Housestaff Lean Academy Module 3: Examining the Current State (Process Mapping, Observations, and Waste) Robert Martin, PsyD Performance Excellence UCLA Health

Where does this module fit into the curriculum? Module Description 1 Lean Principles for Physicians (Important Concepts) 2 Using A3* and PDCA Methodology for your improvement project(s) 3 Examining the Current State (Process Mapping , Observations, & Waste) 4 How to use Root Cause Analysis 5 Organizing & Using Data 6 Identifying Improvements & Actions (A3 Simulation) 7 Working as a Team (Frontline Empowerment & Engagement) 8 Sustaining Improvements through Standard Work 9 Understanding & Leading Change 10 UCLA Operating System - Supporting Infrastructure (ADM, Huddles, A3/A4 Methodology)

Module 1 Summary Use these concepts to focus your improvement project Value Waste Scientific Method (PDCA / A3) Empowered Staff Alignment Use these concepts to focus your improvement project Use the A3 and PDCA methodology (i.e. scientific method for improvement) to manage and communicate your improvement project Use these concepts to maximize your improvement project’s chance for success

Module 2 Summary A3-Problem Solving (11 x 17) Use for: Complex problems Gaining consensus Communicating Managing the project Use if: Root Causes to problems are unknown Solutions aren’t obvious Requires Planning (PDCA) and data collection & analysis

Documenting the Current State is beneficial Idea collection, observations, and discussions of “pain points” engages staff , improves shared understanding and teaming Illustrates a process or patient pathway from both the staff and patient’s perspectives The resulting documentation (a process map, observation sheets, spaghetti charts, etc.): Is easy to understand, highly visual, and aids the change process Help to identify steps that don't directly contribute to patient care (bottlenecks, constraints, problems/issues = waste) Help to identify steps that do contribute to patient care (value-added) Tools Process Maps Time Observation Sheets Spaghetti Charts Waste Analysis

Time Observation Sheets Process Mapping A simple language not taught in medical school Organized visualization of interrelated activities which combine to form a process, patient pathway, or process of care There are more symbols, but these are the most important: Process Mapping can be mapped in several ways! Tools Process Maps Time Observation Sheets Spaghetti Charts Waste Analysis

Process Mapping (Cross-Functional, or “Swim Lanes”) Tools Process Maps Time Observation Sheets Spaghetti Charts Waste Analysis

Process Mapping (Linear/Phased) Where activity takes the longest on this map? Tools Process Maps Time Observation Sheets Spaghetti Charts Waste Analysis This might required a more detailed map or Time Observation Sheets

Using Time Observation Sheets* You can use TOS or more detailed Process Maps to further understand problems Tools Process Maps Time Observation Sheets Spaghetti Charts Waste Analysis Multiple Observations Running clock is used Calculations can be done after (i.e. 8:20 – 8:02 = 18 mins) Remarks can be captured for further analysis *Template is available

Using Spaghetti Charts* You can use Spaghetti Charts to show the impact of motion and movement, and to improve flow Spaghetti Diagram Date: Area:   Process: Distance: Step Description Distance 1 Pt walks into Clinic 2  Scheduler/Registrar checks patient into CareConnect and directs PT to waiting room 3  Patient waits for Care Coordinator 4  Care Coordinator calls patient to the back 5  CC verifies PT in CareConnect 6   Patient completes consent forms 7  CC reviews forms for errors and completion 8 CC directs patient back to waiting room 9  Patient waits for Nurse 10   Nurse calls PT back 11 12 13 14 21 Steps can be copied over from Time Obs. Sheets Tools Process Maps Time Observation Sheets Spaghetti Charts Waste Analysis Distance can be measured 1 4-8 10 3 2 9 *Template is available

Time Observation Sheets While doing observations, you can find more “waste” when you examine with a model*: Process Maps Time Observation Sheets Spaghetti Charts Tools Process Maps Time Observation Sheets Spaghetti Charts Waste Analysis The 8 Wastes 1) Defects How many defects are the Care Coordinator finding? What is the impact? 2) Overproduction Are there any unnecessary forms we ask the patient to fill out? 3) Waiting Patient is waiting at least 24 minutes. Is the MD waiting? Other bottlenecks? 4) Not Utilizing Talent Can the registrar be trained to do consent if the Care Coordinator isn’t available? 5) Transport Is there any transport waste? 6) Inventory Is there any inventory waste? 7) Motion Is the PT being moved too much? 8) Extra-Processing Is there any rework from defects or other waste? *Template for practicing 8 wastes is available

Using Time Observation Sheets* You can use TOS or more detailed Process Maps to further understand problems Tools Process Maps Time Observation Sheets Spaghetti Charts Waste Analysis Waiting: Why 18 minutes waiting for the Care Coordinator to do consent forms! Not utilizing Talent: Can another function help when CC is doing Plan of Care Scheduling? Overproduction: Are all of the forms necessary? Defects & Extra Processing: Why are their defects? What type? What is the impact of defects? *Template is available

Time Observation Sheets Once the Current State is understood, you can analyze the “root causes” of the waste (next module) to eliminate them Tools Process Maps Time Observation Sheets Spaghetti Charts Waste Analysis The 8 Wastes Pareto Cause & Effect Diagrams 5 Why Analysis

What module is next?* * Thank you! Please complete your post-questions Module Description 1 Lean Principles for Physicians (Important Concepts) 2 Using A3 and PDCA Methodology for your improvement project(s) 3 Examining the Current State (Process Mapping , Observations, & Waste) 4 How to use Root Cause Analysis 5 Organizing & Using Data 6 Identifying Improvements & Actions (A3 Simulation) 7 Working as a Team (Frontline Empowerment & Engagement) 8 Sustaining Improvements through Standard Work 9 Understanding & Leading Change 10 UCLA Operating System - Supporting Infrastructure (ADM, Huddles, A3/A4 Methodology) * Thank you! Please complete your post-questions