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

2. 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)

3. 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

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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