Mapping the End to End Process
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The document discusses value stream mapping (VSM) for healthcare processes. It provides an overview of VSM and its objectives to visualize and improve material and information flows. An example VSM is shown mapping the process for hernia patients from referral to follow up. The VSM identifies opportunities to reduce waste, including lead times, and implement a more efficient "green stream" future state with continuous flow and pull systems. Implementation involves breaking the future state into loops and conducting point kaizen events to iteratively achieve the target state.
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Mapping the End to End Process
- 1. Lean Enterprise Academy www.leanuk.org David Brunt June 6th 2006 Mapping the End-to-End Process Lean in Healthcare
- 2. Lean Enterprise Academy www.leanuk.org Objectives To give an overview of Value Stream Mapping
- 3. Lean Enterprise Academy www.leanuk.org The Essence of Lean Thinking Where is the time in your value stream? The physical patient flow? The information flows – patient lists & notes? “All we are doing is looking at the time line - from the moment the customer gives us an order to the point where we collect the cash. And we are reducing that time line by removing the non-value-added wastes” Ohno (1988-ix)
- 4. Lean Enterprise Academy www.leanuk.org Value Stream Improvement & Process Improvement Out Patients Pre-Op Assessment Procedure CUSTOMER Raw Material Finished Product PROCESS PROCESS PROCESS VALUE STREAM: All the steps, VA & NVA, required to bring the product from raw material to customer Necessary but non value adding 35% Value adding 5% Non value adding 60%
- 5. Lean Enterprise Academy www.leanuk.org Out Patients Pre-Op Assessment Procedure Value Stream Improvement & Process Improvement CUSTOMER Raw Material Finished Product PROCESS PROCESS PROCESS VALUE STREAM: All the steps, VA & NVA, required to bring the product from raw material to customer Necessary but non value adding 35% Value adding 5% Non value adding 60% Focus of “traditional” efficiency improvements
- 6. Lean Enterprise Academy www.leanuk.org Out Patients Pre-Op Assessment Procedure Value Stream Improvement & Process Improvement CUSTOMER Raw Material Finished Product PROCESS PROCESS PROCESS VALUE STREAM: All the steps, VA & NVA, required to bring the product from raw material to customer Necessary but non value adding 35% Value adding 5% Non value adding 60% Focus of LEAN improvement
- 7. Lean Enterprise Academy www.leanuk.org Value Stream Mapping Follow a product’s path from beginning to end and draw a visual representation of every process in the material & information flows Then draw (using icons) a “future state” map of how value should flow Helps us see flow
- 8. Hernia Current State GP Practice Lead Time = 65.5 days Process Time = 193 Min 5 Min 22 Min 32 Min 5 Min 7 Min 3 Weeks 70 Min 90 Min 20 Min 60 Min 12 Min 6 Weeks4 Weeks Referral Out Patient Appoint- ment Pre Op Assess- ment Admission (Day Case) Procedure Discharge Follow Up National Choose & Book Local Booking Service List 2 wks Before Appointment 18 Week target Max 6 MonthsMax 13 Months Patient Get Date Consultant Secretary Letter to Patient Letter to GP & Patient & Consultant Letter to GP Follow up Date Daily List Come In List List 2 Weeks Before Appointment Letter to GP I I I I I I Process Box Data Box Inventory “Push” C/T = 7 Min C/O = 0 min. Uptime = 100% 2 Shifts 27,000 sec av.
- 9. Lean Enterprise Academy www.leanuk.org Using the Value Stream Mapping Tool Product Family Current State Drawing Future State Drawing Work Plan Understanding how the processes currently operate Designing a lean flow Deciding what to map
- 10. Lean Enterprise Academy www.leanuk.org Deciding What to Map The Glenday Sieve - A tool to help Implement Every Product Every Cycle Identify product families Remove waste
- 11. Lean Enterprise Academy www.leanuk.org The Glenday Sieve - first analysis 99% 95% 50% Cumulative % Product Range Cumulative % of Sales Last 1%
- 12. Lean Enterprise Academy www.leanuk.org The Glenday Sieve – second analysis 99% 95% 50% Cumulative % Product Range Cumulative % of Sales Last 1% Blue Yellow Green Colour Code Red
- 13. Lean Enterprise Academy www.leanuk.org The Glenday Sieve & Value Stream Mapping Map the “greens” because you want to make these flow Which removes non value added waste Ask questions about yellow, blue & red products Can anything be done to include these in the “green stream?”
- 14. Lean Enterprise Academy www.leanuk.org Focus on One Product Family High volume low variety manufacturing Determine product families via similar downstream “assembly” steps & equipment “Every job is different” processes Sieve & focus on tasks Process Steps & Equipment LH Steering Bracket RH Steering Bracket Instrument Panel Brace Seat Rail Bumper Brackets Electronic Test Fixtures Assy Robot Weld Flash Remove Paint Manual AssySpot Weld X X XX X X XX XXX X XX XXX Products
- 15. Lean Enterprise Academy www.leanuk.org Current State Drawing Material & information flows Draw using icons Start with the “door to door” flow Have to walk the flow & get actuals No standard times Draw by hand, in pencil Foundation for the Future State Product Family Current State Drawing Future State Drawing Work Plan Understanding how the shop floor & offices currently operate
- 16. Lean Enterprise Academy www.leanuk.org “Healthcare” Data Set 1 Demand (Green Stream) Local Anesthetic Cystoscopy = 15% General Anesthetic Cystoscopy = 11% Hips/Knees Arthroscopy = 9% Hernia & VVS = 7% LA Lumps & Bumps = 4% Lower GI Endoscopy = 3% Carpal Tunnel = 3% Process Steps: Following referral from a GP the patient goes through the following steps: Out patient appointment Pre-Operation Assessment Admission The Procedure Discharge Follow Up Acme Healthcare Trust has a number of sites. The case concerns an Elective only site. Analysis of the Green Stream shows that 5% of procedures account for 50% of demand.
- 17. Hernia Current State GP Practice Lead Time = 65.5 days Process Time = 193 Min 5 Min 22 Min 32 Min 5 Min 7 Min 3 Weeks 70 Min 90 Min 20 Min 60 Min 12 Min 6 Weeks4 Weeks Referral Out Patient Appoint- ment Pre Op Assess- ment Admission (Day Case) Procedure Discharge Follow Up National Choose & Book Local Booking Service List 2 wks Before Appointment 18 Week target Max 6 MonthsMax 13 Months Patient Get Date Consultant Secretary Letter to Patient Letter to GP & Patient & Consultant Letter to GP Follow up Date Daily List Come In List List 2 Weeks Before Appointment Letter to GP
- 18. Lean Enterprise Academy www.leanuk.org
- 19. Lean Enterprise Academy www.leanuk.org Analysis Workshop Theme: Lean Workshop Workshop No. Team Date: Slide: Of: Team Members: Dept: Process:
- 20. Lean Enterprise Academy www.leanuk.org Future State Questions What is the Takt Time? Will we build to shipping or to a supermarket? Where can we use continuous flow Where do we have to use supermarket pull systems? At what single point in the production chain do we trigger production? How do we level the production mix at the pacemaker process? What increment of work will we release and take away at the pacemaker process? (levelling the volume) Supporting Improvements What process improvements will be necessary? (e.g. uptime, changeover & training)
- 21. Hernia Current State GP Practice Lead Time = 65.5 days Process Time = 193 Min 5 Min 22 Min 32 Min 5 Min 7 Min 3 Weeks 70 Min 90 Min 20 Min 60 Min 12 Min 6 Weeks4 Weeks Referral Out Patient Appoint- ment Pre Op Assess- ment Admission (Day Case) Procedure Discharge Follow Up National Choose & Book Local Booking Service List 2 wks Before Appointment 18 Week target Max 6 MonthsMax 13 Months Patient Get Date Consultant Secretary Letter to Patient Letter to GP & Patient & Consultant Letter to GP Follow up Date Daily List Come In List List 2 Weeks Before Appointment Letter to GP I I I I I I ? ? ? ?
- 22. Green Stream Future State GP Practice Referral Out Patient Appoint- ment Admission (Day Case) Procedure Discharge Follow Up National Choose & Book Local Booking Service List 2 wks Before Appointment Patient Get Date Letter to GP & Patient & Consultant Letter to GP X Days F I F O X Mins F I F O X Mins F I F O X Days F I F O Visual Upfront Plan Reduce Visits Book Follow Up Book Admission Green Stream Fixed Plan Filter Patients
- 23. Lean Enterprise Academy www.leanuk.org A Plan to Get There Don’t wait! To “manage the exceptions” you need a plan! Tie it to your business objectives Break your Future State into “loops” Make a VS Plan: What to do by when Now relate the Future State Map to your layout Value Stream manager completes VS Review form in advance Conduct Value Stream reviews walking the flow Implementation
- 24. Lean Enterprise Academy www.leanuk.org Implementation via Point Kaizen Process Point Kaizen Eraser Future State Map
- 25. Lean Enterprise Academy www.leanuk.org David Brunt June 6th 2006 Mapping the End-to-End Process Lean in Healthcare