Guest article by Patrick Graupp of the TWI Institute.
Many years ago while managing the final inspection, packaging and shipping areas of a production plant, I was looking for a person to promote to line leader. I was having a difficult time finding a candidate well suited for the role.
One afternoon, one of our superstar operators came in for an interview. He told me he had worked at McDonald’s during high school, and I immediately knew he was the person I was looking for.
As a shift leader at McDonald’s, he had received training at Hamburger University — the company’s legendary training headquarters. During training, McDonald’s stressed the importance of “consistent restaurant operations and procedures”— that a perfect burger was made the same way every single time. No wonder he was such an excellent operator! He’d learned at Hamburger University how critical consistency and process is, and that made him the perfect fit to be our production plant’s new line leader.
If only other industries approached training with the same sense of care and consistency as McDonald's Hamburger University. They are two very different industries, but even healthcare professionals can learn something from how the fast food giant teaches people how to make a Big Mac.
What Healthcare Can Learn from Hamburger University
In healthcare, they train people according to an old adage: “see one, do one, teach one.” It’s led to what my colleague Skip Steward, a former manufacturing leader, calls healthcare’s dirty little secret — we fake it until we make it. In other words, healthcare workers may not always be as skillful as they appear.
Just “seeing” a procedure once is not enough for a person to become competent in performing it. In this paradigm, training turns into “trial and error”. Users eventually figure things out, but only after leaving a trail of mistakes in their wake.
It Takes Skills To Be A Good Instructor
Good instruction takes great skill, but this is different from the skills required to accomplish the task. Just because you are the best nurse at starting an IV does not mean you can effectively teach others. You can tell them how to do it or you can show them how to do it, but—without repetition—the result is usually a confused learner who has very little understanding of the task they’re supposed to perform.
Good instruction should include a consistent demonstration by the instructor and a try-out performance by the learner. The language used in the demonstration must be prepared beforehand, full of simple words that clearly describe what is happening. The length of these instructions is incredibly important, as they must be easy to capture and remember by the learner.
The real skill is being able to identify what we call the “key points” to doing a job. Key points represent the real skill of the task, things that take time and experience to learn to do.
If we can clearly identify these points ahead of time, new learners will be able to quickly and correctly perform the task from the start. Moreover, by identifying the key points we can exclude much of the details that are either common sense or easily understood by watching a demonstration of the work.
Improving A Broken Process In Mississippi
A hospital in Mississippi noticed that the percentage of IV first starts was surprisingly low, causing discomfort to patients. In their analysis, the hospital discovered that many nurses gave up on starting IVs or had even refused to start IVs for difficult patients. As it turned out, nurses used inconsistent techniques—everyone was doing it differently.
Hospital staff worked to identify the “best way” to administer an IV first start.
Using a newly learned job instruction technique called TWI, hospital staff used iPhones to record the two best nurses doing the procedure. After studying these videos, staff was able to identify several key points to highlight while administering the procedure.
Staff’s biggest finding was the angle at which the needle was inserted.
In regular practice, the task was performed so quickly that no one ever noticed the best technique for a painless experience. By reviewing the recording, staff discovered that the needle must initially be inserted at 45 degrees, and then lowered to 10 degrees to cleanly insert the tubing without vein damage. This is the key point they were looking for.
By skillfully picking out this key point, staff was able to retrain nurses, and IV first starts went up almost immediately to nearly 100%.
Repetition Is The Key To Proper Training
Without training on key points, learners are left to their own devices to figure out how a task is done. The variation that ensues creates instability in the process, leading to endless delivery, quality, safety and cost issues—whether you work at a hospital or a fast food restaurant.
Think of it this way: if your Big Mac came out a little bit differently at each McDonald’s trip, would you consider that good customer service? Probably not. It’s no wonder the company cites Hamburger University as a critical component to their success.
Oftentimes, we hear unskilled trainers tell others to “Just keep trying and you’ll find a way that works for you.” We call this training malpractice. When new workers—trying their best to find the correct way—are blamed for making mistakes or not keeping up, it is our fault, not theirs.
A skillful training method, like TWI, teaches people to do a new job correctly the first time and every time. Not only do we get better business results, but we get better relationships with our employees, who are proud of the good work they were trained properly to do.
Oh, and the young man I promoted who used to work at McDonald’s? He ended up taking over my position when I was transferred back to the training center in Japan. Looks like his Hamburger University degree most definitely paid off.
About Patrick Graupp, Senior Master Trainer, TWI Institute - twi-institute.org
Patrick began his training career at the SANYO Electric Corporate Training Center in Japan after graduating with Highest Honors from Drexel University in 1980. There he learned to deliver TWI and other Lean based methodologies. Patrick earned an MBA from Boston University while heading SANYO’s global training effort.
Patrick later conducted TWI pilot projects in Syracuse, NY in 2001 that laid the foundation for the TWI Institute which has since trained a rapidly expanding global network of over 1,100 certified trainers who are now delivering TWI training in the manufacturing, healthcare, construction, energy, and service industries around the globe.
Learn the basics of Training Within Industry (TWI) from Patrick in our recent Dozuki Workshop episode.