2nd Edition

Getting to Standard Work in Health Care Using TWI to Create a Foundation for Quality Care

By Patrick Graupp, Martha Purrier Copyright 2022
    322 Pages 66 B/W Illustrations
    by Productivity Press

    322 Pages 66 B/W Illustrations
    by Productivity Press

    322 Pages 66 B/W Illustrations
    by Productivity Press

    Addressing the challenges involved in achieving standard work in health care, Getting to Standard Work in Health Care, 2nd Edition describes how to incorporate the Training Within Industry (TWI) methods of Job Instruction (JI), Job Relations (JR) and Job Methods (JM) to facilitate performance excellence and boost employee morale in a health care organization. It not only examines the TWI methodologies but also explains how this program is as vital and applicable in today’s health care environment as it was when it was developed to train replacements of an industrial workforce off to fight in WWII.

    Placing this methodology squarely within the health care paradigm, the book uses easy-to-understanding terminology to describe how these methods can make all the difference in the delivery of quality health care. Supplying the foundation for successful Lean practice in health care, it clearly defines the role of standard work and leadership skills in relation to Lean health care.

    The updated text includes new case studies of current TWI usage in health care that demonstrates how to successfully roll out a sustainable TWI initiative. All new chapters on Job Relations and Job Methods give insight into the full scope of TWI skills development. Including examples of TWI application during the Covid pandemic, the book provides readers with the understanding of how to use these time-tested methodologies to improve training, increase engagement, and deliver continuous improvement in your organization.

    Section I: Case for Standard Work in Health Care

    Chapter 1: When Clinical Best Practice Is Not Actual Practice

    Chapter 2: The Challenge of Designing Standard Work

    Chapter 3: Hand Hygiene Training Case Study

    Chapter 4: Need for Good Instruction Skill

    Section II: Job Instruction Training

    Chapter 5: Four Steps of Job Instruction

    Chapter 6: Breaking Down a Job for Training

    Chapter 7: How to Organize and Plan Training

    Section III: Job Relations Training

    Chapter 8: Four Steps of Job Relations

    Chapter 9: Problem Prevention Using JR’s Foundations for Good Relations

    Section IV: Implementing TWI into the Working Culture

    Chapter 10: Starting Out Strong with a Pilot Project

    Chapter 11: Four Steps of Job Methods Improvement

    Chapter 12: Integrating TWI into the Culture to Sustain Results

    Conclusion: A Call to Action


    Patrick Graupp began his training career at the SANYO Electric Corporate Training Center in Kobe, Japan, after graduating with highest honors from Drexel University in 1980. There he learned to deliver TWI and other training to prepare employees for assignment outside of Japan. He was transferred to a compact disc fabrication plant in Indiana, where he obtained manufacturing experience before returning to Japan to lead SANYO’s global training effort. Graupp earned an MBA from Boston University during this time and was later promoted to the head of Human Resources for SANYO North America Corp. in San Diego, California, where he settled.

    Graupp delivered a pilot project in 2001 to reintroduce TWI in the United States. The positive results encouraged him to leave SANYO in 2002 to deliver the TWI program on a wider scale throughout the United States in the same manner as he had been taught in Japan. He described this in his book The TWI Workbook: Essential Skills for Supervisors, a Shingo Research and Professional Publication Prize recipient for 2007. With colleagues in Syracuse, NY he helped found the TWI Institute which has developed over 3,000 certified trainers who teach TWI on six continents in over 30 countries in 18 languages. He is the author of numerous books on TWI including Creating an Effective Management System: Integrating Policy Deployment, TWI, and Kata which was published in 2020.

    Martha Purrier is a registered nurse with over 30 years of experience in the health care setting. She earned a master’s degree specializing in the clinical care of patients with cancer and in the training of nurses. During the past 20 years, she has worked at Virginia Mason Medical Center in Seattle, Washington, in a variety of positions: Oncology Clinical Nurse Specialist, Director of Inpatient Oncology and IV Services, Director of the Kaizen Promotion Office and Director of Nursing Services at Bailey-Boushay House. Virginia Mason adopted Lean as a management methodology in 2001, and Purrier was certified in Rapid Process Improvement Workshops in 2006. During her work in IV therapy, the team won the Mary McClinton Patient Safety award for the application of Lean methods, which produced increased safety for patients receiving central lines. In 2008, Purrier was appointed to the Kaizen Fellowship Program. She is a certified instructor of the TWI Job Instruction program and has spoken internationally on the application of TWI and Lean to health care.