1. Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement Ch. 4 Observing the Process and Value Streams
Presented by Dr. Joan Burtner
Certified Quality Engineer
Associate Professor and Chair
Dept. of Industrial Engineering and Industrial Management

2. Value Stream Map (VSM) Introduction
Womack and Jones Lean Thinking , 2003
Value stream: the set of all specific actions required to bring a specific product (good or service) through the three critical management tasks of any business.
Three management tasks
Problem solving
Information management
Physical transformation
Rother and Shook Learning to See 1999, 2003
Detailed construction of current state and future state maps for manufacturing
Mapping icons that are in standard use in manufacturing and service industries today
IDM ISE ETM 2017
Dr. Joan Burtner, Assoc. Prof. of Industrial Engineering

3. Creating a Value Stream Map
Cross functional team of people
Time commitment
One or two days for a limited-scope VSM
Full week for a full patient journey VSM
Content
Processes and their flow
Time elements
Within process steps
Between process steps
Shared understanding as a result of creating the VSM
IDM ISE ETM 2017
Dr. Joan Burtner, Assoc. Prof. of Industrial Engineering

4. Current State Map vs. Future State Map
Current State Map: The way the process “is”
First step in process
Little value by itself
Used to drive or prioritize improvements
Future State Map: The way the process would be if redesigned well
Fewer process steps
Shorter wait times
Less complexity in the information flow
IDM ISE ETM 2017
Dr. Joan Burtner, Assoc. Prof. of Industrial Engineering

5. Observing the Process Perspective Opportunities Tools
View the process from the perspective of the patient
View the process from the perspective of the employee
Opportunities
Small kaizen – quick process improvement changes
Insight into obstacles other people face
Tools
Digital watch
Digital camera
Video camera with time/date stamp
Specialized software
Time study apps
IDM ISE ETM 2017
Dr. Joan Burtner, Assoc. Prof. of Industrial Engineering

6. Lean Lessons (pages 91 and 92)
Managers have to go and see where the work is actually done, as observation can help identify waste.
It is not enough for each department to be great; the pieces have to work together as a whole (the value stream and system).
VSMs must be used to drive improvement; documenting the current state is not enough. Starting by designing a future state can cause other problems.
Process maps are usually more detailed and limited in scope compared to a VSM.
It is important to observe products (including patients) and employees as they move (or don’t move) in the process.
The observation and mapping should be done by those who do the work and their leaders, facilitated by an expert as needed, as opposed to being done by the expert. Outside eyes and a fresh perspective can be helpful as well.
Walking and wasted motion are due to poor physical layouts and system design, not individuals being inefficient.
IDM ISE ETM 2017
Dr. Joan Burtner, Assoc. Prof. of Industrial Engineering