Board of Directors Meeting - Lab Quality Confab · Value Stream Maps • Value Stream Maps (VSMs)...

Quality Confab

October 21, 2014

Essential Insights: Value Stream Mapping for Intermediate Practitioners, Prioritizing Projects and Selecting the Right Tools

COMPANY CONFIDENTIAL

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Value Stream Maps

• Value Stream Maps (VSMs) are the key to successful Lean projects.

• Their purpose is multifocal: – To expose opportunities for improvement.

– Level-set everyone on the process.

– Identify lack of standard work.

– Identify deviation from policy.

• Their value is to provide a roadmap for the future.

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Intermediate Level Value Stream Mapping

• Most everyone knows how to produce a VSM.

• What are the most efficient ways to produce VSMs? – Paper using cut-outs or just drawing on a large roll of butcher

block paper.

– Electronic using a common program such as Visio, Excel, or other common products.

– Highly sophisticated add-on programs such as EVSM which lays on top of Visio.

– Newer lower cost add ons such as Smartdraw which uses a more common platform (Excel) and is less costly to install and has a faster learning curve to use.

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Advantage/Disadvantage

• Paper advantages: – Cheap.

– Short learning curve to use.

– Flexible.

• Paper disadvantages: – Takes a lot of space to use it.

– Takes preparation work to have everything cut out.

– Hard to move (taping down required before moving).

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Advantage/Disadvantage (cont.) • Electronic Advantages:

– Fast to create.

– You can use a previous map as a template.

– Easier to transport a laptop than a large roll of paper.

– No problem with it coming unglued.

– You can easily make changes.

• Electronic Disadvantages: – Expensive.

– Learning curve, you can’t show and use.

– You have to have a projector for a large group to see it.

– You can’t always see the entire map in details at the same time.

– To print a readable copy you need a large paper roll plotter.

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Paper VSM

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7 7


8

EVSM

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9 9

Demand 10000.00

Work Time 24.00

Takt 416.7

Client

0.25 Hours

1.00 Hours

0.15 Hours

0.10 Hours

0.30 Hours

0.20 Hours

0.10 Hours

0.50 Hours

0.50 Hours

0.10 Hours

0.10 Hours

VA/T=1.90 Hours

NVA/T=1.40 Hours

PCE=57.58%

2500 1500 3000 1000 5000

LIS

HIS

1000

Hospitals, NursingHomes, Drs Offices

Data Entry

C/T(Hours) 1.00

Uptime 99%

Operators 10I

Accessioning

C/T(Hours) 0.10

Uptime 100%

Operators 14I

SpecimenProcessing

C/T(Hours) 0.20

Uptime 100%

Operators 6

I

Specimen Testing

C/T(Hours) 0.50

Uptime 95%

Operators 2I

Result Verificationand Release

C/T(Hours) 0.10

Uptime 99%

Operators 1

I I

SmartDraw


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Good Ol’ Visio!

10

5S Opportunity

5S Opportunity

FIFOSingle Piece Flow

Storage Time Aligned to Customer

Need

Utilization of GEL Technology

Enhanced Utilization of Tube System

Lean Implementation of Phlebotomy

Lean Implementation of

Processing

Standardization of Communication

Channels

Standardization of Product Flow

FIFOLean Product Flow

Batch Flow Reduction

Poka-yokeError Reduction

Standard Work

Lean Product Process Flow

Align to Customer

Requirements

Reduce Storage Space

Requirements

SOP Alignment to

Process

TAT Reduction in

Variation

Cost Reduction by Wasted Process

Reduction

Cellular Layout

Reduction in Required NVA

Activity

Selected Supply Inventory

Reduction

Visual Management Control

1,800sCT

1,800sLT

24/7AT1BX

100%FPY

Micro - Open Lab

1

Manual Body Fluids

1

428sCT

428sLT

24/7sAT1BX

100%FPY

Coag

1

Pneumatic Tube

1I

Sutter - Marin General HospitalCurrent State Value Stream Map

May 12th to May 16th 2003

Add-On Information

Routine Information

Add-On Electronic Information

Routine Electronic Information

Routine Material Flow

Add-On Material Flow

Pn Tube

Phlebotomy Delivery to Lab

Storage(1 week)

1I

1I

1I

1I

1I

1I

1I

LIS (FlexiLab)

Misys

Customer

Scope = Laboratory Material is A Specimen Container

Demand = 447 Specimens/DayTakt Time = 3.22 Minutes

Hospital

H

Emergency Room Hospital InpatientHospital Outpatient Outreach Courier

Financial(Lab Client)

Misys

Interface Engine

Misys

Storage(~8 hours)

Temp Storage(Instrument = 4

Hrs))

Orders Hospital Information System's

6I

Labels

Temp Storage

(Bench = 24 Hrs) Alphabetized

2x Beckman Coulter LH 750

3I

Supplier

Emergency Room = 13% Hospital Outpatient = 13%Hospital Inpatient = 70.5% Outreach = 3.5%

Hospital

M

Results

Add on Orders

Paper Bill Clients

1I

Panic Values

2x MLA 1400C

Demand does not include Histology

0I

0I

Special Hem/Path Review2

I

Manual Body Fluids Verify

1

Total Lead Time0.054 Days 1.30 hours

77.8 minutes

Total Process Time2,707 Seconds45.1 Minutes

500sCT

500sLT

24/7A/T1BX

100%%FPY

Urinalysis

1

240sCT

240sLT

24/7sAT3BX

100%FPY

Immunochem

1

120sCT

120sLT

24/7AT2BX

100%FPY

Blood Gas

1

Hematology

133sCT

133sLT

24/7sAT1BX

100%FPY

2

916sCT

916sLT

24/7AT1BX

100%FPY

Manual DIFF2

300sCT

Chemistry

300sLT

100%FPY

24/7AT

1BX

1

- Manual Reading

- CELL-DYNE 3500R- CELL DYNE 1700

ABL 700 x 2

1I1

I Storage(Store for 14 days)

15sCT

15sLT

24/7AT1BX

100%FPY

Hematology Verify

1

Phlebotomy4

15sCT

15sLT

24/7AT1BX

100%FPY

Manual DIFF Verify

1

15sCT

15sLT

24/7AT1BX

100%FPY

Chemistry Verify

1

15sCT

15sLT

24/7AT1BX

100%FPY

Coag Verify

1

15sCT

15sLT

24/7AT1BX

100%FPY

Blood Gas Verify

1

15sCT

15sLT

24/7AT

1BX

100%FPY

Urinalysis Verification

1

15sCT

15sLT

24/7AT1BX

100%FPY

Immunoassay Verify

1

- Manual Entry- Verify

15sCT

15sLT

24/7AT1BX

100%FPY

Manual Verify

1

1,785sCT

1,785sLT

AT1BX

100%%FPY

1

- Plasma Hgb- Osmo/ESR/Ketone- Mono/Strep/Infl- Pregnancy Test- BNP

Manual/Kits

Receiving 1

Receive Ord/Recd40sCT 90s40sLT 90s

AT 16/7 24/7 100%FPY 100%1BX 1

1I

Delivery to Dispatch

Urinalysis Verification

- Add-ons- Test ordering- Pre Label Tubes- Phlebotomy Mgmt.

- Test ordering- Label Tubes- Phlebotomy Mgmt.

Long Term Storage(5 Days)

Temp Storage

(Bench=8 Hrs)

Long Term Storage(5 Days)

Discard (After Verification)

Storage(1 week)

Temp Storage

(Bench=8 Hrs)

Sendouts

Quest

Sendouts-Novato - Lipids-Quest-Mills

Extra Tubes

Blood In Lab

Axysm

Reflex Testing(Culture if Indicated)

Add on Orders

Patient ID & Register

Courier Delivery & Pickup

Chem HemeCoag

Chem

Heme

Total Lead Time0.035 Days 0.84 Hours

50.4 Minutes


Total Lead Time0.061 Days 1.46 Hours

87.8 Minutes


Quest

HBOC

1

3I

93sCT

93sLT

12/7sAT1BX

100%FPY

Micro

1

Plant Culture Only

Micro - Wounds & Misc. Refered to Mills

1

?sCT

?sLT

12/7AT6BX

?FPY

Micro- Blood Cultures

1

4I

6I

505sCT

505sLT

12/7sAT2BX

100%FPY

Micro-Vitek Set-up

1

317sCT

371sLT

12/7sAT1BX

100%FPY

Respiratory & Blood Culture - Special Testing/

Subculture

1

1I

8I

218sCT

218sLT

12/7sAT1BX

100%FPY

Misc.- Final Report

1

8I

510sCT

510sLT

100%FPY

1BX

24/7AT

- Draw in Patients- Test ordering

EKG's2

- Performs on * Inpatinets *Outpatients

4I

270sCT

270sLT

12/7sAT8BX

100%FPY

Micro- Vitek Read

1

218sCT

218sLT

12/7sAT1BX

100%FPY

Respiratroy- Final Report

1

3I

1I

- Open Lab- Take Temps- Open

98sCT

98sLT

12/7sAT1BX

100%FPY

Micro- Urines

1

6I

10I

2I

439sCT

439sLT

12/7sAT1BX

100%FPY

Urines - Special Testing/

Subculture

1

146sCT

146sLT

12/7sAT1BX

100%FPY

Micro- Gram Stain Prep

1

3I

168sCT

168sLT

12/7sAT1BX

100%FPY

Gram Stain- Read

1

218sCT

128sLT

12/7sAT1BX

100%FPY

Urines- Final Report

1

3I

300sCT

300sLT

12/7sAT1BX

100%FPY

Micro - Respiratory & Blood Culture

Inital Read

1

4I

8I

218sCT

218sLT

12/7sAT1BX

100%FPY

Stools - Final Report

1

1I

3I

3I

Micro- O & Ps, Stools

Refered to Mills

1

10I

510sCT 780s510sLT 780s

AT 24/7 24/7 20%FPY 100%1BX 4

Inpatient Outpatient

3I

1I

24/7

0.002 days 0.005 days 0.020 days

90 sec 510 sec

0.007 days

1,101 sec

0.002 days

916 sec

0.013 days

90 sec

0.005days

0.002 days 0.005days 0.020 days

90 sec 510 sec 240 sec

0.002 days

540 sec

0.005days

30 sec

0.002 days 0.011 days 0.020 days

90 sec 510 sec 240 sec

0.013 days

372 sec

0.002 days 0.001 days

133 sec

0.002 days

916 sec

0.005 days

30 sec

0.005 days

5S Opportunity

5S Opportunity

5S Opportunity

5S Opportunity

Single Piece Flow

Examine ER Rainbow for Necessity

950

Thaw FFP

1

30sCT

30sLT

24/7AT1BX

100%FPY

Blood Bank Verify

1

Add On Crossmatch

2,220sCT

2,220sLT

24/7AT1BX

50%FPY

Type & Screen

1

2,220sCT

2,220sLT

AT 24/71BX

50%FPY

Type, Screen, & Crossmatch

1

Pre-LaboratoryProcess Variation

Reduction EMERGENCY DEPARTMENT

PJM 5/24/2004

Storage(1 week)

Temp Storage

(Bench=8 Hrs)

Utilize Pneumatic Tube to Deliver Blood Products

Pn Tube


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So.. What’s The Right Thing To DO?

• Like everything else with Lean, let the data drive the decision.

• Do you have money for the software?

• Do you have technical expertise to learn to use it?

• Do you have access to projectors where you will be using it to develop the Value Stream Maps?

• How often are you going to be using it?

• Do you need/want to share the maps with others who are not able to come to the exercise (virtual VSMs).

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EVSM

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EVSM

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Smart Draw

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Samples Of Each

• Exercise #1 – The paper VSM.

• Exercise #2 – EVSM.

• Exercise #3 – Smartdraw.

• Exercise #4 – Visio.

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Selecting The Right Tool For The Job

– Value Stream Map.

– 5S.

– RACI Chart.

– Spaghetti Diagram.

– Primary Visual Display.

– Huddle Meetings.

– Metrics.

– Voice of the Customer. 16

– Brown Paper.

– Standard Work.

– Poke Yoke (error proof).

– Single Piece Flow.

– Kaizen/Blitz.

– 20 Keys.

– Hot Button List.

• Lean uses tools much like a carpenter, plumber, doctor, nurse, or laboratory tech does.

• The tools are common to all Lean projects, their application might vary somewhat with the use of each.

• The common Lean tools include:


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Grouping Tools for Use

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• The tools can be grouped into: – Discovery/initiation of CI projects.

– Implementation of change.

– Monitoring to sustain change.


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Discovery/initiation of CI projects

– Value Stream Map (Identifies potential opportunities)

– Spaghetti Diagram (Identifies waste)

– Huddle Meetings (Idea generation for change)

– Metrics (Quantifies potential project benefits)

– Voice of the Customer (Identifies opportunities)

– 20 Keys (quantifies and identifies opportunities)

– Hot Button List (Allows employees to speak up)

– Brown Paper (Identifies Opportunities)

– Primary Visual Display Board (Dashboard of activities, metrics, and success)

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Implementation of change

– Value Stream Map (Future State shows how it could work)

– 5S (Removes waste/clutter)

– RACI Chart (Allows change to occur)

– Standard Work (Directs the new work)

– Poke Yoke (Error proof drives the change)

– Single Piece Flow (Directs the new work)

– Kaizen/Blitz (Provides the vehicle for change)

– 20 Keys (Provides the process for change)

– Huddle Meetings (Directs and educates change)

– Metrics (Quantifies what the change will be)

– Voice of the Customer (Allows employees to speak up concerning change)

– Primary Visual Display Board (Dashboard of activities, metrics, and success)

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Monitoring to Sustain Change

– RACI Chart (Maintains the control of authority).

– Primary Visual Display (Dashboard of metrics and success/shortfalls).

– Huddle Meetings (Communication with the employees which keeps momentum going).

– Metrics (measures success and degree of success).

– Voice of the Customer (Allows employees/customers to speak up).

– 20 Keys (used to monitor success, continue improvements, discover next initiatives).

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How to Engage Employees • Engage ALL employees by knowing all employees.

• Assign employees to the tools. – Employees get scared easily.

– Employees feel left out.

– Employees fear their job will be eliminated.

• Make it interesting. – Golf Tee Game to teach Standard Work.

– Single piece flow exercise to prove the value before asking them to believe.

– Have them cut out the icons for the VSM, or at least have them at least review the work once it is done in an interview/presentation fashion.

– Be creative! E.G. contests to decorate PVD Dashboard.

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How to Engage… (cont.)

• Get everyone involved: – Make sure everyone has a “job” on a team.

– Make it part of their job/evaluation/review.

• Reward good behavior: – Know your staff and what motivates them.

– Provide a reward if metrics are met; pizza, ice cream, special parking place, special lab coat…

• Make the reward easy at first, harder as time goes on: – Reward good behavior even if failure has occurred!

– Avoid money!!!!! It only makes it harder to motivate them later!

– Make them feel like a team.

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How to Engage… (cont.)

• High organizational visibility is a big plus. – Make sure administration/leadership recognizes the team’s

activities and is present at award/reward meetings.

– Have Administration attend huddle meetings periodically.

– Try not to make a big deal out of their attending; make it part of the plan.

– Encourage them to speak BRIEFLY on any organizational global initiatives that the staff might be interested in.

– Possibly the hardest behavior to change is the Administration!

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Use All of the Tools

• There is always a tendency to use your favorite tools and avoid some other tools.

• Understand when to use what tools and use them! Even the most difficult tools become easy when you are comfortable using them.

• Don’t use the tools just to use them. – Once you have used a tool make sure that you show the results

and discuss the outcome with the staff at huddle meetings or special meetings of time is needed to show, discuss, plan.

• It helps if you have a reference that discusses the use of the tools.

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Try Some Games…

• Exercise #4 – Standard Work (Golf Tee Game).

• Exercise #5 – Single Piece Flow (Sort the Tubes Game), Golf Ball Game.

• Exercise #6 – Draw The Pig!

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26 Proprietary and

C f

Standard Work Game

• Standard work is necessary to make any process work efficiently.

• To prove this, we have a game for you to play.

• Play the game without standard instructions.

• The goal is to have only one golf tee left.

• The game plays like “Checkers”.

- As you jump a tee with another tee, remove the tee jumped.

• You have 3 minutes, good luck!


27 Proprietary and

C f

Try it again!

• This time follow the instructions on the next slide.

• You should end up with only one tee left.

• You should always end up with the tee in the same hole (#13).

• You may keep the game as a reminder of the importance of Standard Work, and to remind you to think of BD when you think of Lean-Sigma!

• You have 3 minutes, good luck!


28 Proprietary and

C f

1

3 2

6 5 4

10 9 8 7

15 14 13 12 11

Standard Work Practice#6 to #4remove #5

#1 to #6remove #3and so on

#7 to #2

#13 to #4

#10 to #8

#2 to #7

#7 to #9

#15 to #13

#12 to #14

#6 to #13

#14 to # 12

#11 to #13

Set up Triangle with hole #1 emptyBegin with #4 jumping #2 landing in empty

hole #1


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Standard Work

• Hand out two pieces of blank paper.

• Place a grid on the paper as depicted in the next slide. – First use the attached Standard Work for making a Pig.

• The second piece of paper is to make a second version for the “customer” after improving the standard work.


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Standard Work


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Standard Work Instructions

• Draw the letter M at the top left intersection. Bottom center of M touches the intersection.

• Draw the letter W at the bottom left intersection. Top center of W touches the intersection.

• Draw the letter W at the bottom right intersection. Top center of W touches the intersection.

• Draw an arc from the letter M to the top right intersection.

• Draw another arc from the top right intersection to the bottom right W.

• Draw an arc between the bottom W’s.

• Draw the letter O in the center left box.


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Standard Work… (cont.)

• Draw an arc from the letter M to the tangent of the circle.

• Draw an arc from the left W to the tangent of the circle.

• Draw an arc for the eye. Halfway between M and circle.

• Draw an arc for the mouth. Halfway between W and circle. Must be a happy pig!!

• Draw the cursive letter e near the top arc on the right.

• And finally draw two dots in the middle of the circle for the pigs nose.

• This is the exact the sequence which we must draw our pigs. This is the Standard Work for drawing a pig


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The Approach is to Provide Long-Term Sustainable Results

VSM Current

Brown Paper, Root cause, Spaghetti Diag, 20Keys, VOC

Charter, VSM Future State, Kaizen, 20Keys, PDCA

Blitz, RACI, Std Work

Metrics, PVD, Error Proof

VSM, Huddle/ LDMS, Metrics

Std Work, 5S, Kaizen - Pilots

Coaching, Change Mgt, Huddle/LDMS/PVD

Board of Directors Meeting - Lab Quality Confab · Value Stream Maps • Value Stream Maps (VSMs)...

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