Thinking and Adapting in the Context of Standardized Work
When I was in Sweden recently, we had a lot of good discussion about the Lean concept of “standardized work.”
There was a lot of agreement from different presenters at the Lean laboratories conference, and from the hospital people we visited, that standardized work isn't a robotic form of cookbook medicine or cookbook processes. Standardized work isn't “mindless conformity” as Bill Marriott writes about in regards to the hotel chain.
We found an interesting example of a situation where thinking is required.
Let's say a process for phlebotomy (drawing blood from a patient) says that it's preferable to draw blood from the patient's left arm. Having a standardized process doesn't mean we ALWAYS draw from the left arm.
Somebody asked, in an extreme situation, “what if the patient is an amputee and they don't have a left arm?” Clearly, the phlebotomist should be empowered to make a decision — draw from the right arm! Even if the patient just expresses a preference to using the right arm (because they are left handed and don't want that arm to hurt), the phlebotomist could be allowed to make a judgment call, even if the standardized work doesn't spell out this choice.
As I've heard in other contexts: the role of an employee is:
- Follow the standardized work – unless there's a good reason not to!
- Make contributions to improve the letter and the spirit of the standardized work (because the standardized work is defined by those doing the work, not the bosses)
To point #2, Dr. GÃ¶ran Ornung, a cardiologist and emergency physician said, in their work:
“Standardized work is not what top management says, it's what staff says.”
If people are afraid to use their judgment and make decisions, maybe the standardized work document (and more importantly, the training) should specify that you are not leaving your brain at the door!
Final thought – there's a difference between not following the standardized work for a justifiable reason and not following it because you didn't feel like it. See this article about cardiac surgeons defining standardized work and their guidelines about choosing to not follow it.
What do you do in your training or management to make sure standardized work doesn't mean “mindless conformity”?
Many of these same ideas are expressed in Dr. Atul Gawande's book The Checklist Manifesto: How to Get Things Right. More on that later in a full review of the outstanding book.