1. Value Stream Mapping

2. 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

3. 11 simple steps!!!

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

5. 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

6. 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

7. 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

8. 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)

9. 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?

10. 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

11. 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= 9856 1min2mins40mins

12. 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 9856 1min2mins40mins

13. Sample Sorting START Patient Referral STEP 10 Processing Data Entry 56 98 111 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

14. Sample Sorting START Patient Referral STEP 11 Processing Data Entry 56 98 111 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

15. Future State Value Stream Mapping

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

17. Developing Continuous Flow…

18. Removing the Waits

19. ESCS Eliminate Simplify Combine Sequence

20. 60 33325 136440936 61 136 Inpatients Outpatients 1 x daily Report issueVerifyTypeDictate reportScanBook scan Data entry Vet referral Batch100 Avail = C/O = Defect% CT=60s Batch=15-100 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 120 33325 60 37861 7 900 59245 60 56468 60 12589 7 15 21291 60 Flow time = 709703 sec Touch time = 1335s (22.25 min)

21. 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 125897 2409060 3786 17 Future State Value Stream Map 70/day 352/week

22. 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)