This is our final session and our standard work forms section of the course. Let's first complete our discussion on time observation sheets. As I discussed in the last video, in a fully complete time observation sheet, we need to time each process between six and 10 times or until we have fully captured the variations in the cycle times. Then, on the far right hand column, you should record the mode -- the time interval that is most frequently recorded. For example, look at the first row. There are seven times recorded documenting the time required to collect the medications for patient number three. Three of these times are 280 seconds. Therefore, this is the most frequent reading and is the mode. Finally, at the bottom of the time sheet, it is helpful to document the time devoted to actual work or completing the process and time devoted to walking or waiting. Magnifying this part of the time observation sheet, you see that the observation time was 1,270 seconds and the walk time was 125 seconds. Therefore the time devoted to collecting and administering the medications to the two patients was 1,145 seconds. Now let's look at two other healthful forms: the standard work combination sheet, and the percentage load chart. The standard work combination sheet schematically captures each category of activity. The manual processing time is shown as a solid black line, machine processing time--primarily computer use and in medicine--is shown as a dash black line, walking time as a jigsaw pattern, and waiting time as a straight line with arrows on each end. This is the standard work combination sheet for our bedside nurse Wendy as she collects and administers medications to patients number three and patient number two. I have left out the computer processing time for these steps because they are automated using a scanner. The orange dash line represents the takt time. A single cycle was below takt time as we discussed earlier. In this idealized description, the walk times are relatively short and the processing time constitutes the majority of the activity. Now let's look at the percentage load chart. This chart is useful for determining if the proper number of personnel are assigned to the process. First, you should write down each operator's name. In our case, to make it very simple, we have only one operator--the bedside nurse Wendy. Next, you calculate the average cycle time for each operator. Draw a red line to indicate the takt time. Create a bar graph to represent the time expended for each operator. As you can see, our bedside nurse Wendy's average cycle, work cycle time, to collect and distribute medications to one patient is 627 seconds. As shown by the arrow, this value is divided by the takt time to determine how many operators, in this case, workers are required to meet the demand. In this case, the cycle time for Wendy is 627 seconds and this value is divided by the takt time of 727 seconds and equals 0.87. Or rounding up, this means one operator is appropriate and no additional employees need to be hired. The percentage load chart can be further broken down into process time, walk time, and wait time. Here's the same bar graph depicting the walk time in yellow and the manual process time in blue. Now let's look at the other four bedside nurses on 64 that are administering medications. As you can see, on this percentage load chart in our idealized case, the other nurses are not as efficient as Wendy. Cycle times for the other nurses are all above takt time of 720 seconds being 810, 940, 850, and 900 seconds. If we calculate the total cycle time for all five nurses, it equals 4,127 seconds. Divided by the takt time of 720 seconds and the number of operators required to administer medications to patients on the floor within 60 minutes is 5.73 or, rounding up, six rather than five nurses. Administration has one of two choices, improve the efficiency of the other nurses or hire an addition nurse. As we will document when we complete our value stream mapping of Wendy's work, her activities are all of value added. However, if we performed a similar value stream analysis of the other nurses, it is highly likely we would identify activities that are of non-value added or waste. If we could remove this waste, the other nurses could reduce their cycle times to meet or become shorter than the takt time. And as a team, the five nurses on 64 could meet the demand of administering medications to the patients on the floor 64 within 60 minutes without having to add a sixth nurse. We have now covered four worksheets that help us to gain greater insight into work processes in health care. The standard worksheet that creates a spaghetti diagram that allows a visualization of all the steps in the work process, the time observation sheet that provides accurate times for each step, the standard work combination sheet that schematically depicts the time devoted to each type of activity and, finally, the percentage load chart that allows assessment of the personnel needs or the need for removing non-value added steps. Armed with these four tools now let's learn how to create a value stream map. Thank you.