Value Stream Mapping Constraints Analysis Exercise

2 Exercise Introduction This exercise will enable you to practice creating a value stream map and adjusting resources to assure your objective can be met.

3 Use a Value Stream Map to see the bottlenecks

Calculating Throughput Rates Examples: 30 Staff / 1 minute per client = 30 clients per minute 10 staff /.5 minutes per client = 20 clients per minute 4

Calculating Needed Staff Objective: Vaccinate 29 clients per minute or greater Use a round number, 30 clients, to calculate your throughput rate 30 clients per min x.5 min per patient = 15 staff required 5

Overview The Local Health Department, in response to the H1N1 outbreak is conducting massive flu immunization clinics (PODs) in various locations throughout the county. The initial PODs are targeting children between the ages of 5 to 18, pregnant women, and young adults between the ages of 19 to 55. This is in compliance with the CDC recommendations, and those of the NSDOH. This recommendation is based upon the epidemiology of the strain of influenza. Residents of the County are divided among the PODs based on zip code. They are also assigned time slots based upon the alphabet and their last name. They are being asked to arrive and provide proof of residence and age. All children, under the age of 18, must be accompanied by a parent/guardian. If they have to come with someone else, a written permission from the parent/guardian must be presented at the clinic. During a 6 hour period, 10,500 clients can be immunized in one POD. This is with full Local Health Department staffing as described below. Pre-filled syringes are being used. 6

Staffing Registration: Responsible to verify eligibility for immunization. Provide client with required paper work. 30 people assigned to this station. Average total time for activity - 1 minute. Assure completion of paper work: Review individuals’ paperwork for completion prior to them entering the immunization area. 10 people assigned to this area. Average total time for activity minute. Check for contraindication to vaccine: Done by an RN or LPN. 10 people assigned to this area. Refer anyone with contraindications to the MD. Average total time for activity minute. Vaccinator: RN or LPN. Vaccinate individuals. Sign paperwork indicating vaccine received and site of vaccination. (Lot numbers entered earlier) Provide client with carbon copy of immunization. 60 nurses assigned to this area. Average total time for activity minutes. Develop an AS IS and TO BE Value Stream Map based on the above. 7

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Instructions Develop As Is and To Be value stream maps based on the following case: Where are your bottlenecks? How would you address them? If additional staff is needed, how many would you recommend and where would they be deployed? Pause the module and take about minutes to complete. 9

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Tips On your To Be maps: Did you get all of the activities to have throughput times of 30 clients per minute or greater by adding staff? Considerations Recruit more LHD staff Recruit volunteers Extend the number of hours 11

Summary This exercise enabled you to practice creating a value stream map and adjusting resources to assure your objective could be met. This technique can be applied to any process improvement project where limited resources must be used in the most effective way. 12