The document summarizes an upcoming value stream mapping event for a home healthcare services company. The 2-day agenda includes lean education, creating a current state map to understand existing processes, identifying improvement opportunities, designing an improved future state map, and developing an action plan. The goal is to streamline processes, eliminate waste, and improve customer satisfaction through applying lean principles like value stream mapping.

1. NEW Lean Consulting Group Value Stream Mapping Event Home Healthcare Service Industry October 20-21, 2011

2. NEW Lean Consulting Group Provide Lean consulting services To provide community businesses and not for profits with a quality resource for their Lean journey. Certified Lean Lead Facilitators Amy Lauko – Project Manager Jamie Voster Lisa Rothbauer Lisa Carpiaux Welcome & Introductions

3. The Case for Change EXPECTATIONS AND RESULTS Insanity is doing the same thing over and over again and expecting different results. Albert Einstein

4. Home Healthcare Industry Client Value Stream Mapping Agenda Lean education Customer satisfaction through waste elimination Value stream mapping Create current state map Create future state map Develop action plan

5. Event Summary Day One Call to action Lean education and agenda Understand current state Build current state Prioritize improvement areas Day Two Review wastes identified in current state Brainstorm on future Design future state process Define implementation plans Develop action plan

6. Henry Ford: the first person to truly integrate an entire production process. The problem with Ford’s system: the inability to provide variety. All Model Ts were essentially identical up through the end of production in 1926. Based on Ford’s thinking, Mr. Toyoda and Mr. Ohno created the Toyota Production System (TPS). Toyota believed a series of simple innovations would make it more possible to provide both continuity in process flow and a wide variety in product. TPS shifted the manufacturing from individual machines to the flow of the product through-out the total process. Taiichi Ohno History of LEAN

7. What is Lean? A work philosophy of eliminating waste and increasing value of products and services

8. Elements of Lean Thinking Learning to see Continuous Improvement Standard work One piece flow Error proofing Focus on process not on people Employee Empowerment

9. LEAN Principles Setup Reductions Teams 5S Error Proofing TPM Kanban Work Cell Standardized Work Kaizen A3 Problem Solving Value Stream Map

10. Increased efficiencies Increased ability to serve more customers in the same time Increased customer satisfaction Increased timely customer access to goods and services Improved quality Increased employee engagement Reduced waste, costs, and lost opportunities Benefits of Lean

11. Lean is not…. a headcount reduction an evaluation of your personal performance for companies struggling to stay in business a quick one-time fix applicable only to manufacturing What is NOT Lean?

12. Lean requires change in Thought Culture Perspective Change must occur to achieve success. Lean Requires Change

13. Why Change? We cannot solve our problems with the same thinking we used when we created them. Albert Einstein

14. Critical success factors: Communication Leading Training Acting Sustaining Plan, Do, Check, Act (PDCA) Implementing Change

15. If the solution is not obvious, hold events that enable small continuous improvements These are Kaizen or Rapid Improvement Events (RIEs) Kaizen events use problem solving tools to find solution. Change in Lean is Focused on Problem Solving

16. What is Kaizen? Japanese for improvement or change for the better . It refers to a philosophy or practice that focuses upon continuous process improvement.

17. Business Process Kaizen Teams: Members are diverse Targets: Waste, Variables, and non-value added activities Typically a 3 - 5 day commitment Quick and simple, not slow and elegant Management ensures the necessary resources Immediate results

18. Standardize IMPROVEMENT TIME Kaizen Kaizen Kaizen From “Kaizen”, Masaaki Imai Standardize Standardize Kaizen Starting Process

19. “ The achievements of an organization are the results of the combined effort of each individual.” Coach Vince Lombardi

20. Why do we need Teams? By working together, rather than competing with each other, we’ll see: Increased quality Higher productivity Reduced cost

21. Teams Add Value What’s in it for Me? New job skills Participate in decisions affecting your job Realize you add value to the company

22. Team Building Building Your Team: Establish Team Guidelines Define Team Mission and Goals Conduct Effective Meetings Identify Team Roles and Responsibilities Develop Communication  Speaking and Listening Resolve Conflicts Make Group Decisions

23. Teamwork Fundamentals Open communication Team members with diverse backgrounds Common goals Driven to succeed

24. A team is a group of people working together towards a common goal.

25. The focus of Lean is … waste elimination. Waste

26. Anything other than the minimum resources required to add value to an end product or service. What is Waste?

27. Waste Non-value added work, also called waste, refers to work that doesn't add value to or is unnecessary for the overall project.

28. Non-Value Add Activities Improve Evaluate Reduce Eliminate Value Add Transforms material and information into products or services The customer wants it It’s done right the first time Non-Value Add Consumes resources but does not contribute to the product or service Necessary Customers require it Regulatory or legal compliance Can’t eliminate based on current technology or thinking Not Necessary

29. Waste Wheel 1 2 3 4 5 6 7 8 Value Added Work 5 % Over Production Inventory Transportation Knowledge Corrections Over Processing

30. “ Eliminating…waste is not the problem, identifying it is.” Taiichi Ohno developer of the Toyota Production System (TPS) The Real Problem:

31. Examples of Waste in the Office Motion Going to copy machine or fax, searching for files, extra key strokes, hand-offs, going to get signatures. Waiting (Idle Time) Waiting for system to come up, customer or supplier responses, handed-off file to come back, decisions. Transportation Retrieving/storing files, carrying or posting paperwork, loops. Defects Data entry error, missing information, re-work. Over-Processing Repeated entry of data, “Cadillac” report when something less would do, unneeded steps, duplication, layers of approval. Over-Production Doing more than is needed, doing things too far ahead of customer need, creating reports that no one reads, making extra copies “just in case”. Inventory Open projects, unread e-mails, office supplies, unused records in database, items waiting for attention. Misused Resources Not engaging everyone in improvement, not utilizing all skills available in the organization, unclear roles and responsibilities.

32. Learning to see waste..… If we hadn’t challenged the status quo, we wouldn’t have: microwaves, cell phones, Ipads, portable air conditioners, makes/model of cars, laptops.

33. A one page visual representation showing the flow of all processes, information and material Current state analysis (snap shot) shows All current value added and non-value added processes Future state analysis shows Improved value added processes and eliminates as much non-value added work as possible Action plan for target state implementation Introduction to Value Stream Mapping (VSM)

34. Benefits of a VSM See entire process flow of information and materials Identify waste and the source of waste Establish priorities for improvement Focus on low cost or no cost improvements Reveals opportunities to improve customer satisfaction

35. Establish the areas of focus Determine Book Ends (Start/Stop points) Identify steps by color: Yellow Process Sheets– tasks Pink Post-It Notes– problems/opportunities Green/Red Dots – (Non) Value-Added activities Brainstorm/Creative Problem Solving as needed Map future state / Create Parking Lot Prioritize changes Create Action Plan How to do a VSM

36. Begin with Framework Scope Process Start: Initial call for care Process End: Customer’s 1 st invoice Out-of-Scope: Needs to be filled in Objectives Eliminate 3-5 wastes Improve process flow Implement improvements in 30 days

37. Current State Map out each process step within the boundaries of start / stop Map flow of materials from one step to the next Map flow of information from start to finish Map takt time and cycle time Identify non value-added steps Identify opportunities for improvement

38. Current State Process Request to Proposal Invoice to Cash Receipt Order Confirmed thru Shipping Focus Area for improvement due to high number of wastes

39. Current State Process Effectiveness November 4, 2011 Process Metrics Starting Baseline Full Process Starting Baseline Focus Area Total Number of Steps 45 26 # Value Adding Steps 23 13 # Non-Value Adding Steps 22 13 Number of Approvals 2 0 Number of Hand-offs 19 12 Number of Recycle Loops 12 5 Number Error Proofing Minimal 0

40. Prioritized Areas of Focus Brainstormed potential improvement areas Prioritized using Target Sheet and Effort/Impact Grid Incorporated into future state design

41. Creating the Future State Brainstorm opportunities for potential improvements Focus on (8 Wastes) low cost and no cost improvements Verify management support Verify Future State meets the established goals. Develop action plan for implementation within 30 -60 days

42. Future State Process Generate customer order through shipment Significantly streamlined process Eliminated 16 wastes vs target of 5-10 wastes Implementing improvements next week!

43. Future State Process Effectiveness Process Metrics Starting Baseline Focus Areas Future State Focus Areas Actual Change % Improved Total Number of Steps 26 21 -5 19% # Value Adding Steps 13 13 No change # Non-Value Adding Steps 13 8 -5 38% # Hand-offs 12 4 -8 67% # Recycle Loops 5 2 -3 60% # Error Proofing 0 2 +2 200%

44. Develop Action Plan Create teams to work on tasks Ensure the right members are on the team Ensure teams have support and resources they need Review progress regularly Celebrate successes

45. Ensure Success of Action Plan IMPORTANT TASKS: Conduct regular scheduled meetings for participants. Inform everyone of the plan Inform everyone of what was learned in the process Provide a structure to work on problem solving and to complete tasks Verify progress on goals continuously Give support for the process continuously. Celebrate the success of the team.

46. Plan Do Check Act Act - How to improve next time Plan - What to do. How to do it. Do - What was planned. Check - Did things happen as planned?

47. Keys to Success Teamwork Combat Waste 100% Quality, No Comebacks

48. By the end of event you will … Create Current State Map Understand Current State problems and opportunities. Create a Future State Map Have a plan for implementing future state Have started developing standard work and visual controls to sustain changes. Celebrate your success!

49. Basic Ground Rules Maintain a positive attitude Make no assumptions Take nothing personally Everyone on the team is equal Each person’s opinion matters There are no bad ideas or stupid questions Resolve all issues respectfully

50. Together we can do what one cannot do alone!