Value Stream Mapping

Value Stream Mapping

Aims for session

• Introduce the concept of Value Stream Mapping

• Consider identification of value and waste

Patient Flow Process1. Understand the total process of care delivery

– patient pathway

Diagnostic tests

COMPASS WAITING LIST DIARY - CASE NOTES PULLED 3 WEEKS IN ADVANCE

THEATRE LIST PRINTED L4 HOURS BEFORE - ALLOCATE BEDS

THEATRE LIST SAME DAY FROM JANET. TRY 24 HOURS BEFORE

REPORTS ADMISSION AT FRONT RECEPTION.DETAILS CHECKED

PATIENT ARRIVES RECEPTION DAY SURGERY

TAKE PATIENT TO WARD AND TO BED AREA WITH NOTES. ADVICE TO UNDRESS/GOWN ON. TELL NURSING STAFF.

RECEPTIONIST FINDS OUT IF THEY TO GO TO RADIOLOGY AND WHAT TIME 1 WEEK IN ADVANCE

ADMIT PATIENT VIA CARE PLAN. 5-10 MIN.LOOK AT MOD

CHECK IF TO GO FOR ULTRASOUND - IF TO GO WALK THEM ROUND TO X-RAY WAITING ROOM.

1ST KUB - KID URETER BLADDER X-RAY. PATIENT FULL BLADDER.2ND ULTRASOUND 20-30 MINS IN RADIOLOGY.

PATIENT X-RAY AND ULTRASOUND REPORT BACK - BACK TO BED.

DOCTOR SPEAKS TO PATIENTS - CONSENT SIGNED

THEATRE STAFF ATTEND DAY SURGERY - DATA SHEET GIVEN TO DAY SURGERY STAFF.

THEATRE STAFF TAKE PATIENT STRAIGHT INTO MINOR OP THEATRE.

TEST 10-15 MIN ALLOCATION

DR CANNING 3 1/2 HOUR SESSION

VERBAL REPORT TO PATIENT AND INFORMATION.

TAKEN BACK TO DAY SURGERY

MAKE SURE PATIENT OK - ? DRINK OR EAT. DISCHARGE INSTRUCTIONS

IF DOCTOR NEEDS TO SEE- APPOINTMENT MADE STRAIGHT AWAY - GIVEN TO PATIENT

FOLLOW/REVIEW AT OUTPATIENTS VOL APPOINTMENT NEXT DAY. INDICATED ON CARE PATHWAY

IF RAH DR WILL INDICATE ON TAPE - SECRETARY WILL ARRANGE.

PATIENT ATTENDS RADIOLOGY DEPARTMENT FOR ULTRASOUND

AFTER SCAN PATIENT REPORTS TO RECEPTION DESK IN OUTPATIENTS DEPARTMENT

NURSE ESCORTS PATIENT TO CHANGING ROOM WITHIN THE EXAMINATION

ROOM.PATIENT CHANGES INTO GOWN AND JOINS DOCTOR IN THE EXAM ROOM

DOCTOR EXPLAINS EXAMINATION AND CONSENTS PATIENT.

PROCEDURE CARRIED OUT.

RESULT GIVEN IF APPROPRIATE AND FOLLOW UP INFORMATION GIVEN

PATIENT CHANGES BACK INTO CLOTHES AND LEAVES THE DEPARTMENT.

REPORT TYPED BY UROLOGY SECRETARY AT RAH

What is Value?

Hairdresser activity

The activity is done right first time

The activity transforms the patient and moves them towards the next defined outcome

The activity is something that the patient cares about

What is value?

Who are your patients?What is the ‘value’ your patient wants?

How is the value added?When you describe value use the

customers' words

Define Value in Your Service

Stage 2:

Waste

Waiting – delays for things to happenMistakes – things going wrong

Uncoordinated activity – things out of sequenceStock – too much or too little

Transportation – moving info / thingsMotion – unnecessary human movement

Inappropriate processing – unnecessary work

Opportunities to Remove Waste:

Watch the video, identify and discuss the different sorts of waste shown

Activity:

Value Stream Mapping the patient journeyDefine start and end points

Supporting Organisational Structure:• Sponsor• Team Lead and Clinical Lead, Team Members

Who to Involve

Small team 8-12 people, mixed disciplinesRepresent people at all the steps you will

look at‘Fresh eyes’

Patients/ carersNominate a team and clinical lead

Agree beforehand improvements in - Journey time for patients - Time spent on non value adding work - Throughput (productivity) - Morale / staff satisfaction

What to Measure

Observe and Gather DataWalk the patient journey - see the actual

work placeFollow and make notes about each

component What happens to the patient

What staff are doingWhat the information / communication

flow isTake photos of wastes

Measure the distance patients / staff have to travel

Track both the patient and information flows

Take the cameras on the walkabout, you’ll never convey this verbally!

What do patients actually experience and say about the process?

Ask staff at each step for their views on ‘show stoppers’, frustrations and positives

Take photos

Have plentyof space

Don’t skipprocess steps

Walk theArea

Define the Boundaries of the VSA

Don’t assume

Don’t relyon hearsay

Collect realtime data

Build up the Value Stream Map

Add value

Remove waste

Understanding your Current State Map:

Quantifying Value Added Activity and Time:

Value Adding

Non Value Adding

Highlight opportunities to reduce waste on the map

WaitingMistakes

Uncoordinated activityStock

TransportationMotion

Inappropriate processing

Ideal State

What process would the team design to align the value adding steps in the right sequence, complete the process as fast as possible, right first time, and reduce or eliminate waste?What would the patient, staff and information steps look like?