Profit = NVA/VA- Value Stream · Calculate the total value added (VA) and non value added (NVA)...

1

Mod 3 – Value Stream Mapping

03 Value Stream Mapping

v20130530

©1996-2013, John Black and Associates LLC

Licensed Materials – USA Copyright Laws Apply

Global Production System

Product/Patient Quantity Analysis

Kaizen Kaikuku

Just-in-Time

Measures

Standard

Operations

Heijunka

(Leveling)

Continuous

Flow

Total

Productive

Maintenance

Poka-yoke (mistake

proofing)

Kanban

Setup Reduction

Changeover

Multi-process

Operations

Jidoka (human

automation)

GPS

MUDA MUDA

Visual

Control

Andon

TAKT TIME ONE PIECE FLOW PULL PRODUCTION

R

e

d

e

p

l

o

y

m

e

n

t

Committed Leaders

Profit =

Price - Cost

TAKT Time Map

Capacity Tables

Cost Reduction By Eliminating Waste

GPS Depth Study

NVA/VA-

Functions/Mgrs

Quality Cost Delivery

Morale Safety

Value Stream Mapping

5S • Sorting

• Simplifying

• Sweeping

• Standardizing

• Self Discipline

3P Prod Prep

7 Flows Medicine

7

Wastes

RPIW

7 Flows

Factory

4 No’s

© 1996-2013, John Black and Associates LLC

(modified from Hiroyuki Hirano, Productivity Press).

Value Stream

Mapping

Module 3


2 03 Value Stream Mapping

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Value Stream Mapping Key Points

Understand the purpose of the Value Stream Map, how

to create one, and how to use a VSM to improve your

work.

Define the role of management in the VSM process.

Identify tools and forms needed to create a VSM and

understand the process steps.

Define measures that help identify improvement

opportunities: lead time, cycle time, value added time,

and non-value added time.

Develop a Future State Value Stream Map and an

improvement implementation plan.



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What is Value Stream Mapping?

A visual tool to see and understand the flow of the

patient through the health care experience.

A big picture perspective that focuses on improving the

whole process, not optimizing pieces of the process.

Allows you to see and eliminate waste in the process.

Created from real time direct observation and

measurement of the actual process.

Optimize the whole from the standpoint of the final

customer – the patient.



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What is Value Added for the Patient?

Value for the patient is delivering a health care

experience that is:

Compassionate.

Defect-free (no mistakes).

Without waits or excess travel.

At the right place, at the right

time, and in the right amount.

ALWAYS as defined by the

patient, who is the customer.



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Business as Usual vs. Value Stream Approach

Business as usual:

Process,

activity, or

function

Process,

activity, or

function

Process,

activity, or

function

Process,

activity, or

function

Process,

activity, or

function

Process,

activity, or

function

Value Stream Approach:



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How Value Stream Mapping Helps

Helps visualize the whole flow, not an isolated

process.

It serves as a roadmap for Lean implementation.

It is an excellent tool to describe what

implementation is needed to meet improvement

goals.

Current State VSM = Future State VSM + PDCA



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Why Map your Current State Value Stream?

Identifying your current state allows you to see the

flow through your area.

Analyzing your current state allows you see

opportunities for improvements in quality, cycle

time, lead time, and patient satisfaction.

Understanding your current state allows you to

develop a vision for improved flow.

Displaying your current state in your area for all

team members allows for transparency of the flow

and planned improvement work.



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Future State VSM

Next Future State

VALUE

WASTE

Current State VSM



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Management’s Role

Value stream improvement is primarily a

management responsibility.

It is the role of management to see the overall flow,

develop a vision of an improved Lean flow for the

future, and lead the improvement implementation.

Leaders are responsible for creating the value

stream maps of their processes.

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Remember:

The point of value stream mapping is not the

maps, but to understand the flow of the

patient through the health care experience,

and to use that understanding to drive

improvements.

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How to Create a Value

Stream Map



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Getting Started

Stopwatch.

Pen.

Time observation form.

To capture the steps in the

process and document the cycle

times of each step as well as the

walks and waits.

11 x 17 paper or butcher paper.



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The Measurement of Time

In creating a value stream map, different types of time

measurements are observed and recorded.

Lead Time

The total time for one patient to move through the process

including wait time, i.e. from the time patient enters the

building until discharge.

Cycle Time

The time for one cycle of work in the process, i.e. the time it

takes to check a patient in for an appointment. Starts and

stops by role and allows you to identify work cycles.

Process vs. Wait/Walk

Allows you to identify value added vs. non value added time.



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Value Stream Mapping Process

Process

Current State Value Stream

Map

Future State Value Stream

Map

Work Plan &

Implementation

Choose a process

Understand how the area

currently operates

Design a Lean flow

Plan how to get there and

execute the plan

Re

pe

at

Current State becomes

Future State Sustain improvements



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Mapping Process Steps

1. Walk the process and document the process steps of the

value stream. Always start with following the patient.

2. Obtain time observations on an adequate number of patients

to represent your value stream using a stopwatch. Time

observations should be recorded on the Time Observation

sheets. Be sure to include wait/walk times.

3. From your time observations, calculate the most commonly

observed cycle time for each process step and wait/walk

times.

4. On your 11 x 17 paper or butcher paper, record the process

steps. Patient flow is drawn from left to right in the middle of

the paper in the order of processing steps. Other information

will be placed above and below the patient flow.



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Mapping Process Steps - continued

5. The process box stops whenever processes are

disconnected and the patient flow stops. For example, the

patient checking into a clinic would be one process. The

patient having their exam would be another process.

6. Show the flow of the patient between processes. The

mapping icon for push movement of the patient is a striped

arrow.

7. Draw a data box under each process box and record

process information in each box. Typical process data: C/T

(cycle time), number and type of staff, and available working

time (minus breaks).

8. Record the amount of time under each walk/wait arrow.



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Mapping Process Steps - continued 9. Calculate the total value added (VA) and non value added

(NVA) time as well as their corresponding percentages.

Initially, cycle times will be considered VA and walks/waits

NVA. As you do more maps, you will divide cycle times into

VA and NVA as well.

10. Draw a timeline under the process boxes to compile the

process lead time. Add up the total lead time by summing

all the process box times plus all the walk and wait times.

11. Add information flow. Information flow is in the top half of

the map space. A small box icon or node is used to label or

describe different information-flow arrows – for example,

electronic vs. paper information.

12. Identify improvement opportunities with kaizen bursts to

reach the future state within 12 months.



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Additional Mapping Information

Value stream mapping uses minutes and seconds as the unit

of time for cycle times, takt times, and available working

times.

Look for the other health care flows such as providers, and

supplies.

A current-state map and the effort required to create it

are pure Muda, unless you use it to quickly create and

implement a future-state map that eliminates waste

and increases value for the patient.

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Current


Sample



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Clinic Appointment

1. Patient checks in.

2. Patient waits.

3. Patient sees nurse.

4. Patient waits.

5. Patient sees doctor.

6. Patient leaves.

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Time Observation Form

Process

Clinic Appointment Observation Time 8:00 a.m. – 11:00 a.m.

Observer Susie Jones Observation Date: Monday 5/5/08

Step #

Description of Operation 1

2

3

4 5 6 7 8 9 10 11 12 Component Task Time

Remarks

1 Patient checks in

2 Patient waits

3 Patient sees nurse

4 Patient waits

5 Patient sees doctor

6 Patient leaves

Time for 1 cycle:

Label your process steps

Label your header information

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Time the Process

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Time Observation Form Process

Clinic Appointment Observation Time

8:00 a.m. – 11:00 a.m. Observer Susie Jones Observation Date:

Monday 5//5/08

Step #

Description of Operation 1 0

2 0

3 0


Remarks

1 Patient checks in :30 :10 :28

2 Patient waits 1:00 1:28 1:10

3 Patient sees nurse 3:22 3:45 4;47

4 Patient waits 11:32 13:15 13:01

5 Patient sees doctor 18:04 19:15 18:59

6 Patient leaves 18:12 19:25 19:03

Time for 1 cycle:

18:12

19:25

19:03

Record your timings in

the top box of each

step. Leave the bottom box blank

for now.

Record the total time for each

cycle including

wait times.

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Calculate

Cycle Times

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Step #

Description of Operation

Cycle 1

0

1 Patient checks in 0:30 End of step 1

0:30

Repeat number since there

isn't a previous step

(Convert to seconds

to perform math)

2 Patient waits 1:00 End of step 2

0:30 Difference between end of step 1 and end of step 2

60-30=30

3 Patient sees nurse 3:22 End of step 3

2:22

Difference between end of

step 2 and end of step 3

202-60=142

4 Patient waits 11:32 End of step 4

8:10

Difference between end of

step 3 and end of step 4

692-202=490

5 Patient sees doctor 18:04 End of step 5

6:32 Difference between end of step 4 and end of step 5

1084-692=392

6 Patient leaves

18:12 End of step 6

:08

Difference between end of step 5 and end of step 6

1092-1084=8

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Monday 5//5/08

Step #


2 0

3 0


Remarks

1 Patient checks in :30 :10 :28

:30 :10 :28

2 Patient waits 1:00 1:28 1:10

:30 1:18 :42

3 Patient sees nurse 3:22 3:45 4;47

2:22 2:17 3:37

4 Patient waits 11:32 13:15 13:01

8:10 9:30 9:14

5 Patient sees doctor 18:04 19:15 18:59

6:32 6;00 5:58

6 Patient leaves 18:12 19:25 19:03

:08 :10 :04

Time for 1 cycle:

18:12

19:25

19:03



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Calculating Component Time and Lead Time

1. Component task time is the most reasonable cycle time of each

process step based on the time observations.

2. Begin by throwing out any anomalous cycle times (process step

cycle times grossly different from the majority of your sample).

• For example, if the majority of the cycle times for the first

process step are about 2:00 – 3:00 minutes but one of them was

8:00 minutes, do not reference the process step for 8:00

minutes.

3. Add the component times for process steps and walk/waits to

determine your component lead time.

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Monday 5//5/08

Step #


2 0

3 0


Remarks

1 Patient checks in :30 :10 :28 0:28

:30 :10 :28

2 Patient waits 1:00 1:28 1:10 0:42

:30 1:18 :42

3 Patient sees nurse 3:22 3:45 4;47 2:22

2:22 2:17 3:37

4 Patient waits 11:32 13:15 13:01 9:14

8:10 9:30 9:14

5 Patient sees doctor 18:04 19:15 18:59 6:00

6:32 6;00 5:58

6 Patient leaves 18:12 19:25 19:03 0:08

:08 :10 :04

Time for 1 cycle:

18:12

19:25

19:03

18:54 mm:ss

Time for 1 cycle

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Draw the

Value Stream



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Clinic Appointment

Draw one process box for each step, not including waits



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Patient

leaves

Patient sees

doctor

Clinic Appointment

Label your process flow.

Waits are spaces between each step.

**Waits are only labeled here as reference**

(wait) (wait) (wait) Patient

checks in Patient sees

nurse



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Clinic Appointment

Add your cycle time line and label, and wait time label

Add your lead time

line and labels

Add your

data box

VA =

NVA =

VA % =

NVA % =

L/T =

C/T =

B

C

Cycle Time

Total lead time: minutes

A

Patient

leaves

Patient sees

doctor Patient


nurse

Walk/Wait Time



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Clinic Appointment

Add your lead time data

VA =

NVA =

VA % =

NVA % =

L/T =

C/T =

B


A

Patient

leaves

Patient sees

doctor Patient


nurse

Add your cycle time and wait time data

0:28 2:22

0:42 9:14

6:00

0:08

18:54



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Value Added (VA) & Non Value Added (NVA) Time

1. Any step involving a wait or walk is considered non value added.

2. Calculate the total amount of value added time by adding those

cycles of value added time.

Total VA = 8:50

3. Divide the total amount of value added time by the total lead time to

acquire the total percent of value added time.

Total VA = 8:50 = 530 sec = 47%

Total LT = 18:54 1134 sec

4. Repeat these steps using the non value added time to acquire

those measures.

5. Record these measures in the data box, as well as the total lead

time and total cycle time.



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Clinic Appointment


Patient

leaves

Patient sees

doctor Patient


nurse

0:28 2:22

0:42 9:14

6:00 0:08

18:54

Add all measures to the data box with units of measure

VA = 8:50

NVA = 10:04

VA % = 47%

NVA % = 53%

L/T = 18:54

C/T = 8:50



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Patient

leaves

Patient sees

doctor Patient


nurse

0:28 2:22

0:42 9:14

6:00 0:08

18:54

VA = 8:50

NVA = 10:04

VA % = 47%

NVA % = 53%

L/T = 18:54

C/T = 8:50

Decrease

patient wait

FINAL Clinic Appointment

Current Value Stream Map



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Value Stream Data Collection Issues

Some processes continually change and are not easy to

determine based on observing sequential activities. This

observation is particularly true before the first standard work is put

in place.

Some staff may do step 3 first, then steps 1 and 2, then step 5,

and skip step 4.

You simply may not see a step occur.

Do enough observations to understand the sequence of activities

that occur most frequently.

Remember you are not trying to capture all sequences, just a

sequence that represents what activity happens most frequently.

You can still use times from out-of-sequence operations to

validate the most frequent time of discrete steps, even if they are

taken out of order.



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Value Stream Data Collection Issues

Another issue may be that there are clearly different pathways for

the patient to follow. For example, the emergency department

patient may: 1) be sent home, 2) be admitted, 3) get radiology or

not.

Each of these different pathways dramatically changes the lead

time.

You may choose to create 3 different value streams, or simply

one that represents the most frequently occurring scenario (e.g.,

being seen, then sent home).

Alternately, you may select the value stream that represents the

most opportunities for key improvements (e.g., the patient who is

admitted) and note on the VSM the frequency that path occurs

(e.g., 30%).

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Future

Value Stream Maps



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What is a Future State Map?

A visual of improved patient and information flow.

It unites Lean concepts and techniques.

It is used to drive detailed implementation plans.



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Targeting Your Future State

What type of improvements are needed and why?

What is the time frame for achieving improvements?



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Creating a Future State

Make the health care experience, process, or service flow

without waits, stopping, batching, mistakes, or other waste.

Design the process so the patient can

pull the product or service when they

want it.

Meet your patient’s value expectations:

Quality – no defects

Reliable delivery – right time, right

product

Rapid response to changing needs



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Improvement

“Improvement usually means

doing something that we have

never done before.”

When you examine these processes:

Can you simplify steps?

Can you combine steps?

Can you rearrange steps?

Can you eliminate steps?

Try the improvements.

- Shigeo Shingo



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Examples of Improvement Targets

Reduce the lead time for the patient’s health care

experience.

Reduce the number of patients waiting for services.

Increase the percentage of patient touch-time by

providers and staff.

Increase available capacity to provide services to

patients.

Decrease the area footprint.

Eliminate defects and mistake proof a process.



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Future State Questions

How would this process look if it was completely

patient centered?

Where are the wastes, and what would the process

look like without those wastes?

What is the demand for the process and how could

you redesign the process to meet that demand?

How can you create continuous one-piece flow?



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Future State Questions

At what single point in the value stream will you

trigger flow of information so it is where it is needed

when it is needed?

How will you level production and workload?

What process improvements will be necessary for

the value stream to flow as your future state design

specifies?

Who should be doing what work to maximize the

skill sets of each person in the value stream?



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Implementation Planning

Achieving future state is the goal of Value Stream

mapping.

Keys to success…

Tasks identified and scheduled.

Tasks assigned to individuals or teams.

Required support obtained.

Regular reviews to assess adherence to the plan.



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Implementation Planning Guidelines

Develop a realistic implementation timeline.

Prioritize action items supporting transition process.

Plan regular reviews to assess adherence to the

plan.

Develop a plan to deal with issues/corrective

action.

Develop a robust communication plan.

Stick to the plan…don’t jump around!

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Real Value Stream Maps (Quickly drawn on the gemba)

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Current State

Future State

Park Nicollet Health Services/Used with Permission

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Current State

Future State


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Current State

Future State


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Current State

Future State


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Current State

Future State


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Used with permission; Virginia Mason Medical Center

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Common Value Stream Map Symbols

Operator:

Person doing

the work

Defect,

problem, or

opportunity

Kaizen Burst

Electronic

Information

Flow

Supplier/

Customer

Push Arrow Physical

Information

Flow (paper)

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Other Value Stream Map symbols

Terms Symbols Contents

Material Flow Arrow connects between process and process, between process and storage.

Information Flow

Arrow connects the origin of information with the destination of information.

Kanban: Kanban is used in transferring information of production or delivery.

Cart kanban: Cart is used as kanban of production or delivery.

Box kanban: Box is used as kanban of production or delivery.

Paper note: Paper note is used in transferring information of production or delivery.

Electric transmit: Information is transmitted electrically through computerized system.

Process Refer to production process, temporary crib, receiving yard, shipping yard, collecting yard;enter the name of place in each symbol.

Store Store: Refer to storage of finished goods or work in process. Direction of each symbol’s face should be cautioned.

Type Type: Enter the number of kinds of material type in each symbol; this kind of information should be clarified every store.

Place of planned product Refer to where scheduled-produced products are lined in order of first-in first-out.

Kanban Post Knaban post: Refer to stagnation after removing kanban.

Inventory Inventory: Refer to stagnation of materials expect for planned products; The quantity should be entered also.

Supplier,Customer Refer to suppliers or customers: Enter supplier or customer name in each symbol.



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Value Stream Mapping Summary

Remember…..

The point of value stream mapping is not the

maps, but to understand the flow of the

patient through the health care experience,

and to use that information to drive

improvements.

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Appendix (Additional Value Stream Map Examples)

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Real Value Stream Maps (Put in Final Form)

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0:00:18

Pt. Contact:

-Phone

(CC, MI)

-Referral /

Consult

-Hospital F/U

- F/U Appt

- POL

VA = 0:35:21

NVA = 232:47:16

Walk In

0:02:38 0:02:45 0:08:02 0:15:06

0:0

8:0

4

0:1

3:5

6

0:0

4:1

6

0:03:05 0:02:15

0:0

1:4

8

1 1 1 1 1

1

1

Day Of Service Lead Time 0:59:17 Post-DOS 0:01:30

23

2:1

9:1

2(9

.7 d

ays)

% VA = 0.3%

% NVA = 99.7%

0:01:12

Primary Care Model Line

Family Medicine, SLP 3850Current VSM

Updated: December 4, 2007

Seen Patients

Seen Nov’06-Oct ’07 %

OV 17,273 42%

WELL 7,833 19%

RECK 7,059 17%

FLU 3,683 9%

NURS 2,343 6%

PREO 1,711 4%

WCHD 633 2%

PROC 299 1%

CONS 6 0.01%

CW01 1 0.00%

TOTAL 40,841

NVSU:

Phone notes:

RX Refills: 367,920

(217,073 Refillable by RN)

(150,847 To Care Team)

Hours of Operation:

(7:30-5:00) 510 minutes

Takt Time: 0:03:39 (H:MM:SS)

PQ Analysis

Flow of

Phone

Calls

Stagger

Starts

Load

Level

Schedules

Across the

week

Validate

Standard

Rooming

Clinician

One-

Piece

Flow

Med

Rec

HTN

Auto-

Cuff use

Nursing

One-

Piece

Flow

1

1

Nurse

Treatment

& Visit

Orders

1

Clinician

Visit

11

1

Standard

Rooming

1

Reception:

1. Regist.

2. ISS

3. Check-in

1

ISS Pre-

Work

1

Schedule

Appt

1

Lab

-Add’l

orders

arising

from visit

are done

1 Document

Visit

(Dragon)

1

Reception

F/U

Activities

for Visit

1

X-Ray

-Add’l

orders

arising

from visit

are done

1 MSR

Completion

1

0:28:00

0:1

0:3

5

0:13:00

0:1

0:3

5

0:0

1:4

1

NVSU

NOTE:

-- Updated Cycle Times based on

RPIWs in the Family Medicine Model

Line throughout 2007: 2.1, 10.1, 17.1

= Worked on in 2007

= Opportunities

0:04:41

Updated

Role of

Dept Asst

Pre-DOS 232:21:50

Production ControlDaily Team Huddles

Rounding by Clinic Flow Coordinator

Visual Control

Kanban & Med Kanban

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ISS Pre-Work

0:02:00

MSR

Completion

Dictation /

Document

VisitWalk In

Post-Visit

Management

- Phone Note

- Rx Refill

Patient

Contact

Phone

Pt Online

Visit Wrap-Up

Nursing

Support Staff

Follow-up /

Care

Coordination

Specialized

Support

Resources

E.g.:

- Db Ed.

- Tele-

Assurance

- Nutr. Cons.

- Other

Lab

-Add’l orders

arising from

visit are done

Pt Sees

Clinician

-Reviews

assmt

-links goals

to targets

- performs

exam per

care package

- orders

-sets up next

visit

Patient

roomed (Std

Rooming):

- Prep pt for

exam

-or-

Nursing

Support Staff

reviews

Window

Sticker

Patient

checks in for

Appointment:

1. Regist.

2. ISS

3. Check-in

using Fast

Pass

4. OP Med

list

Patient has

ELM as

appropriate

Pt Receives

Pre-Visit Set-

up Call from

HSN

-ID issues/

concerns

- setup ELM

or add’l

packages

-Data

Collection

Patient Calls

to Schedule

Appointment

-or-

purchases

Care Package

Production ControlPrimary Care Weekly Huddle

Daily Site Huddles

Daily Team Huddles

Rounding by Clinic Flow Coordinator

Clinician Schedules

Visual Control

1 1 1 1 1, 2

1

1

1 1 1

1

Primary Care Model Line

Family Medicine, SLP 3850Future VSM (Dec ’08)

Edited: 12/04/07

07 Proj. % of Overall

OV 18,482 42%

WELL 8,381 19%

RECK 7,553 17%

FLU 3,941 9%

NURS 2,507 6%

PREO 1,831 4%

WCHD 677 2%

PROC 320 1%

CONS 6 0.01%

CW01 1 0.00%

TOTAL 43,700

Hours of Operation:

(7:30-5:00) 510 minutes

Takt Time: 0:03:28 (H:MM:SS)

Faxed

Refill

Requests-RN

completes

Refills

HSN

-H.S.N.

assists pt

prioritizing

health goals

or

- Gathers

information

1

1

PQ Analysis

HSN

-Reviews

self-mgmt &

care plan

-Documents

plan

- sets up f/u

tests, appts,

-connects pt

to

appropriate

resources

2, 1

0:02:38 0:02:35

0:0

5:0

0

0:01:39 0:13:42

0:1

5:0

0

0:06:30 0:18:10

0:0

1:0

0

0:0

5:0

0

0:03:47 0:20:000:28:00

0:1

0:0

0

0:1

0:3

5

0:3

0:0

0

0:0

5:0

0 0:02:00

X-Ray

-Add’l orders

arising from

visit are done

28% 5%x% x% x%

59%Phone Msg

Created in

Response to

Patient

Request

0:02:20

1

1 1 1 1 1

11 1 1 1 1

41%

1 1

0:13:000:07:30

0:0

1:0

0

0:0

1:0

0

48:0

0:0

0

0:1

0:3

5

VA 00:46:12

NVA 216:24:00

VA 1:40:06

NVA 217:28:00

1% VA

99% NVA

1% VA

99% NVA

0:02:00

Decentralized

Triage Nurse

Manages

Messages /

Work of

Patients Not in

Today

1

24:0

0:0

0

74



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Reception:

1. Regist.

2. ISS

3. Check-in

ISS Pre-Work

Digestive and Endoscopic Procedure Center

Current State Value Stream Map Current, January 2007

Schedule

Appointment

Nurse

Treatment

& Visit

Orders

Clinic

Procedure

Room

Reception

F/U

Activities

for Visit

Document

Visit

MSR

Completion

Visit

Planning &

Patient

Rooming

C/T= 0:02:38

C/O=

Min Avail=

C/T= 0:02:00

C/O=

Min Avail=

C/T= 0:03:10

C/O=

Min Avail=

C/T= 0:04:20

C/O=

Min Avail=

C/T= 0:26:12

C/O=

Min Avail=

C/T= 0:03:21

C/O=

Min Avail=

C/T= 0:01:00

C/O=

Min Avail=

C/T= 0:05:21

C/O=

Min Avail=

C/T= 0:02:00

C/O=

Min Avail=

2:38 3:10 4:20 26:12

2:0

0

6:2

3

8:0

9

3:4

7

3:21 1:00

0:0

0

I I I I I I I I

PQ Analysis

Clinic Visits (Daily): Demand Seen

Gastroenterology: 16 18

Procedures (Daily): 163 53

Hours of Operation

Clinic: 8-5pm

Procedures: 6:30-6pm

Takt Time Clinic Visit: 33.75 min

Procedure: 4.23 min

Pre-DOS 90,306:11 (62.7 Days) Day Of Service Lead Time 58:22 Post-Encounter Lead Time 9:212:00

Min Avail=

C/T= 0:02:00

C/O=

Min Avail=

C/T= 25:04–121:00

C/O=

Min Avail=

C/T= 32:00-

62:00

C/O=

Min Avail=

C/T= 0:03:48

C/O=

Min Avail=

C/T= 0:02:00

C/O=

Min Avail=

3:10 2:00

25:04-121:00

10

:00

5:0

0

32:00-62:00

0:0

0

Day Of Service Lead Time

79:14 – 205:10

Post-Encounter Lead Time 7:48 – 48:07:48

Visit Prep

C/T= 0:13:43

C/O=

Min Avail=

Post Patient

visit

management

- visit

closure

C/T= 0:02:00

C/O=

Min Avail=

C/T= 0:02:00

C/O=

Min Avail=

II

C/T= 0:03:10

C/O=

Pre-DOS 139,859:51 (97.1 Days)

2:0

0

Patient

Primary

Care or

Specialty

Department

Hospital

Phone calls

To Digestive

Call Center

Clinic Visits

Endoscopy

Procedures

CT = 65:45min

LT = 90,373:54 min

(62.8 Days)

LT = 139,946:53-142,952:49 min

(97.2 – 99.3 Days)

CT = 105:53-231:49

VA = 65:45 min

VA = 105:53-231:49

NVA = 90,313:09 min

(62.7 Days)

NVA = 139,841:00 min

(97.1 days)

%VA = 0.07%

%NVA = 99.93%

%VA = 0.08- 0.1%

%NVA = 99.92-99.8%

External

Provider

C/T= 0:26:42

C/O=

Min Avail=

C/T= 0:03:48C/T= 0:05:21

C/O= C/O=

Min Avail= Min Avail=

Clinic Exam

Room

Endoscopy

Pre-

Assessment/

Procedure

Room

Recovery

and Closure

5:21

90

,28

8:0

0

62.7

da

ys

3:48

13:43

26:42

13

9,8

24

:00

97

.1 d

ays

5:21 2:00 2:00

3:48 2:00 2:00

0 -

48

:00

:00

7,12141

11

249111

570

Patient pre-

visit

preparation

Increase

Capacity

Standardize

Rooming and

Rooms

Results

trackingPatient Tracking

System

Pull Systems/

Andons

Schedule

Leveling

Specimen

Delivery

Create

Outcomes

Measures

Implement pre-

procedure patient

anxiety survey

Formalize

Service

Recovery

Practices

Implement post-

procedure patient

satisfaction survey

Apply

Outcomes

Measures to

Patient Care

Apply CCE

Module

Learnings

75



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Reception:

1. Regist.

2. ISS

3. Check-in

ISS Pre-Work

Digestive and Endoscopic Procedure Center

Future State Value Stream Map Fall 2007

Schedule

Appointment

Nurse

Treatment

& Visit

Orders

Clinic

Procedure

Room

Reception

F/U

Activities

for Visit

Document

Visit

MSR

Completion

Visit

Planning &

Patient

Rooming

C/T= 0:02:38

C/O=

Min Avail=

C/T= 0:02:00

C/O=

Min Avail=

C/T= 0:03:10

C/O=

Min Avail=

C/T= 0:04:20

C/O=

Min Avail=

C/T= 0:26:12

C/O=

Min Avail=

C/T= 0:03:21

C/O=

Min Avail=

C/T= 0:01:00

C/O=

Min Avail=

C/T= 0:05:21

C/O=

Min Avail=

C/T= 0:02:00

C/O=

Min Avail=

2:38 3:10 4:20 26:12

1:0

0

3:1

1

4:0

5

1:5

3

3:21 1:00

0:0

0

I I I I I I I I

PQ AnalysisClinic Visits (Daily):

Gastroenterology: 36

Procedures (Daily): 80

Hours of Operation

Clinic: 8-5pm

Procedures: 6:30-6pm

Takt Time Clinic Visit: 15:00 min

Procedure: 4:23 min

Pre-DOS 81,234:21 (56.4 Days) Day Of Service Lead Time 55:13 Post-Encounter Lead Time 2:00

2:00

Min Avail=

C/T= 0:02:00

C/O=

Min Avail=

C/T= 25:04–121:00

C/O=

Min Avail=

C/T= 32:00-

62:00

C/O=

Min Avail=

C/T= 0:03:48

C/O=

Min Avail=

C/T= 0:02:00

C/O=

Min Avail=

3:10 2:00

25:04-121:00

5:0

0

2:3

0

32:00-62:00

0:0

0

Day Of Service Lead Time

76:32– 202:28

Post-Encounter Lead Time 2,882:00

Visit Prep

C/T= 0:13:43

C/O=

Min Avail=

Post Patient

visit

management

- visit

closure

C/T= 0:02:00

C/O=

Min Avail=

C/T= 0:02:00

C/O=

Min Avail=

II

C/T= 0:03:10

C/O=

Pre-DOS 125,747:51 (87.3 Days)

1:0

0

Patient

Primary

Care or

Specialty

Department

Hospital

Phone calls

To Digestive

Call Center

Clinic Visits

Endoscopy

Procedures

CT = 65:45 min

LT = 81,291:34 min

(56.5 Days)

LT = 128,706:23-128,832:19 min

(89.4 – 89.5 Days)

CT = 105:53-231:49

VA = 65:45 min

VA = 105:53-231:49

NVA = 81,225:49 min

(56.4 Days)

NVA = 128,600:30 min

(89.3 days)

%VA = 0.08%

%NVA = 99.92%

%VA = 0.08- 0.2%

%NVA = 99.92 - 99.8%

External

Provider

C/T= 0:26:42

C/O=

Min Avail=

C/T= 0:03:48C/T= 0:05:21

C/O= C/O=

Min Avail= Min Avail=

Clinic Exam

Room

Endoscopy

Pre-

Assessment/

Procedure

Room

Recovery

and Closure

5:21

81

,21

6:0

0

56.4

da

ys

3:48

13:43

26:42

12

5,7

12

:00

87

.3 d

ays

5:21 2:00 2:00

3:48 2:00 2:00

4

8:0

0:0

0

7,12141

11

249111

570

Results

tracking

Specimen

Delivery

76



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77



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Profit = NVA/VA- Value Stream · Calculate the total value added (VA) and non value added (NVA)...

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Transcript of Profit = NVA/VA- Value Stream · Calculate the total value added (VA) and non value added (NVA)...