In this post, I will provide you with an easy to follow guide in creating the first tool mentioned: a value stream map. Think of the value stream as the series of processes in which the patient derives value from your organization in order to fulfill a particular need.
1. Identify your value stream:
It’s likely the patient takes value from your operation in multiple ways. There are several obvious choices for those working in a large healthcare organization: cancer care, sports medicine, women’s health — all of these can be considered separate value streams.
2. Define Start & Stop Points:
Next, label appropriate start and stop points for your value stream. For example, when scheduling a surgery or procedure at a hospital, a start point to consider is the patient’s pre-procedure clinic visit. Some organizations might consider the patient’s arrival on the day of surgery as the start point, however, there are critical actions that take place in the pre-procedure clinic that help the day of surgery run more smoothly. In this example, a stop point is the patient’s discharge from the hospital post-surgery. Others may define the stop point at the first post-surgery follow-up visit. Identifying the start and stop points up front provides clear boundaries for the value stream map. This is critical so that everyone involved in helping you develop your value stream knows the scope of the team’s efforts.
3. Fill in High Level Processes:
Now that your start and stop points are defined, place up to five process steps in between the start and stop points. These high level steps will encompass several sub-processes under each step. For example, the surgery process mentioned above has several steps that make up the patient’s pre-procedure clinic visit. These detailed steps include: clinic check-in process, lab draw process, patient assessment/interview and the pre-surgery insurance verification process.
4. Add Sub-Process Detail:
In this step, you’ll add some detail to the sub-process steps. A good way to do this is through direct observation. Use a stopwatch to time how long it takes to complete each step and document all activity required to take the patient through the value stream.
5. Display Information and Material Flows:
There will also be different avenues for information to be passed to the user. For example, in-person, via email or over the telephone are all information flows you should identify. Distinguish between the different types and highlight any standard documents used to pass information on the value stream map. Similarly, there will be consumable material used in the value stream to treat the patient that will need to be restocked/replenished. Classify on the map how the materials are continuously supplied to the value stream and any systems in place to monitor inventory.
6. Categorize Process Activity as Value-Added or Non-Value Added:
Next, visually represent the value (and non-value) steps in your value stream. Label value-added steps with a green-outline and non-value added steps with a red-outline. This exercise makes clear the elements of the process that should be the focus of process improvement. There is a third category to consider as well: non-value added but required. Included in this category are elements of the process that don’t directly contribute to the value proposition of the value stream, but are required by the process because of regulations, accreditation or current form/function of the environment. These steps are labeled with a yellow-outline.
7. Label Waste in the Value Stream:
With the 8 Wastes of Lean, label each step that has a non-value added designation with the appropriate waste category. Accomplish this by using data collection tool to perform real-time observation looking for the non-value added steps (and corresponding wastes). Place an ‘other’ category on the tool to capture any unaccounted for waste in the process.