Profit = NVA/VA- Value Stream
Transcript of Profit = NVA/VA- Value Stream
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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
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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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Value Stream Mapping
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
Value Stream Mapping
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
4 5 6 7 8 9 10 11 12 Component Task Time
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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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
4 5 6 7 8 9 10 11 12 Component Task Time
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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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
4 5 6 7 8 9 10 11 12 Component Task Time
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
checks in Patient sees
nurse
Walk/Wait Time
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Clinic Appointment
Add your lead time data
VA =
NVA =
VA % =
NVA % =
L/T =
C/T =
B
Total lead time: minutes
A
Patient
leaves
Patient sees
doctor Patient
checks in Patient sees
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
Total lead time: minutes
Patient
leaves
Patient sees
doctor Patient
checks in Patient sees
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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Total lead time: minutes
Patient
leaves
Patient sees
doctor Patient
checks in Patient sees
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
Park Nicollet Health Services/Used with Permission
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Current State
Future State
Park Nicollet Health Services/Used with Permission
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Current State
Future State
Park Nicollet Health Services/Used with Permission
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Current State
Future State
Park Nicollet Health Services/Used with Permission
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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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©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
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.
Mod 3 – Value Stream Mapping
61 03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
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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Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Appendix (Additional Value Stream Map Examples)
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Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Used with permission; Virginia Mason Medical Center
64
Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Used with permission; Virginia Mason Medical Center
65
Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
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Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
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Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
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Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
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Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
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Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
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Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Real Value Stream Maps (Put in Final Form)
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03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
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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©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
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
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©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
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
Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
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
Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
77
Mod 3 – Value Stream Mapping
03 Value Stream Mapping
v20130530
©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply