Thirty to forty percent of all activities in healthcare is wasteful. This results in errors, unnecessary testing, and increase cost.

1. Value Stream Mapping
in the Operating Room
Brian Ramos
Director of Practice Operations
Plexus Management Group, Inc.
© 2012

2. Let’s start at the end . . .
• What have you heard about LEAN?
• Is LEAN mean?
• Is it all about the bottom line?
© 2012

3. Lean in Healthcare
© 2012 N.B. List is not exhaustive

4. Reasons for Action
• Patients as Consumers
– Choice
• Quality & Safety
– Wide variation in quality measures and outcomes
across institutions and patient populations.
• Economic Environment
– Cannot sustain current health care cost structure.
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5. Reasons for Action
Source: USA Inc.: Red, White, and Very Blue, Forbes Magazine, February 24, 2011
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6. Core Principles
1. Respect for People
2. Continuous Improvement
3. Customers (i.e. patients)
define value
4. Based on the scientific
method
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7. Value Stream Mapping
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8. Value Stream Mapping Identifies Waste
Value Added Non-Value Added
Any activity that directly Any activity that consumes time or
contributes to satisfying the needs resources but does not add value.
of a customer.
© 2012

9. 8 Wastes in Healthcare (TIM P WOOD)
TRANSPORTING WAITING
Moving patients, specimens, equipment or Patients in a waiting room; waiting for lab
supplies on wheels results
INVENTORY OVERPROCESSING
Stock of medical or operational supplies, Asking patients for their information more
patients in beds, specimens waiting for analysis than once; ordering more labs than needed
MOTION OVERPRODUCING
People reaching, bending, searching for Creating forms “in case” you need them;
supplies, patients, other staff producing more labs than needed
PEOPLE POTENTIAL DEFECTS
Unused or untapped potential of our staff Wrong patient, wrong procedure, redraws
What are some examples of waste in your OR?
Source: Harvard Vanguard Medical Associates, Care Improvement System
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10. Examples of Waste
• Underutilized ORs • Wrong-site surgery accounts
for 13% of medical errors.
Source: injuryboard.com
• Waiting for:
– Surgeon
– Anesthesiologist
– Patient
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11. Measuring Success
• Balanced Scorecard
• Measurement intervals:
– Best: hourly
– Acceptable: daily
• Visually easy to identify
problem areas
• How to improve?
– Double the good.
– Half the bad.
Source: OR Manager, February 2011
© 2012

12. Success Story
Ambulatory Endoscopy Suite
• Staggered Patient Arrival Times Wait Time
RN Overtime Pay
• Gastroenterologist dictated note in Wait Time
EMR in procedure room Motion
• Increased through-put by 20% in each
procedure room. Revenue
• Maintained 99% patient satisfaction
scores on Press Ganey survey.
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13. Recommended Reading
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14. About the presenter
Brian Ramos is a senior healthcare management
professional who is passionate about eliminating waste
and lowering the cost of healthcare delivery systems.
Formally trained in Lean methodology, Brian has created
continuous improvement cultures in clinical and surgical
units at a large multi-site physician group practice using
the tools of kaizen events, value stream mapping, flow
Brian Ramos, MBA
Director of Practice Operations cells, standard work and Managing for Daily Improvement.
Plexus Management Group, Inc.
690 Canon Street | Suite 325
Westwood, MA 02090
bramos@plexusmg.com
ph. 781.407.7771 CME Disclosure & Attestation
The speaker attests that he does not have any real or apparent
Follow me:
@brianmramos financial relationships or commercial interests to disclose.
© 2012