Value Stream Mapping

Chapter 2
 Value Stream
 The flow of physical items—patients, customers,
or materials—through a process
 The flow of information related to the flow of
patients, customers, or materials
 Value Stream Mapping
 Differs from “flow charting”
 Focuses on flow rather than steps
 Includes all important information associated
with the flow of the process
 Best mapping tool: pencil, paper, Post-its !
Expect to make lots of changes and corrections
during the VSM process.
 Flow can be span multiple departments, so VSM
might require a cross-departmental perspective
 VSM is a “systems” view of
the process.
 Gives a picture of the “whole” process.

 Emphasizes “flow” through the whole process.

 Seeks identification of key problems and places

in the process that delimit flow and causes other
sources of waste.
 Steps

 Define the process (inputs, outputs, level of detail)

 Select a “process owner” to lead the VSM effort
 Plan the event
 Form a process inspection team (kaizen team):
include everyone involved at all levels of the process
(especially workers in the process); include “outside
eyes” too.
Do a walkthrough of the process
at the workplace (Gemba)

• Start with the last step of the process and work

backward to the first step
• Observe the process, ask questions, take notes
 VSM workshop
Workshop: Meet to discuss findings, define and draw
the map, specify places needing more information, and
identify areas for potential improvement
Create value-stream map with
Post-its
Create value-stream map with
Post-its
 The map
 Focus on the patient, customer, or product from
beginning to end
 Whenever possible, use timed observations to
determine actual times
 Never map from memory, no matter how familiar
the process
 Everyone on the team must observe the process
steps together.
 The map (Cont.)

 Focus on one process at a time.

 E.g., if focus on patient flow through ED, do not map
flow of specimens to Lab (although indicate order,
transport of specimen, and receipt of results). If Lab is
bottleneck, identify it as opportunity for improvement
and the future target of a VSM.
 Draw the map as a team.
 Spaghetti Map

Develop the Current State Map on paper and using

post it notes as a team
Spaghetti Map (Cont.)
Standard VSM Symbols
 Value Stream Process Map
Example Production
Control
Sig RGC

1/d
Blank
1/w
I =1 Kanban
89374 Buffer
CT=9s 312
3K Assemble
0d SU=1800s I 312-2
0
=.5
UT=95% Test 0d
Lot=6K =1 CT=12s
SU=0
CT=20s Package
UT=100%
SU=480s 50% Less =1
Assembly
UT=95% Time CT=30s
SU=90s
One Step
Process UT=95%
Flow Test
50% Lot Kanban =.5
Pierce Clean Size Cut Buffer
I =1 II =1 Uptime 50% CT=12s
51104 Increased SU=0
50104
1/w CT=2s CT=4s
12K 0 Weld UT=100%
0d SU=2700s 0d SU=600s I =1
UT=95% UT=95% 51104-2 Vent
5K CT=38s Cell
Lot=3K Lot=3K
8d
SU=480s
UT=95% Floats
Blank One Step Vendor Buffer
Clean 91788
II =1 Process
I 91789
50603 I
LT=10d 50114
CT=3s
3.3K Inv=0d 2K 50% Lot
6d SU=3600s 4d Size Cut
UT=95%
50% Lot
Lot=6K Size Cut
 Identify Areas of Opportunity
Possible Waste: Sources of Non-value-added Operations
Delay (Waiting)
Waiting for bed assignments, treatment, discharge, diagnostics, supplies,
approvals, doctor, nurse, etc.
Over processing
Excessive paperwork, unnecessary tests, using IV when meds would suffice,
multiple bed moves, approvals needed for “sure” things, etc.
Inventory
Lab specimens awaiting analysis, ED patients awaiting a bed, patients awaiting
tests, excess supplies kept on hand “just in case”, etc.
Transportation
Transporting lab specimens, patients, medications, supplies
Motion
Searching for charts and supplies, nurses/patients/staff walking between
procedural steps
Over producing:
Mixing drugs in anticipation of demand; forcing patients into ICU beds when
unnecessary
Producing defects
Medication errors, wrong-site surgery, improper labeling of specimens, multiple
sticks for blood draws, injury caused by drugs or restraints, etc.
 Ideal Future State
 Future state VSM is a goal to be reached.
 Can be achieved only through a series of
improvement events (“kaizen blitzes”).
 Bias: want to get things done!
Start improvement efforts immediately upon
completing the VSM.
 Prepare a plan of action: set objectives, assign
responsibility, set dates, and get going.
 Modify Existing Process
Useful tools (discussed later)
 5S

 Visual Management

 Quick changeover

 Mistake-proofing (pokayoke)
 Value Stream Mapping
Loyola University Hospital

Process: Surgical Reprocessing (SRP) Area

SRP: Data gathering at the
gemba
SRP: Creating the VSM
from notes
SRP: Final Value Stream
Map
 Goal
Create maps of all main hospital
areas, then integrate maps into
an “enterprise-wide” map

Other areas
• Cancer
• Inpatient floors
• Radiology
• Pharmacy
• Rehabilitation