Mapping the End to End Process

Lean Enterprise Academy www.leanuk.org

David BruntJune 6th 2006

Mapping the End-to-End Process

Lean in Healthcare


Objectives

To give an overview of Value Stream Mapping


The Essence of Lean Thinking

Where is the time in your value stream?

The physical patient flow?The information flows – patient lists & notes?

“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)


Value Stream Improvement & Process Improvement

Out Patients Pre-OpAssessment Procedure

CUSTOMER

RawMaterial

FinishedProduct

PROCESS PROCESS PROCESS

VALUE STREAM: All the steps, VA & NVA, required to bring the product from raw material to customer

Necessary but non value adding35%

Value adding5%

Non value adding60%




CUSTOMER

RawMaterial

FinishedProduct




Value adding5%

Non value adding60%

Focus of “traditional”efficiency improvements




CUSTOMER

RawMaterial

FinishedProduct




Value adding5%

Non value adding60%

Focus of LEANimprovement


Value Stream Mapping

Follow a product’s path from beginning to end and draw a visual representation of every process in the material & information flowsThen draw (using icons) a “future state” map of how value should flow

Helps us see flow

Hernia Current StateGP Practice

Lead Time = 65.5 daysProcess Time = 193 Min

5 Min 22 Min 32 Min

5 Min

7 Min

3 Weeks

70 Min

90 Min

20 Min

60 Min

12 Min

6 Weeks4 Weeks

Referral

OutPatient

Appoint-ment

Pre OpAssess-

ment

Admission(Day Case) Procedure Discharge Follow Up

National Choose & Book

Local BookingService

List 2 wksBefore

Appointment

18 Week target

Max 6 MonthsMax 13 Months

Patient

GetDate

Consultant Secretary

Letter to PatientLetter to GP &

Patient &Consultant

Letter to GP

Follow upDate

Daily List

Come In List

List 2 WeeksBefore

Appointment

Letter to GP

I I I I I I

ProcessBox

DataBox

Inventory

“Push”

C/T = 7 MinC/O = 0 min.Uptime = 100%2 Shifts27,000 sec av.


Using the Value StreamMapping Tool

Product Family

Current State Drawing

Future State Drawing

Work Plan

Understanding how the processes currently operate

Designing a lean flow

Deciding what to map


Deciding What to Map

The Glenday Sieve - A tool to helpImplement Every Product Every CycleIdentify product familiesRemove waste


The Glenday Sieve- first analysis

99%

95%

50%

Cumulative % Product Range

Cumulative % of Sales

Last 1%


The Glenday Sieve – second analysis

99%

95%

50%

Cumulative % Product Range

Cumulative % of Sales

Last 1%

Blue

Yellow

Green

ColourCode

Red


The Glenday Sieve & Value Stream MappingMap the “greens” because you want to make these flowWhich removes non value added wasteAsk questions about yellow, blue & red products

Can anything be done to include these in the “green stream?”


Focus on One Product Family

High volume low variety manufacturingDetermine product families via similar downstream “assembly” steps & equipment

“Every job is different” processesSieve & focus on tasks

Process Steps & Equipment

LH Steering Bracket

RH Steering Bracket

InstrumentPanel Brace

SeatRail

BumperBrackets

Electronic TestFixtures

AssyRobot Weld Flash Remove Paint Manual AssySpot Weld

X X XX

X X XX

XXX X

XX

XXX

Prod

ucts



Material & information flowsDraw using iconsStart with the “door to door” flowHave to walk the flow & get actuals

No standard timesDraw by hand, in pencil

Foundation for the Future State

Product Family


Future State Drawing

Work Plan

Understanding how the shopfloor & offices currently operate


“Healthcare” Data Set 1

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

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.



5 Min 22 Min 32 Min

5 Min

7 Min

3 Weeks

70 Min

90 Min

20 Min

60 Min

12 Min

6 Weeks4 Weeks

Referral

OutPatient

Appoint-ment

Pre OpAssess-

ment




List 2 wksBefore

Appointment

18 Week target


Patient

GetDate



Patient &Consultant

Letter to GP

Follow upDate

Daily List

Come In List

List 2 WeeksBefore

Appointment

Letter to GP


Analysis

Workshop Theme:Lean Workshop

Workshop No. Team Date:

Slide: Of:

Team Members: Dept:Process:


Future State Questions

What is the Takt Time?Will we build to shipping or to a supermarket?Where can we use continuous flowWhere 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 ImprovementsWhat process improvements will be necessary?(e.g. uptime, changeover & training)



5 Min 22 Min 32 Min

5 Min

7 Min

3 Weeks

70 Min

90 Min

20 Min

60 Min

12 Min

6 Weeks4 Weeks

Referral

OutPatient

Appoint-ment

Pre OpAssess-

ment




List 2 wksBefore

Appointment

18 Week target


Patient

GetDate



Patient &Consultant

Letter to GP

Follow upDate

Daily List

Come In List

List 2 WeeksBefore

Appointment

Letter to GP

I I I I I I

??

?

?

Green Stream Future StateGP Practice

Referral

OutPatient

Appoint-ment




List 2 wksBefore

Appointment

Patient

GetDate

Letter to GP &Patient &

ConsultantLetter to GP

X Days

F I F OX Mins

F I F OX Mins

F I F OX Days

F I F O

VisualUpfront Plan

ReduceVisits

BookFollow Up

BookAdmission

Green StreamFixed Plan

FilterPatients


A Plan to Get There

Don’t wait!To “manage the exceptions” you need a plan!

Tie it to your business objectivesBreak your Future State into “loops”Make a VS Plan: What to do by whenNow relate the Future State Map to your layoutValue Stream manager completes VS Review form in advanceConduct Value Stream reviews walking the flow

Implementation


Implementation via Point Kaizen

Process

PointKaizen

Eraser

Future State Map


David BruntJune 6th 2006

Mapping the End-to-End Process

Lean in Healthcare

Mapping the End to End Process

Education

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