Mapping Clinical Value Streams

117 Pages·2013·5.299 MB·English

by  Thomas L. Jackson

Healthcare Management / Process Improvement R
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Mapping Clinical Value Streams
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Rona Consulting Group & Productivity Press
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Thomas L. Jackson g

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Tens of thousands of patients die unnecessarily every year as a result of errors and defects in our healthcare
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processes. Those that survive often pay too much for the privilege. The value stream mapping methods c
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described in Mapping Clinical Value Streams will help you achieve more efficient healthcare processes o
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and will pave the way to an improved medical system with significantly reduced medical errors and other
costly waste.
Rona Consulting Group & Productivity Press
Part of the Lean Tools in Healthcare series, this user-friendly book will help you understand how to use
Thomas L. Jackson
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value stream mapping to provide quality, patient-centered care. Value stream mapping is a powerful tool
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for observing and depicting processes as they truly are—and for envisioning and reconfiguring the same
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processes to eliminate errors and other waste. With this book, you’ll learn how to: p
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• Map current-state processes
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• Create a future-state map with processes streamlined through “flow” and “pull” C
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• Manage the rollout of your future state with “A3” project plans
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Presented in a highly organized and easy-to-assimilate format, the book includes examples from actual
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healthcare processes, plus numerous illustrations and margin assists that call your attention to key points. l

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Value stream mapping icons make it easy to see and understand the ebb and flow of healthcare processes.
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Each chapter also includes a summary for quick review. Throughout the book you will be asked to reflect on l
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questions that will help you apply these concepts and techniques to your own workplace. e

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To be competitive in today’s marketplace, you cannot afford to leave processes unexamined, or to let them t
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become haphazard. You must apply conscious, quality attention to continuously see and fix your healthcare
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processes. In Mapping Clinical Value Streams, Shingo Prize-winning author Thomas L. Jackson shows
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you how.
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K15189
ISBN: 978-1-4665-5184-8
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www.crcpress.com
9 781466 551848
www.productivitypress.com
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Mapping Clinical
Value Streams
Lean Tools for Healthcare Series
Series Editor: Thomas L. Jackson
Mapping Clinical
PubLiSHed
5S for Healthcare
Value Streams
Standard Work for Lean Healthcare
Kaizen Workshops for Lean Healthcare
Mapping Clinical Value Streams
forTHcoming
Just-in-Time for Healthcare
Mistake Proofing for Lean Healthcare
Rona Consulting Group & Productivity Press
Thomas L. Jackson
Mapping Clinical
Value Streams
Rona Consulting Group & Productivity Press
Thomas L. Jackson
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2013 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20121107
International Standard Book Number-13: 978-1-4665-5186-2 (eBook - PDF)
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Contents
Preface ..........................................................................................................................ix
Acknowledgments ......................................................................................................xi
THOMAS L. JACKSON
1 Getting Started ........................................................................................................1
1.1 The Purpose of This Book ...................................................................................1
1.2 What This Book Is Based On ...............................................................................1
1.3 Two Ways to Use This Book ................................................................................1
1.4 How to Get the Most out of Your Reading ..........................................................2
1.4.1 Become Familiar with This Book ..............................................................2
1.4.2 Become Familiar with Each Chapter ..........................................................2
1.4.3 How a Reading Strategy Works ..................................................................3
1.4.4 Using the Margin Assists ............................................................................3
1.5 An Overview of the Contents ...............................................................................4
1.5.1 Chapter 1: Getting Started ..........................................................................4
1.5.2 Chapter 2: The Production Processes and Operations of Healthcare ......4
1.5.3 Chapter 3: Value Streams and the Mapping Process .................................4
1.5.4 Chapter 4: Map the Current State ...............................................................4
1.5.5 Chapter 5: Map the Future State: Phase I—Flow .......................................5
1.5.6 Chapter 6: Map the Future State: Phase II—Pull .......................................5
1.5.7 Chapter 7: Implement the Future State ......................................................5
1.5.8 Chapter 8: Reflections and Conclusions .....................................................5
2 The Production Processes and Operations of Healthcare .....................................7
2.1 The Industrial Origins of Lean Healthcare ...........................................................7
2.2 Production, Process, and Operation .....................................................................9
2.3 Principles of Lean Healthcare Management .......................................................10
2.3.1 Standard Work ..........................................................................................11
2.3.2 Autonomation ............................................................................................11
2.3.3 Flow Production ........................................................................................12
2.3.4 PDCA .........................................................................................................12
2.3.5 Socratic Method ........................................................................................13
2.4 Summary ..............................................................................................................13
2.5 Reflections ...........................................................................................................13
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Contents
3 Value Streams and the Mapping Process ..............................................................15
3.1 Mapping Clinical Value Streams .........................................................................15
3.2 What Is Value? .....................................................................................................16
3.3 The Seven Wastes and the Purpose of Value Stream Mapping .........................18
3.4 Patient as Customer versus Participant ...............................................................18
3.5 What Is a Value Stream? ......................................................................................19
3.6 The Value Stream Mapping Process ...................................................................20
3.7 Using Value Stream Mapping Icons ....................................................................21
3.8 Summary ..............................................................................................................22
3.9 Reflections ...........................................................................................................23
4 Map the Current State ........................................................................................... 25
4.1 The Power of Direct Observation .......................................................................25
4.2 Building a Current-State Map ..............................................................................26
4.2.1 Choose a Service Family ..........................................................................27
4.2.2 Identify the Patient ...................................................................................28
4.2.3 Walk the Value Stream and Gather Data .................................................29
4.2.4 Identify Sequential Operations in the Process ........................................32
4.2.5 Identify Operational Metrics .....................................................................33
4.2.6 Identify Waits between Operations .........................................................34
4.2.7 Document How Work Is Prioritized ........................................................34
4.2.8 Identify Manual and Electronic Information Flows .................................37
4.2.9 Identify External Patient Flows ................................................................37
4.2.10 Build a Process Time Line and Calculate Summary Statistics .................37
4.3 Another Example .................................................................................................40
4.4 Summary ..............................................................................................................43
4.5 Reflections ...........................................................................................................43
5 Map the Future State: Phase I—Flow ....................................................................45
5.1 Principles of Flow Production in Healthcare ......................................................45
5.2 Building a Future-State Map with Flow ..............................................................46
5.2.1 Produce Services to Takt Time .................................................................47
5.2.2 Eliminate Waits to Flow the Process ........................................................49
5.2.3 Create Continuous Flow with Clinical Cells ............................................50
5.3 Summary ..............................................................................................................54
5.4 Reflections ...........................................................................................................55
6 Map the Future State—Phase II: Pull ...................................................................57
6.1 Introduction .........................................................................................................57
6.2 If You Cannot Flow, Pull .....................................................................................58
6.3 Link Separate Processes with FIFO Lanes..........................................................59
6.3.1 FIFO Lanes and Reaction Plans ................................................................61
6.3.2 Where to Use FIFO Lanes ........................................................................61
6.3.3 Is FIFO Consistent with Patient Safety? ....................................................62
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Contents
6.4 Pull Production with Buffers ...............................................................................64
6.4.1 When to Use Buffers ................................................................................66
6.4.2 Examples of Buffers ..................................................................................66
6.4.3 Push Me, Pull You ....................................................................................68
6.5 Pull to the Pacemaker .........................................................................................69
6.6 Level the Production Volume ..............................................................................71
6.7 Level the Case Mix ..............................................................................................77
6.8 Summary ..............................................................................................................79
6.9 Reflections ...........................................................................................................80
7 Implement the Future State .................................................................................. 81
7.1 Focus ....................................................................................................................81
7.2 Loop the “Loops” .................................................................................................81
7.3 Hoshin Kanri, A3-Ts, and PDCA .........................................................................83
7.3.1 Plan: Write an A3-T for Each Loop ..........................................................84
7.3.2 Do: Conduct Kaizen Workshops ..............................................................84
7.3.3 Check and Act: Develop Leader Standard Work .....................................89
7.4 Where to Begin? ..................................................................................................91
7.5 Summary ..............................................................................................................92
7.6 Reflections ...........................................................................................................92
8 Reflections and Conclusions .................................................................................95
8.1 Reflecting on What You Have Learned ..............................................................95
8.2 Applying What You Have Learned .....................................................................95
8.2.1 Possibilities for Applying What You Have Learned .................................95
8.2.2 Applying Value Stream Mapping in Your Organization ..........................96
8.2.3 Your Personal Action Plan ........................................................................98
8.3 Opportunities for Further Learning ....................................................................98
8.4 Conclusions ..........................................................................................................99
Appendix .....................................................................................................................101
Further Reading about Value Stream Mapping ........................................................101
Further Reading about Lean Healthcare ...................................................................101
Useful Websites ..........................................................................................................102
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