2. Your Instructor
Provides Lean transformation
support to non-manufacturing
settings.
Co-author, The Kaizen Event
Planner: Achieving Rapid
Improvement in Office, Service, and
Technical Settings
Co-Developer, Metrics-Based
Process Mapping: An Excel Solution
Lean Enterprise Program Instructor
University of California, San Diego
Karen Martin, Principle,
Karen Martin & Associates
2
16. Traditional vs. Lean Thinking
Traditional
Lean
Revenue-focused
Margin-focused
Improvement focus: optimizing value-added
work
Improvement focus: eliminating non-valueadded work
Fire fighting is rewarded
Fire prevention is rewarded
Focus on financial metrics & lagging
indicators
Focus on operational metrics & leading
indicators
Suboptimization is rewarded
Value stream performance is rewarded
Specialized workers organized by function
Cross-trained workers organized by value
streams
Complexity is the norm
Simplicity is the norm
Inspect in quality
Build in quality
Non-visual workplace / management
Visual workplace / management
Dynamic schedule and priorities
Static priorities and schedule
Unclear ownership & accountability
Clear ownership & accountability
Excessive reviews and approvals by
leadership
Decisions are made by those closest to the
work
Improvements identified by management
Improvements identified by workers
33. Value Stream Mapping Process
Products (good or services) with
common process steps
Document Current
State
Repeat
Define
Product Family
Foundation (the basis) for the
future state; 70-80% accurate is
acceptable (directionally correct)
Design Future
State
Create flow by eliminating waste
it is now obvious from your
current state map); typically 3-6
months out
Create
Implementation Plan
Implement!
3 Day
Event
Include accountability and
timeframes for completion
The goal of mapping!
34. Future State Value Stream Map
Outpatient Imaging Services
Standard
Work
Work
Balance
Customer Demand:
15 patients perDay
(Takt Time1920 seconds)
8 hours per day
Co-locate
Schedule appt
Pre-register
Referring
Physician
Hospital
3
Lead Time = 15 days
2
6
1
Lead Time = 45 mins.
Cycle Time = 11 mins.
Lead Time = 45 mins.
% C&A = 98 %
% C&A = 85 %
Risk
Reduction
(Joint
Commision)
Symposium
E Pay
Excel
Internet
Waiting Room
Management
System
Work
Balancing
Standard
Work
3
35 mins.
4
Cycle Time = 1 mins.
% C&A = 98 %
0.0833 hrs.
2
Complete
Exam
(Tech)
5
20 mins.
Cycle Time = 10 mins.
% C&A = 100 %
0.583 hrs.
1 mins.
2
Transmit
Images
(Tech)
6
5 mins.
Cycle Time = 10 mins.
% C&A = 90 %
0.333 hrs.
10 mins.
Visual
Workplace
Set-up
Reduction
Prep
Patient
(Tech)
Check-in
Patient
(Imaging)
Fax Order
Solutions
PACS
Auto Fax 80%
Us Mail 15%
MD Mailbox 5%
5S
Value Stream
Alignment
Pull System
(Supplies
Kanban)
Remove
Check in
and Reduce
System Access
5 mins.
Meditech
CT=Cycle Time
LT=Lead Time
%C&A=% Complete & Accurate
2
7
120 mins.
2
Review
Draft/Sign
(Radiologist)
420 mins.
Cycle Time = 15 mins.
% C&A = 95 %
2 hrs.
2 mins.
8
Batch
Reductions
Voice
Recognition
Read/Dictate
Exam
(Radiologist)
Cycle Time = 2 mins.
% C&A = 100 %
0.0833 hrs.
10 mins.
Continuous
Flow
2
Print
Reports
(Imaging)
9
2 mins.
Cycle Time = 1 mins.
% C&A = 95 %
7 hrs.
15 mins.
Rework Loop
via Fax 10% of
the time
2
30 mins.
Cycle Time = 1 mins.
% C&A = 99 %
0.0333 hrs.
1 mins.
10
Send
Reports
(Imaging)
6
0.5 hrs.
1 mins.
11
Cycle Time = 3 mins.
% C&A = 90 %
LT = 11.3 hrs.
3 mins.
CT = 43 mins.
CT/LT Ratio = 6.32%
Rolled First Pass
yield = 40%
35. Future State Implementation Plan
Value Stream Outpatient Imaging
Implementation Plan Review Dates
Executive Sponsor Allen Ward
11/1/2007
Value Stream Champion Sally McKinsey
11/21/2007
Value Stream Mapping Facilitator Dave Parks
12/13/2007
Date Created 10/18/2007
Block
#
2
Goal / Objective
Improve quality of referral
Improvement Activity
Type
KE
Implement standard work for referral
process
Owner
Sean O'Ryan
PROJ
1/10/2008
Implementation Schedule (weeks)
2 3 4 5 6 7 8 9 10 11 12
Dianne
Prichard
3, 4
Reduce lead time beween schedulingand
Cross-train and colocate work teams
preregistration steps
5, 6
Eliminate the need for two patient checkins
Collect copays in Imaging
KE
Michael
O'Shea
6
Eliminate bottleneck in waiting area
Balance work / level demand
KE
Dianne
Prichard
9
Eliminate lead time associated with
transcription step
Implement voice recognition technology
PROJ
Sam Parks
10
Eliminate batched reading
Reduce setup required
KE
Sam Parks
7
Reduce inventory costs, regulatory risk
and storage needs
5S CT supplies area; implement kanban
KE
Michael
O'Shea
12
Reduce delay in report delivery
Implement additional fax ports
PROJ
Martha Allen
12
Reduce delay in report delivery
Increase percentage of physicians
receiving electronic delivery (rather than
hard copy)
KE
1
Martha Allen
Approvals
Executive Sponsor
Value Stream Champion
Value Stream Mapping Facilitator
Signature:
Signature:
Signature:
Date:
Date:
Date:
Date
Complete
39. I.T.R. Project – A3 Report
METHODS
MACHINE
Multiple entry methods
no standard means
PEOPLE
IT access to equipment / user
1 stop shop ITR Form
call friend
fly by
Customer/user process traning
Inventory hard to manage
Support resources (not enough staff)
Only 8 techs to complete the work
Inconsistent work close-out activities
Manual processing / tracking
Inability to define specific needs
Lack of req'd product and
accounting info
Software installation takes too long to
complete and close out
Limited process tracking
Accessibility
Time until completion
(due dates, completion dates)
License procurement
Support resources
Work location
ENVIRONMENT
MEASURES
MATERIALS
39
41. Kaizen Event Charter
Event Scope
Value Stream
Leadership
Schedule
Executive Sponsor
Dates
Specific Conditions
Value Stream
Champion
Start & End
Times
Process Trigger
Facilitator
Location
Team Lead
Interim
Briefings
Event Name
First Step
Last Step
Event Boundaries &
Limitations
Workforce
Training
Event Coordinator
Event Drivers / Current State Issues
Final
Presentation
Team Members
Function
1
2
3
3
5
Contact Information
2
4
Name
1
4
Event Goals and Objectives
5
1
6
2
7
3
8
4
5
9
10
Potential Deliverables
On-Call Support
Function
1
2
2
4
Contact Information
1
3
Name
3
5
4
Possible Obstacles
1
Approvals
Executive Sponsor
Value Stream Champion
Facilitator
2
3
4
Signature:
Date:
Signature:
Date:
Signature:
Date:
46. Key Success Factors for
Achieving Results
Tenacity
Strategic improvement tied to business
goals
Value Stream Mapping
Dedicated resources
More on this in next month’s webinar
Heavy use of Kaizen Events initially
46
With the goal of maturing to “daily kaizen”
47. Learning Objectives
Participants will learn how to help your leadership
team understand their role in the improvement
process, including:
Setting improvement strategy
Roles & responsibilities of project sponsors and A3 coaches
“Letting go” of tactical decisions
Briefing attendance
Authorizing the frontline to make improvements
Modeling lean behaviors
Assumption – already familiar with principles and tools
47