Value stream mapping has been used for decades in other industries but has only more recently become a familiar tool in healthcare settings. This article explores value-stream mapping as part of lean methodology to identify sources of waste and inefficiencies in processes specific to healthcare.
Table of Contents
- What is Value-Stream Mapping?
- How to Create a Value-Stream Map
- Interpreting your Value-Stream Map
- Related Lean Tools
- Successful Applications of Lean Tools/Methods in Healthcare Settings
What is Value-Stream Mapping?
Value stream mapping is "a lean-management method for analyzing the current state and designing a future state for the series of events that take a product or service from its beginning through to the customer." It is a graphical representation (such as the image above) designed to document a process. Value refers to those activities that are important from a customer or client perspective (see a related article on What is Value-Based Care?)
Examples of value streams in health care include the process from hospital admission to discharge; the surgical process from referral to date of surgery, etc. It is important, however, to view the entire value-stream as a system of processes rather than as individual discrete processes, since the components are inter-related and can have both upstream and downstream impacts on process components. Value-stream mapping exercises could be conducted within a rapid improvement or kaizen event. More information about planning and running a kaizen event is available here.
It is important to actually observe or walk the process in order to accurately document the steps and information flows involved. Quality improvement methodologies including the Model for Improvement, and various lean techniques can be utilzed to assess problems, identify new processes and eliminate waste within healthcare systems. Lean manufacturing tools aim to eliminate waste, simplify systems, and create flow. Manufacturing companies like Toyota first adapted the technique but hospitals have been saving money by applying it to healthcare systems for a number of years.
Lean process defines the 7 wastes of inefficient systems as:
- Producing products too early or too much,
- Value not being added to inventory,
- People/parts waiting for the work cycle to be completed,
- Unnecessary movement of people, parts or machines,
- Unnecessary transportation,
- Repetition or correction process not done right the first time, and
- Over-processing beyond the standard required by the customer.3
How to Create a Value-Stream Map
The following steps may be useful in value-stream mapping exercises:
- Determine what product or process your organization wishes to map (e.g., patient discharge, use of specific supplies or equipment, etc);
- Select symbols to represent different aspects of the product/process;
- Bound the process with discrete start and end points (these become the first boxes on your diagram);
- Identify the process steps or various operations that are performed;
- Add information/data flows to your process steps (e.g., referral forms);
- Collect process data for each step (e.g., inventory, cycle time, number of FTEs involved) and add metrics (try to avoid using historical data, but rather focus on real-time measures where possible);
- Perform inventory counts for each process step; inventory and overproduction are common forms of waste in systems (e.g., ordering and stockpiling excess medical supplies);
- Create a timeline for process and inventory times and use it to calculate a total lean time
The image below shows some of the commonly used symbols in value-stream mapping exercises:
Another good resource that includes details on symbol use and types in creating process maps with links to relevant videos is accessible here: Value-Stream Mapping.
Interpreting Your Value-Stream Map
The value stream map will help you to identify waste within your processes that does not add value to the client, customer or patient. Problems such as excess inventory, long cycle times, excessive setup times, poor quality and re-work can be identified. Categorizing each step as either value-add, non-value-add, or non-value add but necessary/essential will help identify some of these problems. Engaging the right people in the process can also enable a fresh perspective on where your process is value-add and where it isn't (e.g., patients, families, external vendors, etc).
Related Lean Tools
Some of many lean process tools that can eliminate waste in healthcare systems and yield financial gains while improving care for patients include:
Heijunka is a Japanese word that means “levelling.” When implemented correctly, heijunka elegantly—and without haste—helps organizations meet demand while reducing while reducing wastes in production and interpersonal processes.
In healthcare, 5S is used to enhance the quality of care for patients by reducing a common time-waster for staff—looking for supplies and equipment.
Proclaimed as the most effective method of reducing supply costs for hospitals, standardization is said to promote quality patient care at a cost effective price. Using the data from our research, we are proposing a formal definition of standardization for the healthcare industry in order to unify the perception of all key stakeholders.
Kanban is a visual method whose purpose is to ensure that you only produce what the customer is asking for and nothing more. It is a system of signals that is used through the value stream to pull product from customer demand back to raw materials.
Jidoka is the often forgotten pillar of the Toyota Production system and lean manufacturing yet it is one of the most important principles of lean that can help you achieve true excellence.
Poka Yoke or Mistake proofing is a simple technique that developed out of the Toyota Production system through Jidoka and Autonomation.
A PICK Chart is a very effective visual tool for organizing ideas. It is used to categorize process improvement ideas using Lean Six Sigma. The purpose of the PICK Chart is to help identify the most useful ideas.
FMEA is a step-by-step approach for identifying all possible failures in a design, a manufacturing or assembly process, or a product or service.
Kaizen events are short duration improvement projects with a specific aim for improvement; typically they are week long events led by a facilitator with the implementation team being predominantly members of the area in which the kaizen event is being conducted plus a few additional people from support areas and even management.
- Design (concept to customer)
- Build (order to delivery)
- Sustain (in-use through life cycle to service)
Successful Applications of Lean Tools/Methods in Healthcare Settings
After only two years of using lean process, Virginia Mason Medical Centre saved $12-15 million dollars of their budgeted capital, halved their inventory, reduced staff walking distances and time by 38%, and more, including the Toyota Production System at the Virginia Mason Medical Center. In its everyday healthcare operations, Florida Hospital Orlando increased patient admission rates, decreased patient length of stay, saved $5.3 million dollars and increased patient satisfaction by 10%.
Lean process aids in delivering just the required amount of supplies and service through fully understanding what the needs are and eliminating obscurity within the system. Lean process allows healthcare organizations to better care for patient needs while simultaneously reducing unnecessary expenditures.
Other example case studies where organizations have succesfully achieved fiscal efficiency and improved patient care using QI methods include Partners HealthCare, Bellin Health and Christiana Health Care. St. Joseph's Healthcare successfully used process mapping techniques as part of their Integrated Comprehensive Care Project.