (×) （120″） (＝) （9,600″）

(c) （40） (×) （100″） (＝) （4,000″）

Total Sum（A）(200） Total Sum(B) （25,600″）

Weighted Average of Workload = Total Sum of Daily Working Time（B）

Total Sum of Daily Workload（A）

(a)

T.T. ＝ 138″

Daily Operating Time ： 460 min.（27,600″）

T.T. ＝ 27,600″

200 ＝ 138″ C.T. Weighted Average ＝

25,600″

200 ＝ 128″

120″ 100″

(b) (c)

150″

Weighted Average

CT 128”

Weighted Average Calculation Method of Workload

for Standardized Work Type II




Percent Load Chart of multiple tasks within

a fixed amount of time.

T.T.=460′

③

ィィ A

⑩

②

①

⑤

④

⑧

⑦

⑥

⑨

Time to do task ⑩each time

multiplied by the number of

times the task is done per day ⑩ Calculation of required

working time for a task

Opera

ting

Tim

e

Workers ィィ B ィィ C

ィィ D

Stack up the

required time

for each task

Check to see if the

operating time is

taken up by different

tasks. If not, start

Kaizen with the task

which is taking longer

time.

Illustration of





Calculation of Available Time ＜Hours in a day (Fixed Amount of 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

※Correspond to Takt Time for Types I and II

Calculation Method for





Worker Work Details No. of Tasks/day Working Time by

Task Daily Working Time

(a) （5 times） (×) （50 min.） (＝) （250 min.）

(b) （3 times） (×) （30 min.） (＝) （90 min.）

(c) （5 times） (×) （30 min.） (＝) （150 min.）

(＝) Total Sum（490 min.）

(a)

Daily Operating Time ： 460 min.

Daily Working Time ： 490 min.

(b)

(c)

Operating Time ＝ 460 min.

490

min.

Calculation Method of Workload in

Standardized Work III





Copyright 2009 John Black and Associates LLC

7) Perform Kaizen to meet takt time

· Eliminate waste in process

· Eliminate process

· Redistribute workload

· Add value

· Add quality

· PDCA

5) Calculate weighted average cycle time for each task group using percentages from step 2 and cycle times

from step 4

=

==

=a%

b%

x

x

exam cycle time

call cycle time

X

Y

ZTotal weighted average

cycle time (WACT)

27%

73%

x

x

636

228

172 seconds

166 seconds

338 seconds weighted average cycle time

3) Calculate takt time of combined task groups

Time available -60 min break

# total daily tasks= =

420

137

3.06

minor 184

sec

takt

time

4) Determine average cycle time for each task group

based on time observations

exams = 636 seconds cycle time

calls = 228 seconds cycle time

2) Determine task group percentage of whole

YX

Z= a%

38

137Z

= b%

99

137

exams = 27%

calls = 73%

1) Determine task groups by PQA and/or stick tallies

X

Y

Z

+

38 patient exams

99 patient calls

137 daily tasks

7 Steps to Calculate a Weighted Average Cycle Time (WACT)

6) Graph percent load chart

==

338 sec

WACT

184 sec takt time

Exam 172

Call 166

338 Σ O.C.T

takt time

338

1841.8 people

required





How to calculate Productivity?

Patient (Output)

A type: 10 patients per day

B type: 20 patients per day

C type: 10 patients per day

Total: 40 patients per day

Provider (Input)

1 doctor: 10 hours per day

2 nurses: 11 hours per day

1 clerk: 8 hours per day

Total: 40 hours per day

Output 40 patients Productivity = = Input 40 hours

1.0 patient / provider･hour

Patient (Output)

A type : 11patients

B type : 21patients

C type : 12patients

total : 44patients

Provider (Input)

1 doctor : 10hours

2 nurses : 11hours

1 clerk : 8hours

total : 40hours

44 patients

Productivity = = 1.1 patient /provider

40 hours hour

Productivity = (1.1-1.0) × 100 =10%up

Patient (Output)

A type : 10patients

B type : 20patients

C type : 10patients

total : 40patients

Provider (Input)

1 doctor : 9hours

2 nurses : 10hours

1 clerk : 7hours

total : 36hours

40 patients

Productivity = = 1.11 patient /provider

36 hours hour

Productivity = (1.11-1.0) × 100 =11%up

Up

Kaizen ① “ Increase Output “ Kaizen ② “ Decrease Input “

Demand No

Current





How to calculate Capacity?

Department open time

8 hours (480 min)/day

Patient (Output)

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

total : 40 patients 400 min

480 min

Capacity = = 48 patients / day

10 min

※ Same patient ratio

Pre－Kaizen

Demand

40 patients (or Jobs) /day

Weighted 400 min

Average = = 10 min / patient

Cycle time 40 patients

Patient (Output)

A type : 10 patients × Cycle time 14 min = 140 min

B type : 20 patients × Cycle time 7 min = 140 min

C type : 10 patients × Cycle time 4 min = 40 min

total : 40 patients 320 min

480 min

Capacity = = 60 patients / day

8 min

※ Capacity 25%up

Post－Kaizen Weighted 320 min

Average = = 8 min / patient

Cycle time 40 patients

●Spot KAIZEN (Process)





Department open time

8 hours (480 min)/day

Demand

40 patients (or Jobs) /day

●Line KAIZEN (Flow)

Check－In Nurse Doctor

480 min

T.T= = 12 min /patient

40 patients

Percent Load Chart

T.T

Clerk

10min

12min

Pre

T.T

Nurse

14min

12min

Pos

t

T.T

Doctor

12min 12min

Pre

Process map

14min

Pre

8min

post

12min

Pos

t

Kaizen?

Capacity

up?

Bottle

Neck

No

Change!

No

Change

!

How to calculate Capacity?