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These are slides from a talk given on 1/8/14 in San Diego, California at SME Connect's Operations Roundtable.
Too many organizations today suffer from silo-centric behavior and intra-organizational conflict. And yet most don’t understand what’s holding them back from achieving outstanding performance. This is where Karen Martin’s new book Value Stream Mapping comes into play.
Value stream mapping can unleash the full potential of an organization and deliver greater customer value, increased profit margins, and create fulfilling work environments.
In this talk, Karen discussed how to:
• Prepare and engage your leadership team in the transformation process
• Gain a deep understanding about your current work systems and the related barriers to delivering value
• Design a future state that enables outstanding performance on all fronts
• Adopt a new design and lay the foundation for continued improvement
28. Create the Current State Map
Prepare
1.
2.
3.
4.
5.
Understand
Current State
Design
Future State
Develop
Transformation
Plan
Execute
Transformation
Plan
Value stream walk #1
Layout the map
Value stream walk #2
Add map details
Add timeline; calculate
summary metrics
28
30. Create the Future State Map
Prepare
Understand
Current State
Design
Future State
Develop
Transformation
Plan
Execute
Transformation
Plan
1. Define the “right work”
2. Make the right work flow
3. Manage the right work
30
31. How will you realize the future state?
Prepare
Understand
Current State
Develop
Transformation
Plan
Design
Future State
Execute
Transformation
Plan
Value Stream Transformation Plan
Value Stream
Executive Sponsor
Value Stream Champion
Value Stream Mapping Facilitator
Date Created
FS VSM
Block #
2
Measurable Target
Scheduled Review Dates
Outpatient Imaging
Allen Ward
1-Nov-12
Paul Scanner
21-Nov-12
Dave Parks
13-Dec-12
10/18/2012
10-Jan-13
Proposed Countermeasure
Exec.
Method*
Owner
Planned Timeline for Execution
1
2
3
4
5
6
7
8
9
10 11 12
Status
Improve quality of referral to 85%
Implement standard work for referral
process
KE
Sean
Michaels
100%
Reduce lead time between scheduling
and preregistration step to 45 minutes
Cross-train and co-locate work teams
Proj
Dianne
Marie
75%
4
Only one check in per patient
Collect copays in Imaging
KE
Ryan
Austin
50%
4
Reduce wait time in waiting area by 50% Balance work / level demand
KE
Dianne
Marie
50%
6
Eliminate 6 hour lead time associated
with transcription step
Implement voice recognition technology
Proj
Dave
Gerald
50%
7
Eliminate redundant data entry
Auto populate between PACS and
Meditech
Proj
Dave
Gerald
25%
5
Visually managed inventory; no outages
or expired items
5S CT supplies area; implement kanban
KE
Michael
O'Shea
100%
6
Reduce imaging LT to one hour
Value-stream specific radiologists
Proj
Martha
Allen
25%
8
Reduce report delivery LT to 30 minutes
Increase % of physicians receiving
electronic delivery
Proj
Martha
Allen
0%
7
Reduce LT at image review to 1 day
Visual metrics and indicators
JDI
Dave
Gerald
100%
3,4
Agreement
Executive Sponsor
Value Stream Champion
Value Stream Mapping Facilitator
Signature:
Signature:
Signature:
Date:
Date:
Date:
* Execution Method = JDI (Just-do-it), KE (Kaizen Event), or Proj (Project)
31
32. Where the rubber meets the road…
Prepare
Understand
Current State
Design
Future State
Develop
Transformation
Plan
Execute
Transformation
Plan
• Accountability rests with executive sponsor
• Monthly status meetings
• Adjust plan as new discoveries are made
32
34. Current State Value Stream Map
Outpatient Imaging Services
Pre-register
Patient
Customer Demand:
15 patients perDay
(Takt Time 1920seconds)
8 hours per day
Schedule
Appointment
Referring
Physician
Hospital
4
3
5
Lead Time = 24 days
2
6
Lead Time = 990 mins.
Cycle Time = 30 mins.
Lead Time = 990 mins.
% C&A = 100 %
Demand = 15 per day
1
Lead Time = 12 mins.
Cycle Time = 11 mins.
Lead Time = 12 mins.
% C&A = 98 %
% C&A = 65 %
CT=Cycle Time
LT=Lead Time
%C&A=% Complete & Accurate
Symposium
E Pay
Excel
ADS
Internet
Meditech
Fax Order
Solutions
Waiting Room
Management
System
PACS
Auto Fax 50%
Us Mail 25%
MD Mailbox 25%
Rework Loop
via Fax 25% of
the time
Check-in
Patient
(Admitting)
Prep
Patient
(Tech)
Check-in
Patient
(Imaging)
Complete
Exam
(Tech)
Transmit
Images
(Tech)
Read/Dictate
Exam
(Radiologist)
Transcribe
Report
(MDI)
Review
Draft/Sign
(Radiologist)
Print
Reports
(Imaging)
Send
Reports
(Imaging)
5 mins.
5
5
5 mins.
Cycle Time = 2 mins.
% C&A = 90 %
0.0833 hrs.
3
0.0833 hrs.
2 mins.
6
Cycle Time = 1 mins.
% C&A = 98 %
45 mins.
2
0.75 hrs.
1 mins.
7
30 mins.
Cycle Time = 10 mins.
% C&A = 100 %
2
0.5 hrs.
10 mins.
8
5 mins.
Cycle Time = 15 mins.
% C&A = 90 %
2
0.0833 hrs.
15 mins.
9
248 mins.
Cycle Time = 3 mins.
% C&A = 100 %
2
10
4.13 hrs.
3 mins.
365 mins.
Cycle Time = 15 mins.
% C&A = 95 %
6
11
6.08 hrs.
15 mins.
960 mins.
Cycle Time = 5 mins.
% C&A = 75 %
2
12
16 hrs.
5 mins.
110 mins.
Cycle Time = 1 mins.
% C&A = 95 %
2
1.83 hrs.
1 mins.
13
120 mins.
Cycle Time = 1 mins.
% C&A = 99 %
6
2 hrs.
1 mins.
14
Cycle Time = 3 mins.
% C&A = 90 %
LT = 32.5 hrs.
3 mins.
CT = 56 mins.
CT/LT Ratio = 2.87%
Rolled First Pass
yield = 29%
35. Future State Value Stream Map
Outpatient Imaging Services
Standard
Work
Work
Balance
Customer Demand:
15 patients perDay
(Takt Time1920 seconds)
8 hours per day
Co-locate
Schedule appt
Pre-register
Referring
Physician
Hospital
3
Lead Time = 15 days
2
6
Demand = 15 per day
1
Lead Time = 45 mins.
Cycle Time = 11 mins.
Lead Time = 45 mins.
% C&A = 98 %
% C&A = 85 %
Risk
Reduction
(Joint
Commision)
Symposium
E Pay
Excel
Internet
Waiting Room
Management
System
Work
Balancing
Standard
Work
3
35 mins.
4
Cycle Time = 1 mins.
% C&A = 98 %
0.0833 hrs.
2
Complete
Exam
(Tech)
5
20 mins.
Cycle Time = 10 mins.
% C&A = 100 %
0.583 hrs.
1 mins.
2
Transmit
Images
(Tech)
6
5 mins.
Cycle Time = 10 mins.
% C&A = 90 %
0.333 hrs.
10 mins.
Visual
Workplace
Set-up
Reduction
Prep
Patient
(Tech)
Check-in
Patient
(Imaging)
Fax Order
Solutions
PACS
Auto Fax 80%
Us Mail 15%
MD Mailbox 5%
5S
Value Stream
Alignment
Pull System
(Supplies
Kanban)
Remove
Check in
and Reduce
System Access
5 mins.
Meditech
CT=Cycle Time
LT=Lead Time
%C&A=% Complete & Accurate
2
7
120 mins.
2
Review
Draft/Sign
(Radiologist)
420 mins.
Cycle Time = 15 mins.
% C&A = 95 %
2 hrs.
2 mins.
8
Batch
Reductions
Voice
Recognition
Read/Dictate
Exam
(Radiologist)
Cycle Time = 2 mins.
% C&A = 100 %
0.0833 hrs.
10 mins.
Continuous
Flow
2
Print
Reports
(Imaging)
9
2 mins.
Cycle Time = 1 mins.
% C&A = 95 %
7 hrs.
15 mins.
Rework Loop
via Fax 10% of
the time
2
30 mins.
Cycle Time = 1 mins.
% C&A = 99 %
0.0333 hrs.
1 mins.
10
Send
Reports
(Imaging)
6
0.5 hrs.
1 mins.
11
Cycle Time = 3 mins.
% C&A = 90 %
LT = 11.3 hrs.
3 mins.
CT = 43 mins.
CT/LT Ratio = 6.32%
Rolled First Pass
yield = 40%
36. Outpatient Imaging
Value Stream Improvement Results
Current
State
Improved
State
%
Improvement
LT
32.5 hrs
11.3 hrs
65%
PT
AR
RFPY
# Steps
56 mins
2.9%
29%
14
43 mins*
6.3%
40%
11
23%
117%
38%
21%
100%
25%
75%
Metric
Tech turnover
(annual)
* This reduction (freed capacity) enabled the client to collect $500K more in annual
revenue without incurring additional labor or equipment expenses.
37. Current State Value Stream Map
Purchasing — Non-repetitive purchases less than $5,000
Supplies Purchasing - Current State VSM
Inititate Req.
1
Originator
31
PT = 10 mins.
C&A = 10%
Supplies
Hard Copy
Form File
File Maker
Quicken
Vendor
Website
Excel
ERP
Data Entry
Review
Budget
2
Review Req.
Finance
PT = 5 mins.
C&A = 60%
0.25 days
4 hrs.
PT = 5 mins.
C&A = 95%
0.5 days
5 mins.
20 Reqs
Review
Requisition
Review
5
Requisition
PT = 5 mins.
C&A = 90%
8 hrs.
PT = 5 mins.
C&A = 100%
1 days
5 mins.
7
10 Reqs
1
PT = 10 mins.
C&A = 95%
4 hrs.
PT = 15 mins.
C&A = 98%
0.5 days
10 mins.
Approve in
ERP
24 hrs.
PT = 5 mins.
C&A = 90%
3 days
15 mins.
Submit PO
to Supplier
8
63 Reqs
9
10
External
Supplier
Corp Purchasing
Manager
1
Admin Asst
Financial Mgr
1
8 hrs.
1 days
5 mins.
Enter
Requisition
Review
6
Requisition
IS Manager
1
1
40 hrs.
5 days
5 mins.
4
Sys Engineer
Supervisor
2
6
2 hrs.
3
Corp Purchasing
6
56 hrs.
PT = 15 mins.
C&A = 98%
7 days
5 mins.
80 hrs.
PT = 20 mins.
10 days
15 mins.
LT = 28.4 days
PT = 65 mins.
AR = 0.477%
RFPY = 4.2%
Customer Demand:
615 requisitions per y ear
PT = Process Time
LT = Lead Time
C&A = % Complete & Accurate
AR = Activ ity Ratio (PT/LT x 100)
RFPY = Rolled First Pass Y ield
38. Future State Value Stream Map
Purchasing — Non-repetitive purchases less than $5,000
Supplies Purchasing - Future State VSM
Additional
IT access
Enter Req.
in ERP
Integrate Form
File with File
Maker
1
Originator
31
PT=30 mins.
C&A = 85%
Supplies
Requisition
Checklist
Vendor
Websites
File Maker
Cross
Training
Approval
Additional
IT access
2
2
6 hrs.
0.75 days
5 mins.
Place
Order
3
4
5
External
Supplier
6
PT=20 mins.
80 hrs.
PT=20 mins.
C&A = 98%
1 days
5 mins.
Dedicated
Buyers
Corp Purchasing
8 hrs.
PT=5 mins.
C&A = 90%
PT=5 mins.
C&A = 95%
0.5 days
Approve
in ERP
Dept.
Manager
1
Supervisor
4 hrs.
Use budget in place
of Quicken
Auto Notify
Standard
Work for
review
Review
Req.
ERP
10 days
20 mins.
LT = 12.3 days
PT = 30 mins.
AR = 0.508%
Customer Demand:
615 requistions per year
PT = Process T ime
LT = Lead T ime
C&A = % Complete & Accurate
AR = Activity Ratio (PT /LT x 100)
RFPY = Rolled First Pass Yield
RFPY = 71%
39. Purchasing Process
Projected Results
Current
State
Projected
Future State
%
Improvement
28.4 days
12.3 days
56.7%
65 mins
30 mins
53.8%
Activity Ratio
0.48%
0.51%
6.3%
Rolled %C&A
4.2%
71.0%
1,590%
# Handoffs
10
5
50%
# IT Systems
6
3
50%
Metric
Total Lead Time
Total Process Time
%C&A = Correct & accurate (Quality)