We Completed Our Value Stream Map.  Now What?

Posted on Posted in Lean Tools

For many, the Value Stream Map is a visual representation of any lean effort.  It displays the flow that a patient follows through various processes in a healthcare organization in order to receive medical care.

A complete value stream map is going to show:

  1. The patient’s flow through the entire value stream for a specific care episode
  2. The detail in sub-processes that make up each high-level process step
  3. The 8 Wastes of Lean
  4. Identified value-added and non-value added make up

But what do you do with the value stream map after it is complete?

First, create a future state value stream map that represents what the patient will experience once all wastes have been removed from the system.  This is a road map, of sorts, that’ll provide the team with a vision for the future.  When the team encounters the inevitable challenges that will arise within their change effort, the future state value stream map will keep them grounded in a common purpose to create a better patient experience.

The challenge lies in creating a future state that is not limited by the realities of the current environment in which the value stream operates today.  It can happen so easily that we might place assumptions on what will or will not be in place in the future because of past experience that influences this design process.  I can recall one team in particular where their value stream map went from 7 high-level process steps down to 3 high-level process steps in the future state.  This was where they ended up, but it wasn’t where they started.  In actuality, their first attempt at creating a future state value stream map was a 5 step high-level process map that had embedded certain systematic-limitations that were not outside of the scope of the team to address.

When creating the future state value stream map, identify someone in the group who will approach the exercise with a point of view of someone specifically looking to challenge assumptions that might be embedded in the future state.  This person will look for ways in which the future state is painting too limited of a picture.

Second, prioritize the pieces of the current value stream to be modified in order to achieve  the desired future state value stream map.  Using a prioritization method, have the team collectively decide which items are most critical and impactful to achieving the future state.

At the same time, the team will want to identify those items that will build the maximum amount of momentum quickly.  One tool that can help the team achieve this end is the prioritization matrix.  After all wastes and issues within the value stream have been identified, having the team plot them on a matrix consisting of impact on the vertical and ease of addressing on the horizontal will provide the team with a powerful visual.  This visual will drive the teams’ initial focus.


A word of caution here:  not everything can be the most impactful and the easiest to implement.   Be certain to allow more than enough time for the team to complete this exercise, and then allow some more time for discussion and challenging assumptions that may have been made.  Challenge the team on having too many items placed in the high-impact/high-ease quadrant.  This should be the first place the team looks to for quick wins.

Third, develop an action plan for the team to execute over the next 30, 60 and 90 days.  This will be the living document that keeps rack of the team’s progress towards the future state.  A basic what, who and when format will suffice.

Before completing the action plan, something for the team to consider is what method of improvement they may take to tackle some of the items identified by the team as critical and impactful to achieving the future state.  There are number of ways to get this information from the team.  One way I’ve seen work in the past is considering a matrix like the one below.


Using this matrix , the team considers two characteristics about the change needed:

  1. Certainty of the solution needed (do we know what needs to be done), and
  2. Complexity of the change needed (is this something that will be easily bought-into by stakeholders).

With the method to achieve the change identified, more detail can be given to action items that need to take place in order to move the effort forward and the team can begin tracking progress towards their defined future state.