Value Stream Mapping

Tips Keep it high level Remember this is a value stream map NOT a process map Use approximately 8 process steps Focus on the high volume work i.e. ~80% of the work. This is called the ‘Green Stream’ Walk through the pathway yourself BEFORE you attempt to create a value stream map Have lots of brown paper and post it notes

11 simple steps!!!

Patient Referred Result Received START STOP Establish process START and STOP points STEP 1

START STOP Insert the key process steps Use approx 6-8 boxes Start from the end of the process and work backwards Patient Referred Result Issued STEP 2 Sample Sorting Processing Primary Screening

START STOP Add in the outside agencies Customers, other processes, other agencies Patient Referred Result Issued Sample Sorting Processing Data Entry GP SurgeryEnd Customer (Patient) Ward STEP 3

START STOP Add in the data flows – electronic and paper Patient Referred Result Issued Sample Sorting Processing Data Entry GP SurgeryEnd Customer (Patient) Ward STEP 4 = symbol for electronic link = symbol for paper data flow

START Insert arrows between the boxes to show how the information / items are flowing. Is it a push or is it a pull? Patient Refered STEP 5 Sample Sorting Pull Push Processing Data Entry GP SurgeryEnd Customer (Patient)

Sample Sorting START Patient Referral STEP 6 Cycle time = Batch Size = Defects = Trigger= Insert the measurements - Gather real data - this is your chance to really understand what’s happening. Cycle time – How many seconds/mins/hours does it take to process ONE item? Batch Size – What is the size of each batch that is handled in this stage of the process? Defects – What percentage is not right first time and requires further work? Trigger – What causes the process to start? i.e. what triggers staff to start processing referrals?

Sample Sorting START Insert the measurements Patient Referred STEP 7 Processing Add the length of time spent on the process – this is the same figure as the cycle time in your data box Add the time delay which occurs between the process steps Cycle time = Batch Size = Defects = Trigger= 1min2mins40mins 60mins90mins Data Entry W Add a triangle with a ‘W’ to indicate a wait. GP SurgeryEnd Customer (Patient) W

Sample Sorting START Insert the inventory between the steps – how much is waiting between the stages? This can be Request Cards, patients, slides, samples, unauthorised reports… Patient Referred STEP 8 Processing Data Entry ii Cycle time = Batch Size = Defects = Trigger= min2mins40mins

Sample Sorting START Patient Referral STEP 9 Sample Processing Data Entry 111 Cycle time = Batch Size = Defects = Trigger= Cycle time = Batch Size = Defects = Trigger= Now add the number of people that process ONE form/patient at each stage (not how many you have working in that area) = people ii min2mins40mins

Sample Sorting START Patient Referral STEP 10 Processing Data Entry Cycle time = Batch Size = Defects = Trigger= Cycle time = Batch Size = Defects = Trigger= Calculate the touch time by adding all the information on the bottom of your timeline Touch Time / Cycle Time = 5mins120mins5mins 60mins90mins

Sample Sorting START Patient Referral STEP 11 Processing Data Entry Cycle time = Batch Size = Defects = Trigger= Cycle time = Batch Size = Defects = Trigger= Calculate the Lead Time by adding all the figures on the top and bottom rows of your timeline Touch Time / Cycle Time = Lead Time = 5 mins120 mins5mins 60mins 90mins

Future State Value Stream Mapping

What you need before you start Current State Value Stream Map Understand Waste Understand Takt Time An open mind

Developing Continuous Flow…

Removing the Waits

ESCS Eliminate Simplify Combine Sequence

Inpatients Outpatients 1 x daily Report issueVerifyTypeDictate reportScanBook scan Data entry Vet referral Batch100 Avail = C/O = Defect% CT=60s Batch= Avail = C/O = defects = % CT = 15 sec Batch= 12 Avail = C/O = defects = % CT = 60 sec Batch= 12 Avail = C/O = defects = % CT = 60 sec Batch= 32 Avail = C/O = defects = % CT = 15 min Batch= 50 Avail = C/O = defects = % CT = 60 sec Batch=100 Avail = C/O = defects = % CT = 60 sec Batch = 130 Avail = C/O = defects = % CT = 120 sec 70 per day (352/week) I II I I II Current State Value Stream Map Flow time = sec Touch time = 1335s (22.25 min)

136 Issue Report Scanning II Batch= Avail = C/O = Uptime = C/T = 260 Batch= Avail = C/O = Uptime = C/T = 90 Batch= Avail = C/O = Uptime = C/T = 60 1 x daily GPs Cutpatient Inpatient 409 Booking FIFO Future State Value Stream Map 70/day 352/week

How do we get to our future state? SMART OBJECTIVES -Simple -Measurable -Agreed -Realistic -Timely » Planning » Who, Why, What, Where, When, How? » Measures » Barriers / Risks » PDCA Cycles (plan, do, check, act)