Mapping The End-to-End Process: Lean in Healthcare

Mapping the
End-to-End Process
Lean in Healthcare
David Brunt
June 6th 2006
Lean Enterprise Academy
www.leanuk.org
Objectives
To
give an overview of
Value Stream Mapping
www.leanuk.org
The Essence of Lean

Thinking
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)
Where is the time in your value

stream?
The physical patient flow?

The information flows patient lists &
notes?
www.leanuk.org
Value Stream Improvement

& Process Improvement
PROCESS
Out Patients
PROCESS
Pre-Op
Assessment
PROCESS
Procedure
Raw
Material
Value adding
5%
CUSTOMER
Finished
Product
Non value adding
60%
Necessary but non value adding

35%
VALUE STREAM: All the steps, VA & NVA, required to bring the
product from raw material to customer
www.leanuk.org

PROCESS
PROCESS
Pre-Op
Assessment
Out Patients
Raw
Material
Value adding
5%
PROCESS
CUSTOMER
Procedure
Finished
Product
Focus of traditional
efficiency improvements
Non value adding
60%

35%
www.leanuk.org

PROCESS
Out Patients
PROCESS
Pre-Op
Assessment
PROCESS
Procedure
Focus of LEAN
Raw improvement
Finished
Product
Material
Value adding
5%
CUSTOMER
Non value adding

60%

35%
www.leanuk.org
Helps us see flow

Follow a products 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
www.leanuk.org
Hernia Current State
Patient
GP Practice
National
Choose & Book
Push
Letter to Patient
Get
Date
List 2 wks
Before
Appointment
Local Booking
Service
Process
Box
Referral
Letter to GP &
Patient &
Consultant
Letter to GP
Consultant
Secretary
Letter to GP
Inventory
Follow up
Come In List
Date
List 2 Weeks
Before
Appointment
Daily List
Out
Patient
Appointment
Pre Op
Assessment
Admission
(Day Case)
Procedure
Discharge
Follow Up
C/T = 7 Min
C/O = 0 min.
Uptime = 100%
4 Weeks
5 Min
Max 13 Months
22 Min
Data
Box
5 Min
3 Weeks
32 Min
2 Shifts
27,000 sec av.
7 Min
Max 6 Months
18 Week target
90 Min
60 Min
70 Min
6 Weeks
20 Min
12 Min
Lead Time
= 65.5 days
Process Time
= 193 Min
Using the Value Stream

Mapping Tool
Product Family
Deciding what to map
Current State Drawing
Understanding how the processes

currently operate
Future State Drawing
Designing a lean flow
Work Plan
www.leanuk.org
Deciding What to Map
The Glenday Sieve - A tool to help

Implement Every Product Every Cycle
Identify product families
Remove waste
www.leanuk.org
The Glenday Sieve

- first analysis
Cumulative % of
Sales
Cumulative %
Product Range
50%
95%
99%
Last 1%
www.leanuk.org
The Glenday Sieve

second analysis
Cumulative % of
Sales
Cumulative %
Product Range
Colour
Code
50%
Green
95%
Yellow
99%
Blue
Last 1%
Red
www.leanuk.org
The Glenday Sieve &

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?
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
Products
Spot Weld
Robot Weld
Flash Remove
Paint
Manual Assy
LH Steering Bracket
RH Steering Bracket
Instrument
Panel Brace
Seat
Rail
Bumper
Brackets
Fixtures
Assy
Electronic Test
X
X
X
www.leanuk.org

Understanding how the shop
floor & offices currently operate
Product Family
Future State Drawing
Material & information flows

Draw using icons
Start with the door to
door flow
Have to walk the flow & get
actuals
Work Plan
No standard times
Draw by hand, in pencil
Foundation for the

Future State
www.leanuk.org
Healthcare Data Set 1

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.
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
www.leanuk.org
Patient
GP Practice
National
Choose & Book
Letter to GP
Get
Date
List 2 wks
Before
Appointment
Local Booking
Service
Letter to GP &
Patient &
Consultant
Letter to Patient
Consultant
Secretary
Letter to GP
Follow up
Date
Come In List
List 2 Weeks
Before
Appointment
Daily List
Out
Patient
Appointment
Referral
4 Weeks
5 Min
Max 13 Months
Pre Op
Assessment
5 Min
22 Min
Admission
(Day Case)
3 Weeks
32 Min
Procedure
90 Min
7 Min
Max 6 Months
18 Week target
Discharge
60 Min
70 Min
Follow Up
6 Weeks
20 Min
12 Min
Lead Time
= 65.5 days
Process Time
= 193 Min
www.leanuk.org
Analysis
Workshop Theme:
Lean Workshop
Workshop No.
Team
Date:
Team Members: Dept:

Process:
Slide:
Of:
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)
www.leanuk.org
Patient
GP Practice
National
Choose & Book
Letter to GP
Get
Date
List 2 wks
Before
Appointment
Local Booking
Service
Letter to GP &
Patient &
Consultant
Letter to Patient
Consultant
Secretary
Letter to GP
Follow up
Date
Come In List
List 2 Weeks
Before
Appointment
Daily List
Referral
?
I
Out
Patient
Appointment
4 Weeks
5 Min
Max 13 Months
Pre Op
Assessment
5 Min
22 Min
Admission
(Day Case)
3 Weeks
32 Min
Procedure
90 Min
7 Min
Max 6 Months
18 Week target
Discharge
60 Min
70 Min
Follow Up
6 Weeks
20 Min
12 Min
Lead Time
= 65.5 days
Process Time
= 193 Min
Green Stream Future State
Patient
GP Practice
National
Choose & Book
Letter to GP &
Patient &
Consultant
Get
Date
Local Booking
Service
Filter
s
Patient
Referral
List 2 wks
Before
Appointment
Visual lan
tP
Upfron
Out
Patient
Appointment
Book n
io
Admiss
Green Stream
Fixed Plan
FIFO
X Days
Reduce
Visits
Letter to GP
Admission
(Day Case)
Book
Up
Follow
FIFO
X Mins
Procedure
FIFO
X Mins
Discharge
FIFO
X Days
Follow Up
A Plan to Get There

Implementation
Dont 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
www.leanuk.org
Implementation via Point

Kaizen
Eraser
Future State Map
Process
Point
Kaizen
www.leanuk.org
Mapping the
End-to-End Process
Lean in Healthcare
David Brunt
June 6th 2006
www.leanuk.org

Mapping The End-to-End Process: Lean in Healthcare

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Mapping the

Lean Enterprise Academy

The Essence of Lean

Where is the time in your value

The physical patient flow?

Lean Enterprise Academy

Value Stream Improvement

Necessary but non value adding

Value Stream Improvement

Necessary but non value adding

Value Stream Improvement

Non value adding

Necessary but non value adding

Helps us see flow

Follow a products path from beginning to end

Lean Enterprise Academy

Hernia Current State

Using the Value Stream

Deciding what to map

Current State Drawing

Understanding how the processes

Future State Drawing

Designing a lean flow

Lean Enterprise Academy

Deciding What to Map

The Glenday Sieve - A tool to help

Lean Enterprise Academy

The Glenday Sieve

Lean Enterprise Academy

The Glenday Sieve

Lean Enterprise Academy

The Glenday Sieve &

Can anything be done to include these

Lean Enterprise Academy

Focus on One Product Family

High volume low variety manufacturing

Determine product families via similar

Every job is different processes

Sieve & focus on tasks

Process Steps & Equipment

Lean Enterprise Academy

Current State Drawing

Current State Drawing

Future State Drawing

Material & information flows

Lean Enterprise Academy

Foundation for the

Healthcare Data Set 1

Demand (Green Stream)

Local Anesthetic Cystoscopy = 15%

General Anesthetic Cystoscopy = 11%

Hernia & VVS = 7%

LA Lumps & Bumps = 4%

Process Steps: Following referral from a GP the patient goes through

Out patient appointment

Lean Enterprise Academy

Hernia Current State

Lean Enterprise Academy

Team Members: Dept:

Lean Enterprise Academy

Future State Questions

What is the Takt Time?

Lean Enterprise Academy