ValueStreamMapping

Introduction
Seetheflow/streamforyourself
Designfuturestatevaluestream

WhatisValueStream
Graphic representationofthetrialofactivitiesthatoccurfromthe
momentarequestismadeuntilthemomentthattherequestis
satisfied
Allowbetterunderstanding&evaluationoftheprocessesofdaily
work
Objectivelyvisualizing whataddsandwhatdoesnotaddsvalueby
providingelementalinformationobtainedbydirectobservation
Asyoueliminatewastes,youcreatecapacity,decreaseworker
frustration,andmostimportantly,developameansforquicker,
saferdeliveryofthecareapatientrequest

IdealStateinHealthcare

Goalsyouconsiderunachievable
100%ofthetime?

IdealStateinHealthcare
1. Defectfreedelivery

exactlywhatthepatientneeds
Defectfreeisnotanorminserviceindustry(ToErrisHuman)

2. Nowastesinthesystem

Anythingthatdoesnotaddvaluetothepatientortheprocess

3. Individualattentiontoeachpatient

Withoutfocus,reworkaremorelikelytocomplicateordelaythe
deliveryofcare
Designstandardizedprocessesthatsupportheflexibilityof
professionalcare

4. Immediateresponsetoproblems

Definingwhatisexpectedofasystemallowsworkersto
recognizeerrorsandtriggerandimmediateresponsetothat
failure

Wastes
Theelementsthataddnovalue butwastes
costsandtime

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8wastes

4rulesforhealthcareprocesses
1. Clearlyspecifyallactivitiesofwork
2. Allstepsinarequestaresimpleanddirect
3. Theflowofstepsrequiredtodeliverarequestis
simpleanddirect
4. Allproblemsareaddresseddirectlyandina
timelyway,undertheguidanceofacoach

Rule1
theactivitiesofworkwithinaprocessshould
beclearlydefinedastowhatshouldhappen,
inwhatorder theyshouldoccur,andhowlong
theactivitiesshouldtaketocomplete.
Italsostatesthattheoutcomeorgoalofthe
workmustbeabsolutelycleartothepeople
doingthework.

Rule2
Thisrulepointstothecomplexityandvariety
ofwaysthataserviceorproductcanbe
requested.
Thegoalisthattherequestprocessbesimple
(i.e.,withasfewstepsaspossible)anddirect
(i.e.,therequestorgetsascloseaspossibleto
thepersonwhocanoffertheserviceor
delivertheproduct).

Rule3
Thegoalistouseasfewstepsandasfew
peopleaspossibletoproducethehighest
possiblequality
Isthisactivitynecessarytoproduceanideal
outcome?

Rule4
noerror,onceidentified,willbeallowedtobe
repeated
Inorderforthisruletobeusedtoits
maximumeffect,youmusthaveawaytolook
atprocessfailuresthatwillquicklyand
objectivelyexposewherethefailureoccurred.

AnatomyofVSM
Unlikeconventionalflowchart,whereinyou
mightmaphowworkisintendedtohappen
WithVSMyoucharteverystepasitreally
happens andeachwaythatitmaybe
communicated
Looksat(1)People,(2)material&
(3)informationflow

AnatomyofVSM
Theupperthirdisoccupiedbytherequestor
andthestepsthatcomprisetherequest.
Thecentersectionisfortheprocessstepsin
answeringtherequest.
Thebottomthirdisforthecompilationof
relateddata.

Upperthird
Stepsthatcomprise
arequest

CenterThird
Stepsdeliverthe
requestedservice

BottomThird
Compilingrelated
data

UpperThird
StepsThatComprisetheRequest
Thetopthirdofthevaluestreammapwill
revealtheoftencomplicatedandredundant
stepsinvolvedwithinitiatingthedeliveryofa
productorservice
Flowfromrighttoleft

CenterThird
Stepsdelivertherequestedservice
Flowfromlefttoright
processboxes aredrawnasverticalrectangles,withtitles
onthetopofeachbox
Therearelikelymanyactivitiesthatoccurinsideeachprocess
boxtocreatethatstep,
Preferably,writetheactivitiesineachboxintheorderin
whichtheyoccur.
Thinkoftheboxesashavingdoors.Askyourself,whatisthe
firstactivitythatopensthedoortothisprocessboxandwhat
isthelastactivitythatclosesthedooronthatstep?

BottomThird
Compilingrelateddata
Dataarecollatedonthebottomthirdofa
valuestreammaptoaddanotherlayerof
understandingbeyondwhatyouseeinitially
relatedtotheflowofworkactivities.
Althoughthisdatacompilationdoesnothave
tobelengthy,itaddsobjectivityandemphasis
totheassumptionsyouwoulddevelopby
lookingatflowalone.

CurrentStateMap
Therulesforcreatingacurrentstatemapare
simple,butcreatingitdemandssomerigor:
Themapcanbefinalizedonlywhentheentire
processhasbeendirectlyobserved
mustbevalidatedbythepeoplewhodothe
work,bothforaccuracyandtogeneratebuy
inforupcomingimprovements

WhotoInvolve
starteverywhereandincludeeverybody!
Frontline
definefrontlineworkastheworkdonedayby
daytoaccomplishtheexpectationsofeach
job

PreparingEveryoneInvolved
Theymustknowthatthisobservationisnota
criticizingorpunitiveevent
thattheobserverislookingattheprocesswithan
eyeonimprovement
willultimatelyimprovetheworkenvironment
workersbeingobservedneedtobeactivelyengaged
intheobservation,nottointerrupttheirwork,but
forthemtobemindfulofandsignaltotheobserver
smallinterruptionsorvariationsintheprocessasthe
observationprogresses.

GoodTeam
Localmanagementisinformedabouttheprocess
andexpectationsandeagertothinkoutsidethebox
andtrysomethingnew.
Staffingisreasonablystable.
havephysiciansupport,ifthisisaclinicalareaor
process
haveastableenvironment,meaningnootherlarge
initiativesarebeingintroducedsimultaneoustothe
improvementwork
Someonefromtheadministrativeteamwillown
theefforts

IdentifyProblems
Isthisprocessnecessary?Whatisitspurposeandcoulditbe
doneabetterway?
Areallthestepsintheprocessnecessary?Aretheyadding
value?Aretheydoneconsistently?Dotheyinvolvethe
fewestnumberofpeople?Aretheygeneratingand
distributingcompleteinformation?
Arealltheactivitieswithintheprocessboxeshappeningin
thesameorder?Aretheyhappeninginthebestorder

IdentifyProblems
Arethereredundantactivitiesinsomestepsthatcouldbe
eliminated?Cansomeoftheactivitiesinoneboxbedone
betterinanotherbox?
Aretheprocessboxesthemselvesinthebestorder?Iseach
oneessentialtotheprocess?Canoneormorebeeliminated?
Cantheybecombinedandstreamlinedwithoutsacrificing
qualityforthepatient?
Istheinformationflowdirectandsimple?Istheinformation
ineachboxoriginal(notredundant)andcanitbesharedor
eliminated?

AddingDatatoCurrentStateMap
Processengineeringprinciplesindicatethat
forprocessevaluation,30measurements
shouldbeadequatetoestablishstatistical
significance.
Youwanttoobservesomething30times
beforeassigninganaveragenumbertoit.

FutureState
Definingthefuture involvessomethought.
Itiseasytoconfusethefuturestatewithideal.
Rememberthatidealisthegoldstandardfor
perfectiontowardwhichyouarealways
striving,butitmaynotbeachievableinthe
currentfiscalandtechnologicalstateofyour
organization.

FutureStateMap
(1)beachievable
(2)moveyouclosertotheidealstate

BeingRealistic
Creatingamapthatreflectschangesthatcanberealistically
achievedonadefinedtimelineincludesconsiderationofthe
following:
1. Youhavethehumanresourcestomakethechangeshappen
2. Youhaveleadershipsupportoftheimprovement.(Where
doesthisworkfallinthestrategicplanoftheorganizationor
department?Whoowns itontheadministrativeteam?)
3. Youhavearealisticdateforexperimentingwithnewideas
andreflectingonchanges.
4. Youarerealisticinyourconsiderationofconstraints,suchas
costandotherinitiativesscheduledontheunit.

FutureState
fourmaintechniquestodesignyourfuture
state.JustrememberECSS!
Eliminate
Combine
Simplify
Sequence

FutureState
Wherepossible,trytoeliminateanyprocesssteps.
Ifitisntpossibletoeliminateanysteps,lookto
combinesteps.
Aftercombining,considerwherethesystemcanbe
simplified.
Oncestepsinthesystemhavebeenhavebeen
eliminated,combinedandsimplified,reviewthe
sequenceofeventstopromoteefficiency.

FutureState
Theaimistoproduceaservicewhereeachprocess
steplinksseamlesslytothenext,intheshortest
amountoftimeatthehighestqualityandsafetybya
groupofstaffwithahighmorale.
OncethefuturestateValueStreamMapis
completed,itisthenessentialtoreviewmeasures,
analyse thegapbetweencurrentandfuturestate
andthenagreeanactionplanofPDCAcyclestotrial
thechanges.
Beclearaboutthepurposebeforedesigningthe
process then,organizethepeople!

Standardworktoproducehighquality
everytime
Standardworkisaboutestablishingoutofallthe
possibleways,thebestworkmethodofconducting
ataskandthenensuringthateveryonealways
workstothisgoldstandard.
Thegoldstandardshouldhavetheleastamountof
waste,withthehighestqualityandsafety.These
standardprocedurescreatestabilityandconsistency
inthesystemtoproducehighperformanceresults
everytime.

threekeyelementstostandardised
work
Takttime howfastweshouldbeworking
Worksequence theorderthatworkshould
bedone
Workinprogress definingtheworking
inventorytomakeabnormalitiesobvious.

 Itisimportanttounderstandthatstandard
workisnotstatic.Standardsareactuallythe
basisforsubsequentimprovements.Oncea
bettermethodisfound,theteamshould
agreeonthenewstandard,updatethe
processes,proceduresandvisual
managementandthenensurethatitis
adoptedbyall.

Standardisedwork:
Ensuressafetyandmaintainshighqualityandefficiency
Ensuresprocessstabilityandthereforerepeatability
Allowsustoassessifweareincontrol,aheadorbehind
schedule
Preservestheorganisationalexpertise
Allowsustoidentifyandrectifyproblems
Providesagaugebywhichwecanerrorproofforthefuture
Givesusabaselinefromwhichtomeasureimprovementand
continuallystriveforabetterway
Providesabasisforemployeetraining.

Understandingtakttime
Takttimeissimplytherateatwhichweneed
toworktokeepupwithdemand.
Thecalculationfortakttimeis:
(available_work_time)/(demand)=TaktTime

Workedexample:
Ascanningdepartmentisopenandstaffedfor8hoursper
dayhasadailydemandof80referrals.
TaktTime =8hours/80=480minutes/80=6minutes
Everysixminutesapatientshouldmovethroughthescanning
process thisisthetakttime.
Thecycletimeisthetimeittakestoactuallydo thetaskand
theaimistomatch(wherepossible)takttime.
Ifthecycletimeisgoingtobeidenticaltoorlessthantakt, all
thenonvalueaddingactivitiesneedtoberemovedfrom
eachstep.Onlywhenthenonvalueaddingactivitieshave
beenremovedfromeachstepshouldadditionalresourcesbe
considered.