Value Stream Mapping

& Lean Event

Education
 What Is a Value Stream?

Defines value from the customers

perspective
All of the actions and tasks, both value added
and non-value added, required to bring an
item (an idea, information, product or service)
from its inception through delivery.
These include actions to process information from
the customer and actions to transform the product
on its way to the customer.
Value streams vary in scope: reach beyond
the enterprise to single process size
 Lean Guiding Principles

VALU
E
VALUE
PERFECTIO STREA
N M

PULL FLOW
 What Flows Through the
Value Stream?
Products, information, or services flow
through a value stream
In manufacturing or distribution, materials are
what flow
In health services, patients are what flow
In office areas, information is what flows

In service areas, external customer needs flow
through the value stream

In administration, internal customer needs flow
through the value stream

In many cases, the item flowing in service or
administration is a document, an order, or a request
 Purpose of Value Stream
Mapping & Analysis
Develop a common understanding of the
current process
The relationship of process steps
A true picture of the process
Create a baseline to measure improvements
against
Define a vision of the future process

Establish common leadership objectives

Identify opportunities for improvement

Design an implementation plan for

improvements
If you cant describe what you are doing as a process,
you dont know what youre doing. W. Edwards Deming
Value of a Value Stream
Map
The Value Stream Map provides
visibility of the entire process
The process may cross functional
boundaries
Without the map, you may focus on
the wrong areas to try to improve
Sub-optimization may result
 Analyzing the Value Stream

Planning tool to optimize

results of eliminating waste

current state VSM future state VSM

Lean =
+ +
Basics
 Key Tool: The Charter
Project Information Process Purpose Problems/Case for Change

Leadership Participant/Process
Representatives Time
Executive Steering Process Owners:
Committee: XXX Quality
VP Dr. YYY
Dr. VP Team Members: Pt Sat
Dr. VP RN
Director RN- Primary nurse Cost
VP LVN
HUC Project Goals
ED tech
EVS
ED resident
Management Guidance: ED Reg
Bed Board
Floor nurse
IT (ad hoc)
Executive Sponsor:
VP Observers: (Outsiders & next PO)
TTTT
Co Facilitators: UUUU
XXX VVVV Project Time Frame
YYY
Lean Coach: Milestone/Date
ZZZ
Scoping Session #1
Scoping Session #2 sponsor meeting
Scoping Session # 3
All Team Prep Phone Con (1 hr, 11-noon)
Training day
VSM Vision & Implementation plan
Process Scope: Process Scope: In/Out Follow-up
Start/Stop
Working sessions
Start: In Scope:
14 day follow-up
30 day follow-up/Audit (25% of Action s done)
End: 60 Day follow-up/Audit (50% of Actions done)
Out of Scope: 90 Day follow-up/Audit (75% of Action s done)

Last Update: Charter Owner:

 Setting up and Scoping a Lean Value
Stream Mapping Project
Charter and other Pre-work
Roles for the VSM Team
Executive Sponsor
Process Owner
Lean Coach (Facilitator)
Workshop Participants
 Role of the Executive Sponsor

Owns the Charter!

Addresses necessary cross-functional involvement
Ensures appropriate participating in the workshop
(make sure the subject matter experts are freed up
full-time for the 3-day event, and part-time to
implement Action Items)
Serves as a proactive roadblock buster for the
project
Presents project status to leadership
Participates in:
Scoping
Workshop Kick-of
Leadership Panel
Project Reviews (30/60/90 day follow-up audits)
 Role of the Process Owner

Owns the Setup Tasks and Action Plan!

Leads VSM project from pre-scoping through implementation
Ensures action item pre-work is complete for scoping, workshop, and
reviews
During VSM event, takes over ownership during Action Item assignments
Responsible for project meeting scheduling, preparation, and minutes
Documents the implementation plan after the workshop and schedules
30-, 60-, and 90-day reviews
Drives implementation plan activities for completion of the project
Provides updates to Sponsor
Monitors post-workshop process performance seeking opportunities to
continuously improve and standardize work
 Role of Lean Coach

Coaches Process Owner in the application of

lean principles and tools
Leads project scoping while mentoring Process
Owner
Prepares Process Owner for workshop
Trains team and facilitates most of the
workshop activities, sometimes with the
Process Owner
Transfers lean skills to leaders and participants
Helps participants track and measure future
state improvements
Serves as the subject matter expert in driving
and institutionalizing lean throughout the
organization
 Role of Workshop Participants

Participate in the 3-day event as

Subject Matter Expert (SME) (full-time);
be the change agent for implementing
Action Items (part-time)
Representative staf as SME from each
area that touches the process
Staf who are well respected within their
area
Group of less than 15 is ideal
 Value Stream Process Steps
1. Prepare

2. Gather Data & Develop Current State

3. Develop Future State & Action Plan

4. Execute to Plan

5. Align
 Value Stream Process
Step 1 - Prepare
Gather Preparatory Information
Document the Case for Change
Define the Scope (start and end of process)
Identify the Requirements
Review/establish Measurements
Set Logistics for Event
Participants
Location
Materials
Meals/Refreshments
Etc.
 Value Stream Process
Step 2 - Gather Data (Develop Current
State)
Observe and gather data
Walk the value stream - see the actual work place
Follow and make notes about item and information flow
Gather data for each step in the flow
Trigger/done actual lead time output

Actual cycle time on time delivery staffing
Defect rate batch sizes overtime
Quality variations work in process

Map the flow of items

Map the flow of information
Add data and issues
 Value Stream Process
Step 3 Future State & Action Plans
Discuss the ideal state
Develop the future state map
Develop action plans & cadence tracking
Build draft time line for implementation

Communication & training as required

 Action Plan Template
Process Person Due
Step or Original Responsibl Dat Metrics and
# Function Problem Action Items e e Comments
1
2
3

4
5
6
7
8
9

10

11

12

13

14

15

16

17
 Value Stream Process
Step 4 Execute to Plan

Implement improvements
Conduct Workshops, events, projects, bursts per
implementation plan

Achieve value stream objectives

Create an environment of continuous

improvement
 Value Stream Process
Step 5 Align
Conduct Value Stream Alignment Meeting
Periodic basis (based on action plan schedule)

Agenda
Review event implementations & results
Review impact to value stream metrics (individual events and
overall)
Review next quarter events
Review changes in business environment
Communicate results
Update value stream as required
Update implementation plan as required
Address resistance and sustainment issues
 Value Stream Process
Additional Tips for Success
Capture as you go:
Issues
Acronyms / terminology
Parking Lot issues
Action items
Establish a time each day for Leadership to visit the workshop
Status update
Ask questions
Barrier busting
Capture at the end of each day:
Lessons Learned
Agenda for next day
Champion summarization for Leadership at end of each day (email):
Team accomplishments for the day
Agenda for next day
 Customer Need:
Stapled pages
A Simple Example
Info: Location of stapler Info: Where to place staple

Pick Up Paper Walk to Stapler Staple Paper

Time: 1 sec. Time: 5 sec. Time: 2 sec.

Distance: 0 Distance: 20 ft. Distance: 0

Excess Travel

Walk to Desk Put Down Paper

Total Time: 14 sec.
Total Dist: 40 ft.
Time: 5 sec. Time: 1 sec.
Value Added Time: 4 sec.
Distance: 20 ft. Distance: 0
Value Added Dist: 0

Value Added Time: 28%

 Emergency Room Current
State
Treatment
Information

Attending Patient history Attending Insurance

Hospital
Patient Nurse Vital Statistics Physician Company
Records
Treatment
Information

Information Flow
Insurance Info
Nature of Injury
Available Room Patient ready
for Treatment
Diagnosis &
Patient history Supply Needs
Patient history
Vital Statistics
Patient Info Patient history
Vital Statistics
Diagnosis & Departing
Departing Inst. Instructions
Material Flow
Wait Wait Wait Wait Wait Wait
Out Patient Go to Nurse Doctor Nurse brings
Taken to ER Doctor Treats Departing Patient Goes
Waiting Examines Examines Medical
Registration Room Patient Instructions Home
Area Patient Patient Supplies
 Emergency Room Current
State Add data for Material and Information Flows
Treatment
Information
Attending Attending Insurance
Hospital Patient his tory
Patient Nurse Vital Statistics Physician Company
Records
Treatment
Information
Patient history
Vital Statistics
Information Flow
Insurance Info
Nature of Injury
Available Room Patient ready
for Treatment
Diagnosis &
Patient history Supply Needs
Patient history
Vital Statistics
Patient Info Patient history
Vital Statistics
Diagnosis & Departing
Departing Inst. Instructions
Material Flow
Wait Wait Wait Wait Wait
Go to Nurse Doctor Nurse brings
Out Patient Taken to ER Doctor Treats Departing Patient Goes
Waiting Examines Examines Medical
Registration Room Patient Instructions Home
Area Patient Patient Supplies
MAT'L FLOW MAT'L FLOW M AT'L FLOW M AT'L FLOW MAT'L FLOW MAT'L FLOW MAT'L FLOW M AT'L FLOW
Trigger: Trigger: Trigger: Trigger: Trigger: Trigger: Trigger: Trigger:
Done: Done: Done: Done: Done: Done: Done: Done:
Yield: Yield: Yield: Yield: Yield: Yield: Yield: Yield:
Flow Time: Flow Time: Flow Time: Flow Time: Flow Time: Flow Time: Flow Time: Flow Time:
MCT: MCT: MCT: MCT: MCT: MCT: MCT: MCT:
Queue Time: Queue Time: Queue Time: Queue Time: Queue Time: Queue Time: Queue Time: Queue Time:
# of People: # of People: # of People: # of People: # of People: # of People: # of People: # of People:

INFO FLOW INFO FLOW INFO FLOW INFO FLOW INFO FLOW INFO FLOW INFO FLOW INFO FLOW
From/To: From/To: From/To: From/To: From/To: From/To: From/To: From/To:
Frequency: Frequency: Frequency: Frequency: Frequency: Frequency: Frequency: Frequency:
Yield Rate: Yield Rate: Yield Rate: Yield Rate: Yield Rate: Yield Rate: Yield Rate: Yield Rate:
Queue Time: Queue Time: Queue Time: Queue Time: Queue Time: Queue Time: Queue Time: Queue Time:
FTE's: FTE's: FTE's: FTE's: FTE's: FTE's: FTE's: FTE's:
TCT: TCT: TCT: TCT: TCT: TCT: TCT: TCT:
MCT: MCT: MCT: MCT: MCT: MCT: MCT: MCT: INFORMATION FLOW

0 30-60 5 30-120 30 0 15-30 Queue = 125-275 min

15-30 0 5 0 5 0 10-15 0 10-15 0 0 15-30 15-30 0 5 Touch =70-110 min
0 0 0 0 0 5 0 0 Total Cycle Time = 3.4 to 6.3 hrs
Touch Time = 1.2 to 1.8 hrs
MATERIAL FLOW Queue Time = 2.0 to 4.5 hrs
9 Process Steps
6 Wait Points
Remember
The Value Stream Map is a plan
Helps you get from the current state to the
future state
A good plan creates the opportunity for
success even if you cant see the path to
get there
 Pre-Transplant Current Value Stream Map

Undesirable
Effects (UDEs)

Total Leadtime: 270 days (ave.)

VSM
Example

Used with permission from UM Health System

 Pre-Transplant Future Value Stream Map

Kaizen Bursts
(changes to Flow)

Total Leadtime: <<90 days (ave.)

67%

Used with permission from UM Health System

Types of Lean
Events
Value Stream

5S Kaizen Project Do-it Burst

Kaizen event
3-5 days
Scope significant - can be cross-functional
6-12 people or more
Quick impact
80% of improvements implemented during
event
20% of improvements implemented within 30
days
Implementation per prior management
agreement
 Typical Kaizen Schedule
Day 1 Training
Day 2 Analyze Current Process
Day 3 Define New Process
Day 4 Test & Finalize New Process
Day 5 Report Out & Celebrate

Some of these days may be reduced to hours, depending

on the scope of the efort
Burst Event
Short duration (2-4 hours)
Minimal scope/Single issue
4-6 people
Quick impact
Intended for relatively simple tasks
Do-It
Very short duration (1-2 hours)
Simple scope/Single task
1-3 people
Immediate impact
No decisions or management
intervention required
Project
Long duration (3-12 months)
Complex scope
Multiple departments/functions
Long-term impact
5S
Typically a 3-5 day event
Provides workplace organization
6-12 people
Provides framework for monitoring
& continuous improvement
 How do we know which
event type to use?
Type of activity
Scope of process/task
Resources required

Dont worry about fitting the event type

into a specific category
Keys to Successful Events
Have the right people in the room
Empower the team to make immediate
changes to the process
Full participation from all team members
Attack process, not people
Agree on measures and how they will be
collected
Review action plan frequently for progress
Questions?