How to standardize procedures
JOB AIDS &
STANDARD OPERATING PROCEDURES
(SOPs)
Oktober 2009
INTRODUCTION
Why having written procedures?
reliable and consistent results
backbone of the quality system
Verbal instructions:
• forgotten
• not heard
• ignored
• misunderstood
JOB AIDS
INTRODUCTION
= “INSTRUCTIONS”
Describes step by step what you should do to perform
a procedure
Is used on the job while performing the task at hand
Tells when to take action
Gives directions on what actions to take
and how to do each action
DIFFERENT FORMATS
1. “Cookbook format”: describes all alternatives
tells how and when
2: “Decision table”: lists the alternatives
3: “Flowchart”: goes through the alternatives
tells how to think about a task
DIFFERENT FORMATS
Example: we will improve the job aids below
Hands are disinfected with either antimicrobial soap or
alcohol. If hands are visibly dirty, they should always
be washed with household soap first. Next,antibacterial
soap should be used in case you have running water; if
not, you should use alcohol.
DIFFERENT FORMATS
Format 1: “Cookbook format”:
→ Describes all alternatives
Ex:
1. If your hands are visibly dirty, wash them with
Household Soap.
If your hands are visibly clean, go to step 2.
2. If there is running water, use Antimicrobial Soap.
If there is no running water, use Alcohol.
DIFFERENT FORMATS
Format 2: “Decision Table”:
→ Lists the alternatives
Ex:
DIFFERENT FORMATS
Format 3: “Decision Table”:
→ Goes through the alternatives
Ex:
BENEFITS AND CONSTRAINTS
+
-
Reducing recall training
Over simplify
Easier to perform complex tasks
Require updating
Reducing errors
May not eliminate all training
Motivate less experienced
Cannot solve all performance
problems
Easier to do tasks that are NOT
done often
Slow performance
USE
Use job aids when:
Performance is infrequent
Knowledge, education level is limited
Procedures cover complex decision making
Training resources are limited
The consequences of errors are high
(ex. job aids for treatment of spills or blood exposure accidents)
Avoid the use of job aids:
Masterful performance is needed
Staff fears lack of credibility (towards patients or doctors)
People don’t how to use them
WRITING JOB AIDS
How to write a good job aid: general rules
1.
2.
3.
4.
5.
Give a Meaningful Title
Mention Author, Version number and Date
List the Materials
Describe the Action Steps
Have your job aids Read and Performed by a
Colleague
1. MEANINGFUL TITLE
→ The title must mention the content of the
job aid.
Ex:
Do NOT give a title like
“Job Aids_ Medical Service_ 015/1”
PREFER Title with meaning
“How to disinfect my hands”
2. MENTION AUTHOR, VERSION NUMBER &
DATE
→ Put this information in the “Header” or
“Footer” of your document.
→ In this way, it will be visible on the printed
page.
3. LIST THE MATERIALS
→ List the Materials you need
→ Distinguish between
- Material provided
(for example, in the test kit)
- Materials not provided
Ex:
For washing your hands with antimicrobial soap, you need:
• Liquid antimicrobial soap in a dispense
• Running water
!! Use a Bulleted or Numbered list.
• Towels
4. DESCRIBE ACTIONS STEPS
→ Decide on the format:
- Cookbook
- Decision table
- Flowchart
→ Use simple style:
1. Number the steps 1,2,3,…
If > 10 steps, subdivide in ≠ topics
One step describes 1 action of max 30 sec
4. DESCRIBE ACTIONS STEPS
2. Use Short and Simple Sentences:
-Not more than 15 words
3. Use Short and Simple Words:
- Avoid use of Acronyms, spell them out the first
time you use them
- Add list of Abbreviations
-Use always same word or term
Ex: USE always “household soap” and not bar soap
4. DESCRIBE ACTIONS STEPS
4. Use Active Verb, not passive voice
Use Imperative, not verb or “you”
Ex: NOT: you have to use household soap
BUT: use household soap
5. Turn any list into a bulleted or numbered list
6. Stress important information:
- use CAPITALS
- use bold or italicized or underlined text
- use Color
4. DESCRIBE ACTIONS STEPS
7. Put “When’s” or “Ifs” before “What’s”
Ex: NOT: Use of towel to cover your hand in case you have to close the tap
by hand.
PREFER: If you have to close the tap by hand, use a towel to cover your
hand.
8. Put warnings before the steps
4. DESCRIBE ACTIONS STEPS
9. Use pictures/drawings
- Check if picture fits the text
- Refer to the picture in the text
- Put pictures on the left side of the paper,
text on the right side
- Use colours if needed
5. LET READ AND PERFORM BY COLLEAGUE
1. Ask a Colleague to Read the draft of your job aid
and to give comments
2. Ask a Colleague to Perform the job with the draft
- Do NOT help him/her
- Do not give further explanations
- Make notes of what should be added or
changed
- Make these notes on your copy of the
job aid
STANDARD OPERATING
PROCEDURES
(SOPs)
Introduction
SOP definition:
a written document describing all steps how to perform a
procedure.
part of quality assurance (QA)
prevents mistakes (rather then detects)
carried out without deviation by every member off staff
Needs updating
Introduction
Benefits:
Minimize variability (person-to-person, test-to-test)
Improve and maintain quality
Consistent and reproducible results
Training tool
Continuity (personnel turn-over)
Procedure review:
optimalization of techniques
identification of problems
Introduction
Constraints for implementation:
Time-consuming in preparation
Often not kept up to date
Who writes SOPs?
The staff must not only understand, but also carry out.
Those who do, should write (prevents unfamiliar SOPs)
Improves sense of responsibility for using the SOP
Steps towards successful integration
1. Get support by all members of staff!!
Implement appropriate SOP training
Discuss on current procedures and their steps
User-Author Principe
2. Ensure Readability
SOPs must be crystal clear on who is to do what
Steps towards successful integration
2. Ensure Readability
SOPs must be crystal clear on who is to do what
Standard lay-out
Simple words
Short active sentences: “do this”, “do that”
Instructions in the right order
Separate general information
(as a footnote or in different format)
Diagrams and pictures
Steps towards successful integration
3. Authorizing of SOPs
Decides on an appropriate method
Agreement author - supervisor (specialist)
Way to communicate to all staff
4. Training of SOP
Staff should get familiar with the agreed procedure
(documenting reading and training by staff members can help you in the follow-up)
Steps towards successful integration
5. Regulary Review and Update
on regular basis by the author
Communicate changes
6. Organization and archiving
Only current version available in work (bench) area
Document management
Change control: withdrawal and archiving
Main reasons for SOP failure
The SOP is
written in difficult/foreign language
difficult to follow
difficult to locate (accessibility)
Not used
Structure of SOP
Two parts:
1. Info about the SOP
2. Description of the procedure per se
1. Info about SOP:
Title
Identification code + version
Name of author and date of issue
Name of authorizer
Page number (with reference to total page number)
Structure of SOP
2. Description of procedure:
Introduction
Scope
Equipment and reagent/materials
Sampling
Test procedure and QC
Results and reporting
Sources of error
References
SOPs vs. Job Aid
Which Format to use?
Which format to use?
Depends on various factors:
Setting
Level: small field vs. reference laboratory
Current status, already written procedures? And Expectations?
Staff
Education level and experience
Motivation
Resources
Time and budget
Type of process or procedure
Frequency, complexity, performance needed
Summary and conclusion
Get everyone involved
Be ambitious but realistic
Work step- by- step
Priorities
Include training
Write down what you do, do what is written down!