Training Within Industry Job INSTRUCTION Healthcare Participant Guide TWI Institute TWI-Institute.org #250Rev03
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2 TWI Job Instruction Healthcare Participant Guide
1. Patient Care and Problems A. Definition of Supervisor A supervisor is anyone who is in charge of people or anyone who directs the work of others. B. Key Roles of Supervisors Patient Care C. Problems What problems at your own work place have a bad influence on these three roles? TWI Job Instruction Healthcare Participant Guide 3
2. Five Needs of Supervisors 3. KNOWLEDGE 1. 2. 4. SKILLS 5. 1. Knowledge of Work KNOWLEDGE Knowledge of work is unique and differs from work to work. In an Intensive Care Unit, for example, it would include what you know about equipment, instruments, and patient care processes. Similarly, in other areas of work, we are required to have specialized knowledge to carry out work there effectively. Even in a routine job, we are required to increase our knowledge day by day. In addition, if we were to provide a new service, or if we were to change our present method of patient care, then we would need a new type of knowledge. 2. Knowledge of Responsibilities Knowledge of responsibilities relates to the necessary responsibilities and authority we hold as supervisors. This knowledge consists of institution policies, agreements, regulations, safety rules, and interdepartmental relationships, etc. Supervisors responsibilities are different for each hospital or institution. So a different knowledge is needed for each. Therefore, every supervisor needs to understand completely the responsibilities and authority given them. 4 TWI Job Instruction Healthcare Participant Guide
3. Skill In Improving Methods This skill enables you to break down your work into small parts so that you can take a look at the details. Based on this breakdown, you can then look at improving the method by eliminating, combining, rearranging or simplifying these details. When this skill is used continuously, it will allow you to utilize the workforce, equipment and supplies now available more effectively to achieve greater patient care. This skill is learned in the Job Methods Improvement component of the Training Within Industry (TWI) program. SKILLS 4. Skill In Leading Skill in leading allows supervisors to have good relationships among people. This skill can help the supervisor get the necessary cooperation from other people so that the work can be carried out effectively. The result of a supervisor s work depends on the output of other people. To be a good supervisor, then, the cooperation of others is crucial. He or she can get the necessary cooperation from others by using this skill in leading. Furthermore, if this skill is used daily, fewer problems will arise. And even if problems do arise, using this skill the supervisor will be able to solve them effectively. This skill is learned in the Job Relations component of the Training Within Industry (TWI) program. 5. Skill In Instructing Skill in Instructing is an essential skill that helps employees to be trained so that they can quickly begin to work on their own. When this skill is acquired, we can help reduce the number of errors, rework, and waste. We can even help reduce the number of accidents and the amount of tool and equipment damage. This skill is learned in the Job Instruction component of the Training Within Industry (TWI) program. TWI Job Instruction Healthcare Participant Guide 5
3. Two Groups of People Who Need Instruction 1 st Group: Employees Advances in medicine New treatments Promotions Transfers Changes of work duties New equipment and techniques New and higher standards 2 nd Group: Employees Every job is new to this group so, in most cases, they will have to be trained. 4. Definition of Job Instruction Job Instruction is the way to get to to do C S C 6 TWI Job Instruction Healthcare Participant Guide
5. Two Kinds of Faulty Instruction A. Telling Alone Why Telling Alone is NOT a good means of instructing: Most people just don t get it through telling Things seem complicated when listening to words We cannot use the exact words necessary Many tasks are difficult to describe in words It s hard to tell the right amount and to know whether it is understood or not B. Showing Alone Why Showing Alone is NOT a good means of instructing: Even if it looks completed, in most cases it is just a copy of the motions and doesn t mean we understand the job Many motions are hard to copy Tricky points are missed We don t know what comes next We cannot translate what we see into what we should do IF THE WORKER HASN T LEARNED, THE INSTRUCTOR HASN T TAUGHT TWI Job Instruction Healthcare Participant Guide 7
6. Correct Instruction Fill in chart as the class reviews the presentation. 1. 3. 2. 4. 8 TWI Job Instruction Healthcare Participant Guide
7. Get Ready to Instruct: Break Down the Task A. Some Difficulties with First Practice Demonstration B. What needs to be done before instructing? Jobs need to be more carefully before instruction. C. Why? Because we know a job well, we may carelessly miss important points during instruction and confuse the learner. In some cases, we know it so well that we never think about how to put it across to others. On the contrary, we sometimes think we know a job when, in fact, we don t and only notice our ignorance when we try to teach it to someone else. TWI Job Instruction Healthcare Participant Guide 9
8. Breakdown of the Fire Underwriters Knot Fill in Breakdown Sheet as instructor demonstrates method. Task: Supplies: Equipment & Materials: BREAKDOWN SHEET IMPORTANT STEPS A logical segment of the operation when something happens to advance the work. KEY POINTS Anything in a step that might 1. Make or break the job 2. Injure the employee 3. Make the job easier to do, i.e. knack, trick, special timing, bit of special information 1. 2. 3. 4. 5. 10 TWI Job Instruction Healthcare Participant Guide
9. What is an Important Step? An Important Step is a logical segment of the operation when something happens to. These breakdowns are NOT hairsplitting micro motion studies. They are simple, common sense reminders of what is really important to put across in a job. Example: When washing your hands: Go to the sink is not a step worth noting during instruction. The person will get this without being told. Turn on water is a step, but it is not an Important Step. It does not advance the work. Wet hands is the Important Step. It is the most important thing that happens here in order to advance the work. It is unnecessary to go into greater detail. TWI Job Instruction Healthcare Participant Guide 11
10. What is a Key Point? Key Points are the to percent of a job that represents the hard or tricky parts. These parts require skill that is gained through experience and take time to learn. A. 3 Kinds of Key Points 1. Things that the job. 2. Things that (Safety). 3. Things that make the task. (feel, knack, trick, special timing, a piece of special information) B. Some Examples of Key Points 1. When adjusting the screw for the liter gauge on an oxygen tank, the Key Point is how loose - a matter of feel. 2. When removing dirty gloves, the Key Point is to peel off, inside out so as not to spread germs. 3. When taking blood pressure, while releasing the valve to let air pressure out you must do so slowly while listening to the pulse in order to get an accurate reading. 4. When using a knife, a Key Point is to cut away from you. Cut away from you. 5. When placing a peripheral IV, how far to advance the needle once you have entered the vein is the Key Point. 6. When mixing citrate with blood for a transfusion, the Key Point is to gently rotate the container in a circular motion. 7. Connect IV tubing to the hub of the catheter by twisting the treads to be sure you have a tight seal. How much power to put into the turn will be the Key Point. 12 TWI Job Instruction Healthcare Participant Guide
11. Job Breakdown Summary A. Rule of Thumb BREAKDOWN SHEET IMPORTANT STEPS KEY POINTS you do you do it B. Simple is Best A breakdown is a kind of reminder to ourselves, like notes or an outline when you are going to speak in front of a group. So, few words are required and simple words are best. Otherwise, the training may be confusing to the learner and important points will be left unclear. C. Sample Breakdowns See next page for two sample breakdowns. Notice that Example 1A is a detailed breakdown for just Step 1 of Example 1. Notes on Sample Breakdowns: Breakdowns should be utilized for both experienced and inexperienced workers. Depending on who is being instructed, each step can be as precise or as general as needed. TWI Job Instruction Healthcare Participant Guide 13
TWO SAMPLE JOB BREAKDOWNS Example 1: Job Breakdown TASK: Using Mercury bulb thermometer INSTRUMENT: Clinical Thermometer IMPORTANT STEPS 1. Prepare thermometer 2. Take temperature 3. Read 4. Record KEY POINTS Read below 95 Clean cotton alcohol Under tongue Closed lips 1.5-minutes Mercury line Clean safety wipe toward bulb Accuracy Chart Re-read A supervisor made this job breakdown in about 10-minutes. She uses it as is for those who have had some experience in reading a thermometer. For a new person, she makes a separate breakdown for some of these steps. Example 1A shows a detailed breakdown of Step #1. 5. Replace Safety Example 1A: Job Breakdown TASK: Prepare Thermometer INSTRUMENT: Clinical Thermometer IMPORTANT STEPS 1. Examine KEY POINTS Markings 94-106 red arrow Mercury bulb caution 2. Read Mercury line knack 3. Shake 4. Clean To below 95 Away knack Alcohol or cleaning agent Cotton toward bulb Discard cotton safety 14 TWI Job Instruction Healthcare Participant Guide
12. Get Ready to Instruct: Get Everything Ready, Arrange Workspace A. Definitions Get Everything Ready means the proper equipment, instruments, supplies and so on; things that will aid instruction. Arrange the Worksite means neatly, as in the actual performing conditions. B. Key Points Supervisors must set the right example for every worker. Makeshift instruments or equipment should never be used. Lack of materials or forgetting something makes for poor work standards. A cluttered desk or a poorly arranged workspace, any single thing that is wrong, sets a poor example for the employees. TWI Job Instruction Healthcare Participant Guide 15
13. Get Ready to Instruct: Make a Timetable for Training A. Training Must Be Done by Plan, Not by Accident. should be trained? For? By? B. Timetable Practice Example Fill in the Timetable on the next page as the instructor explains the contents. C. Steps to Filling Out Training Timetable 1. Fill in supervisor s name, department, and date. 2. Fill in job headings. When there are a variety of jobs, write in job names. When all jobs are the same, list by classification or level of skill. 3. Fill in workers names. 4. Check off jobs that can be done by each of them. 5. Spot training needs. Workers: turnover, poor performance Job Headings: meeting schedules, changes in schedule 6. Plan to meet needs Who on which job by what date 16 TWI Job Instruction Healthcare Participant Guide
JOB INSTRUCTION TRAINING TIMETABLE Breakdown No. Name: Dept.: Date: Turnover Performance Changes In Schedule TWI Job Instruction Healthcare Participant Guide 17
14. Special Instruction Problems A. Long Operations Many tasks in a healthcare facility may actually take several hours to perform. Naturally these larger tasks contain so many items that they cannot be learned at once. In these cases, the instructor will have difficulty deciding how to teach it properly and the learner, consequently, becomes confused. Correct instruction is indispensable here. The answer is to break up the long operation into small sections and teach one segment at a time within the limits of a learner s ability to understand. For example, for a long operation on a piece of equipment, the instructor should do most of the operation while having the learner try the easiest segment first. After they have mastered that segment, teach the second easiest unit and have them do that together with the first one. Continue from easiest to hardest until they can do the complete operation. B. In a Noisy Area Teaching in a noisy area is a common problem in the mechanical rooms of larger healthcare organizations (chiller, compressor, or boiler rooms). A principle of TWI Job Instruction is to teach the job at the actual work site. However, when people cannot hear the explanation, telling and showing are incompatible methods of teaching. What needs to be done is to go to a quiet place when telling is necessary and to show with exceeding care at the actual work site. This showing should contain everything that is to be taught. Also in Step 3, the Try-out Performance, we have to go to a quiet place when we have the learners point out the Important Steps and Key Points. Performance itself should be done at the work site. C. Getting the Knack or Feel of the Job Quite a few tasks require some kind of knack or feel. But people are prone to think that these are mysterious or impossible to put across since one can master them only through many years of experience. While it certainly does require time and practice to acquire these skills, if a learner is taught what that piece of information is and where to find it, they will learn it easily and more quickly than with no instruction at all. 18 TWI Job Instruction Healthcare Participant Guide
For example, when adjusting the screw on a liter gauge of an oxygen tank, the snugness of the screw is a matter of feel. 1. First of all, the instructor adjusts the screw until the liter gauge indicates zero or 0, then loosens it until the feel is right. 2. The instructor then allows the learner to note the feel of the loose screw and explains to him/her, This is the correct adjustment. Remember this adjustment. 3. Then the instructor tells the learner to adjust and loosen the screw to get the same feel. 4. If the instructor sees the learner is able to adjust the screw correctly, he or she should examine it and praise the learner. If not, ask the learner to try again until the proper adjustment is made. By loosening the screw in this manner a few times, the worker quickly learns the feel. 15. Conclusion Results gained from training workers using Job Instruction: Improved patient care Fewer errors Reduced training time Less instrument and equipment damage Fewer injuries to patients and staff Reduced costs Higher morale TWI Job Instruction Healthcare Participant Guide 19
...thanks to TWI Training Within Industry (TWI) originated in the U.S. in the early 1940s to support the war effort by boosting industrial production. It effectively and efficiently trained employees, including many women entering the manufacturing world for the first time. TWI was an unqualified success: 86% of companies increased production by at least 25% 100% reduced training time by more than 25% 55% reduced scrap by at least 25% Rosie the Riveter poster, circa 1942, U.S. National Archives and Records Administration 100% reduced grievances by more than 25% After the war, the U.S. adopted a mission to help quickly rebuild Japan s industrial base. TWI was introduced to the Japanese government and industry where it was embraced and intensively integrated into manufacturing methods and culture throughout Japan. TWI was one of the crucial building blocks of the Toyota Production System, the model for Lean Manufacturing. Since 2001, when the TWI Institute reintroduced TWI, thousands of people have been trained in its methods; creating substantial competitive advantages for companies adopting it. By learning and applying TWI in your organization, you are part of this remarkable revival!