1. Value Stream Mapping Defining the Value Stream

2. Your Time to Relax

3. Value Stream Value Stream: The flow of materials and information through a process to provide a product or service to a customer; including operations and equipment needed.

4. Value Stream Mapping Value Stream Mapping: Involves walking and drawing the processing steps (material and information) for one product/service family from door to door.

5. Kahuna Manager A Manager B Manager C Manager D Systems Approach Value Stream A Value Stream B Value Stream C

6. Benefits of Value Stream Mapping VSM allows you to see beyond the single process step and see process flow. VSM allows you to see sources of waste in the value stream. VSM provides a common language to discuss issues. VSM links lean concepts and techniques. VSM provides a blueprint for improvement.

7. Benefits of Value Stream Mapping VSM shows the linkage between information flow and material flow. VSM makes decisions regarding flow apparent. VSM is both a quantitative and qualitative tool, with the qualitative being most significant.

8. Consider…. ….what benefits might be realized within your organization using Value Stream Mapping?

9. VSM Uses Project planning and reporting High level strategizing Aligning improvements with strategic plan Training (visual aids) Patient education Explaining procedures to patients

10. VSM Uses Demonstrating/documenting improvements to regulatory agencies Communicating change between departments Initiating new policies Replacing or augmenting policy manuals

11. Value Stream Mapping Value Stream Mapping Process

12. Defining a Product/Service Family Process Steps and Equipment Products/Services 12345678 AXXXXX BXXXXXXX CXXXXXX DXXXXX EXXXX FXXXX GXXXX

13. Defining a Product/Service Family Process Steps and Equipment Products/Services 12345678 AXXXXX BXXXXXXX CXXXXXX DXXXXX EXXXX FXXXX GXXXX

14. Flow Chart versus VSM Flow Charting Visual representation of process Generally localized within functional area Identifies process steps Value Stream Mapping Visual supplemented with selected process data Crosses functional boundaries (door to door) Illustrates process steps and information flow

15. Product/Service Flow Information Material

16. Value Stream Manager Value Stream Manager: In an organization structure designed most fully to reflect lean philosophy, all the support groups related to making a value stream operate would report on a solid line to Value Stream Manager.

17. Kahuna Dept. A Dept. B Dept. C Manager D Value Stream Manager Approach Value Stream A Value Stream B Value Stream C VSM A VSM B VSM C

18. VSM Job Description Reports lean implementation progress to top person on site Person with capability of making change across functional and departmental boundaries Leads the creation of current state and future state maps and implementation plans Monitors all aspects of implementation

19. VSM Job Description Walks and checks the flow of the value stream daily or weekly Makes implementation a top priority Maintains and periodically updates the implementation plan Insists on being a hands on person

20. Two Kaizens Flow Kaizen (Value Stream Improvement) Process Kaizen (Elimination of Waste) Focus Task Level Senior Management.

21. VSM Steps Product/Service Family Current State Drawing Future State Drawing Implementation Plan

22. Value Stream Mapping Current State Map

23. Four Levels of Mapping Process Level Single Facility (Door to Door) Multiple Facilities Across Companies

24. Mapping Tips Collect current state information while walking the actual pathway of material and information flow Begin with a quick walk along the entire door-to-door value stream Begin at discharge and work upstream Bring your stopwatch and do not rely on standard times Map the whole process yourself Confirm observations with task experts

25. One Final Tip Draw by hand with a pencil …can be done without delay …allows task expert ability to do the mapping …focuses on understanding of material and information flow, rather than how to use computer

26. Questions to Ask Is it clear what should happen, in what order, and is there an approximate time frame for completion? Is every step in the current process adding value to the patient? Is the participation of every person that touches the process necessary? Does everyone do the process the same way?

27. Questions to Ask How does new worker learn the process? How did you learn the process? About how long should it take to complete the process? Is the expected outcome clearly understood? What is the expected outcome?

28. Takt Time: literally the “beat” of the process, it is the pace of production or service based on customer consumption. Lean Definitions

29. Cycle Time: total amount of elapsed time from the time a task, process or service is started until it is completed Lean Definitions C/T

30. Value-Creating Time: time of work element that actually transforms product or service in a way that the customer is willing to pay for Lean Definitions VCT

31. Lead Time: time it takes one product or delivery of service to move all the way through the value stream from start to finish Lean Definitions L/T

32. Your Data and Your Assignment Determine the source of process data needed Develop a plan to collect the data Bring the data with you to the next session

33. Three Zones of VSM Upper Third-Information Flow Middle Third-Process Flow Bottom Third-Process Data ◦ Maximum, minimum, and average process time ◦ Value added time ◦ Non-value added time

34. Step #1 Begin with the Customer Cardiac Patient

35. Step #1-Add Customer Requirements Cardiac Patient Immediate attention Appropriate treatment Accurate diagnosis

36. Step #2-Process Steps Add Process Steps, Data Boxes, Task Experts, Delay and Inventory Triangles across the bottom I C/T= C/O= VCT= Uptime= Seconds available= C/T= C/O= VCT= Uptime= Seconds available= C/T= C/O= VCT= Uptime= Seconds available= I D Check inRN ConsultMD Consult

37. Step #3-Add Material Flow I C/T= C/O= VCT= Uptime= Seconds available= C/T= C/O= VCT= Uptime= Seconds available= C/T= C/O= VCT= Uptime= Seconds available= I D Check inRN ConsultMD Consult

38. Step #4-Add Information Flow I C/T= C/O= VCT= Uptime= Seconds available= C/T= C/O= VCT= Uptime= Seconds available= C/T= C/O= VCT= Uptime= Seconds available= I Check inRN ConsultMD Consult D

39. Step #4-Add Push Arrows I C/T= C/O= Uptime= Seconds available= C/T= C/O= Uptime= Seconds available= C/T= C/O= Uptime= Seconds available= I Check inRN ConsultMD Consult D

40. Step #5-Add Timeline I C/T= C/O= Uptime= Seconds available= C/T= C/O= Uptime= Seconds available= C/T= C/O= Uptime= Seconds available= I Check inRN ConsultMD Consult D

41. Practice Time Working in table groups create a Current State Value Stream Map for a Value Stream in your organization

42. Value Stream Mapping Lean Value Stream

43. Your Time to Relax

44. Lean Value Stream Goal …All we are trying to do in lean value stream is to get one process to deliver product or service to the customer in the most efficient way possible …We are trying to link all processes- from the final customer back upstream in a smooth flow without detours that generates the shortest lead time, highest quality, and lowest cost.

45. Transport (Conveyance) Inventory Motion (Movement) Waiting (Delay) Overproduction Over-processing Defects (Correction, Repair, Rejects) Which source is costing you the most? Sources of Waste (Muda)

46. Timeline and Waste I C/T= C/O= Uptime= Seconds available= C/T= C/O= Uptime= Seconds available= C/T= C/O= Uptime= Seconds available= I Check inRN ConsultMD Consult D

47. Review your current state value stream map. Label areas of waste. Which source is costing you the most? Sources of Waste (Muda)

48. Old paradigm: ◦ Cost + Profit = Price New paradigm: ◦ Price (fixed) – Cost = Profit Key to profitability: ◦ Cost reduction The Goal Is….. Fixed Price

49. Consider…. …how are costs established in your organization? …how is waste impacting cost to your organization?

50. Cost Dollars of Output Cost = Dollars of Input

51. Guidelines to a Lean Value Stream 1. Provide service at your takt time 2. Consider whether process is necessary 3. Evaluate activities within a process box 4. Optimize order of activities 5. Optimize order of processes 6. Consider information flow 7. Evaluate complexity 8. Determine consistency

52. Guideline #1 Provide service at your takt time available working time per day = customer demand rate per day

53. Timeline and Takt Time I C/T= C/O= Uptime= Seconds available= C/T= C/O= Uptime= Seconds available= C/T= C/O= Uptime= Seconds available= I Check inRN ConsultMD Consult D

54. Takt Time… Synchronizes pace of delivery with pace of demand Tells you how often service needs to be completed or product produced to meet customer requirements Tells you how you are doing and where improvement is needed

55. Guideline #1… … requirements: ◦ Rapid response (within takt) to problems ◦ Eliminate causes of unplanned disruptions ◦ Eliminate non-value added steps

56. Reflect… …what inherent changes associated with the first guideline would be necessary in your organization? …what might be the challenges to implementing these changes?

57. Guideline #2 Consider whether process is necessary What is its purpose? Does it add value? Can it be eliminated? A I B C A C D I

58. Guideline #2 Evaluate…. Each process step of your value steam using guideline #2 What did you find?

59. Guideline #3 Evaluate activities within a process box Are all steps adding value? Are they being done consistently? Do they involve more people than necessary? a.1 a.2 a.3 a.etc Process A

60. Guideline #4 Optimize order of activities Are process activities being done in same order consistently? Are they being done in the best order? Are there redundant activities? Could activities be done more efficiently in a different process box?

61. a.1 a.2 a.3 a.etc Guidelines #3 and #4 Your Turn… …Evaluate and Optimize activities within each Process Box a.3 a.1 a.3 b.1 Process A

62. Guideline #5 Optimize order of processes Are process boxes in optimal order? Can process steps be combined? A I B C B AC D

63. Guideline #6 Consider information flow Is information flow direct and simple? Is information in each box original (not redundant)? What information is missing?

64. Guideline #7 Evaluate complexity Are there more process steps necessary to provide the intended outcome? How can processes be simplified?

65. Your Turn…. Optimize order of processes Consider Information Flow Evaluate complexity Share your results

66. Guideline #8 Determine consistency What areas of inconsistency exists within the value stream? What might you learn from these inconsistencies?

67. Value Stream Mapping Future State Map

68. Your Time to Relax

69. Purpose of Value Stream Mapping Purpose: to highlight sources of waste and eliminate them by implementation of a future-state value stream that can become a reality within a short period of time. Source: Learning to See by Rother and Shook

70. Goal of Value Steam Mapping Goal: to build a chain of product or service delivery where the individual processes are linked to their customer(s) either by continuous flow or pull, and each gets as close to possible to providing only what its customer(s) need when they need it. Source: Learning to See by Rother and Shook

71. Future-State Map Assumptions First iteration future-state map should take as givens: Product or Service Design Process Technologies Current Facilities Ask: “What can we do with what we have?” Source: Learning to See by Rother and Shook

72. Questions to Ask-Future-State Map 1. What is the takt time? 2. Where is the bottleneck operation? 3. What is the pacemaker process? 4. Where can you achieve continuous flow processing? 5. Where will you need to use supermarket pull systems?

73. Questions to Ask-Future-State Map 6. At what single point in the value stream (pacemaker process) will you schedule work? 7. How can work be smoothed at the pacemaker process? 8. What process improvements/changes will be necessary?

74. Question #1 What is the takt time? Available Working Time = takt time Customer Demand  Evaluate each process step relative to takt time

75. Question #2 Where is the bottleneck process?  Determine which process has longest cycle time  How does longest cycle time compare to takt time?  What are the implications?  What actions are suggested?

76. Question #3 What is the pacemaker process? The pacemaker process: ◦ Sets the pace for the value stream ◦ Is the only operation scheduled ◦ Is process closest to the customer that provides continuous flow  Determine your pacemaker process  What are the implications?

77. Question #4 Where can you achieve continuous flow processing?  Evaluate the cycle time of your processes  Where do you see interruptions in flow?  How might you achieve continuous flow?

78. Question #4 Is there continuous flow?

79. Question #4 Closer to continuous flow?

80. Question #4 Continuous flow achieved?

81. Question #4 What changes will be necessary to achieve flow Where can you achieve continuous flow processing? Kaizen

82. Question #5 Where will you need to use supermarket pull systems? Used as a store of in-process work where continuous flow cannot be achieved Often necessary when a single process is serving multiple value streams

83. Question #5 Where will you need to use supermarket pull systems? Process 1 Process 2 Kanban Supermarket Kanban

84. Question #5 Where will you need to use supermarket pull systems? Kanban is a signal that triggers replenishment or withdrawal in a pull system  Where and what types of kanban will you use in your value stream? Kanban

85. Question #6 At what single point in the value stream (pacemaker process) will you schedule work?  How is this different from current practice?  What challenges does it present? Process 1Process 3Process 2 Schedule

86. Question #7 How can work be smoothed at the pacemaker process?  What are sources of mura?  How might they be overcome? Demand Equal to Takt Time

87. Question #8 What process improvements/changes will be necessary? Kaizen1 Kaizen 2 Kaizen 3

88. Value Stream Mapping Achieving the Future State

89. Your Time to Relax

90. Reality Check In considering the future state you should realistically assess: Do we have the human resources to commit to make the change happen? Is there sufficient support from leadership? Are improvements consistent with strategic direction of the organization? Are there constraints of cost and competing initiative?

91. Break Implementation into Steps Pacemaker Loop: Encompasses the flow of materials and information between your customer and your pacemaker process. The most downstream loop in a facility, it impacts all upstream processes. Additional Loops: Upstream of the pacemaker loop are material and information flow loops between pulls.

92. Establish Outcomes For the pacemaker loop and all other loops establish objectives and goals.

93. The Value Stream Plan Based on the future state map the value stream plan shows: Exactly what you plan to do by when, step-by-step Measureable goals Clear checkpoints with real deadlines and named reviewers

94. Future State Map to A3 Report Theme: Background Current Condition Goal Root-Cause Analysis Countermeasures Effect Confirmation Follow-up Actions PlanDo, Check, Act Kaizen

95. And finally… …Value Stream Plan Review Maintains commitment and accountability While recognizing the need for flexibility in executing implementation plan

96. Share an insight, question, concern, or confusion regarding Value Stream Mapping Review Time