The Principles of Lean Value Stream Design

First Global Lean Healthcare Summit 25-26 June 2007
The Principles of Lean
Value Stream Design
Ian Glenday & David Brunt
Senior Faculty
Lean Enterprise Academy

Lean Thinking
A Refresher
• Specify what creates value from the
customers perspective
• Identify all steps across the whole
value stream
• Make those actions that create value
flow
• Only make what is pulled by the
customer just-in-time
• Strive for perfection by continually
removing successive layers of waste

Value Stream Mapping
Purpose? What exactly is the main
problem (or set of problems) in the
organisation?
• Follow a patient’s journey from beginning to end
and draw a visual representation of the physical
& information flows
– Physical flow: every step the patient takes
– Information flow: how everyone knows what work to
do next
• Then draw (using icons) a “future state” map of
how value should flow

The Essence of Lean Thinking
• Where is the time in your value stream?
– Physical flow or information flow?
“All we are doing is looking at the time line
- from the moment the customer gives us
an order to the point where we collect the
cash. And we are reducing that time line by
removing the non-value-added wastes”
Ohno (1988-ix)

Current State
GP Practice
Lead Time
= 65.5 days
Process Time
= 193 Min
5 Min 22 Min 32 Min
5 Min
7 Min
3 Weeks
70 Min
90 Min
20 Min
60 Min
12 Min
6 Weeks4 Weeks
Referral
Out
Patient
Appoint-
ment
Pre Op
Assess-
ment
Admission
(Day Case)
Procedure Discharge Follow Up
National
Choose & Book
Local Booking
Service
List 2 wks
Before
Appointment
18 Week target
Max 6 MonthsMax 13 Months
Patient
Get
Date
Consultant
Secretary
Letter to Patient
Letter to GP &
Patient &
Consultant
Letter to GP
Follow up
Date
Daily List
Come In List
List 2 Weeks
Before
Appointment
Letter to GP
I I I I I I
Process
Box
Data
Box
Inventory
or
Delays
“Push”
C/T = 7 Min
C/O = 0 min.
Uptime = 100%
2 Shifts
27,000 sec av.

Value Stream Mapping is Fractal
Supply Chain Ideal State
Supply Chain Network &
Value Stream
Alpha Motors
Platform A
Apex
Wheels
Beta wipers
Epsilon
Fuel Pumps
Cosmic
Brakes
Eclipse
Engine
Computers
Gamma
Stampers
Ampersand
Magnets
Utopia
Castings
Michigan
Steel
Odyssey
Fasteners
Smith Heat
Treatment
Supply Chain Future StateSupply Chain Current State
Begin Here
e.g. Cardiology Current State e.g. Cardiology Future State
Future State by Area
PRODN.
CONTROL
We
ekl
y
Sc
he
dul
e
Pro
d’n
Pla
n
For
eca
st
Dai
ly
Call
In
For
eca
st
We
ekl
y
Call
InWeekly
Suppliers Customer
Mon.
+ Wed.
PRESS ASSEMBLY SHIP
I I
C/T = 30 sec.
C/O = 30 min.
3 shifts
2% Scrap
C/T = 90 sec.
C/O = 5 min.
2 shifts
3% Scrap
600 pieces
2 Day
300 pieces
1 Day
30 sec
2 days
90 sec
1 day
Total lead time 3 days
VA time 2 mins
Current State by Area
PRODN.
CONTROL
We
ekl
y
Sc
he
dul
e
Pro
d’n
Pla
n
For
eca
st
Dai
ly
Call
In
For
eca
st
We
ekl
y
Call
InWeekly
Suppliers Customer
Mon.
+ Wed.
PRESS ASSEMBLY SHIP
I I
C/T = 30 sec.
C/O = 30 min.
3 shifts
2% Scrap
C/T = 90 sec.
C/O = 5 min.
2 shifts
3% Scrap
600 pieces
2 Day
300 pieces
1 Day
30 sec
2 days
90 sec
1 day
VA time 2 mins
e.g. 2ndary Care Current State e.g. 2ndary Care Future State
Current State by Org’n
PRODN.
CONTROL
We
ekl
y
Sc
he
dul
e
Pro
d’n
Pla
n
For
eca
st
Dai
ly
Call
In
For
eca
st
We
ekl
y
Call
InWeekly
Suppliers Customer
Mon.
+ Wed.
PRESS ASSEMBLY SHIP
I I
C/T = 30 sec.
C/O = 30 min.
3 shifts
2% Scrap
C/T = 90 sec.
C/O = 5 min.
2 shifts
3% Scrap
600 pieces
2 Day
300 pieces
1 Day
30 sec
2 days
90 sec
1 day
VA time 2 mins
Future State by Org’n
PRODN.
CONTROL
We
ekl
y
Sc
he
dul
e
Pro
d’n
Pla
n
For
eca
st
Dai
ly
Call
In
For
eca
st
We
ekl
y
Call
InWeekly
Suppliers Customer
Mon.
+ Wed.
PRESS ASSEMBLY SHIP
I I
C/T = 30 sec.
C/O = 30 min.
3 shifts
2% Scrap
C/T = 90 sec.
C/O = 5 min.
2 shifts
3% Scrap
600 pieces
2 Day
300 pieces
1 Day
30 sec
2 days
90 sec
1 day
VA time 2 mins
Action Plans

Examples: Elective Surgery

Examples: GP Referral
Admission to Home Discharge

Examples: Consumable Stock
to Ward

Principles of Value Stream Design
• Define the problem(s)
– What exactly is the main problem (or set of problems) in the
value stream?
• What are the steps – valuable, necessary but not
valuable & waste?
• How will we build in quality (jidoka) at each process?
• How will we enable just in time (compress lead time?)
• How will we standardise work practices?
• How will we stabilise & improve availability?
• How will we develop people & work team leaders?
• How will we sustain & improve efforts over time?

Define the Problem(s)
• What exactly is the main problem (or set of
problems) in the value stream?
– What is the Process Capacity?
– What was the throughput?
– How many patients are currently waiting?
– What are typical (ranges) lead times for patients?
Understand the Demand

What are the Steps?
Touches & Time
• Valuable
• Necessary but not
valuable
• Waste
Worker
Movement
Waste
Net Work
Value Added
Work
Non-Value Added Work

How will we Build in Quality?
(Jidoka)
• Quality built in at each process step
– Mistake proofing
– Quality control
– Contain problems & don’t pass on defects

(Jidoka)
• Purpose: To design a toilet where people always put the
seat down!
• Process: Flush button located behind seat (when raised)
Ref: Chesford Grange: Lean Healthcare Summit

(Jidoka)
• Quality built in at each process step
– Mistake proofing
– Quality control
– Contain problems & don’t pass on defects
• Make problems visible
– So we can see if we are behind or ahead
– So we can see if we have abnormlities
Solve root causes of problems

How will we Enable Just in Time?
Compress lead time?
• What is the Takt Time (drum beat)?
• Where can we flow the work?
• Where do we have to use supermarket pull systems?
• What point can we gather information on what to do?
• At what single point in the value stream do we schedule
the work?
• What timeframe do we use to plan?
• How do we make sure workloads are levelled?
What is the Every Patient Every Interval?

How will we Standardise
Work Practices?
• Are Standards Simple/Complex?
• Where are they located?
– Point of Use/Remote
• Changeable tools/Unchangeable?
• “Pictures of what should be happening”
• Level 0: No Standards
• Level 1: Exist but are not followed
• Level 2: Standards exist and are often followed
• Level 3: Standards exist and they are followed
• Level 4: Evolutionary Learning
Without a Standard there can be NO Kaizen

How will we Stabilise & Improve
Availability?
• What are the problems in each process that lead to instability?
– Quality, reliability of equipment, reliability of methods being used etc?
Plan
Do
Act
Check
Process
Method
Material
Man
Machine
Ref: Suzaki (1993): The New Shop Floor Management
Plan
Actual

How will we Develop
People & Work Team Leaders?
• The challenge lies in managing the transformation
• Not a comprehensive list, but more questions:
• How do we show leaders the importance of thoroughly understanding
the work, living the philosophy, and teaching it to others?
• Go and see for yourself to thoroughly understand the situation
(genchi genbutsu)
• Thoroughly consider all options - Make decisions slowly by
consensus but implement decisions rapidly (nemawashi)
• Become a learning organisation through relentless reflection
(hansei) and continuous improvement (kaizen)
Act our way into a new way of thinking,
or think our way into a new way of acting?

How will we Sustain
& Improve Efforts over Time?
• Plan
– Communicate, scope, discuss,
set targets & agree the plan
• Do
– Collect & analyse data, carry
out the work
• Check
– Are we performing to plan?
– If not, why not?
• Act (Standardise)
– Standardise to sustain the
gains
Without a Standard there can be NO Kaizen
Plan
Do
Act
Check

Background/current situation
Historical/organisational/
business context
Analysis/detailed Current State
The specifics of the issues
Fishbones
Causes
5 Whys
Requirements, constraints &
alternatives

Recommendations
What will we do to
enact the Future State
Measures/Review
How we will know if the
actions make the
planned difference
Follow Up
Plan/Schedule
What to do,
actions,
deliverables

Manage your plan like a Value
Stream
• Focus on the timing and deliverables of the plan
– Manage the exceptions
– Ask “why” things went wrong in order to address root
cause
• Make sure someone is responsible
• Watch that you perform reviews (even when
things go wrong)

Conclusions:
Lean Implementation
Some Lessons Learned
• Cherry picking tools is not enough
• The tools comprise a system
– We focus on the flow of value to create a system
• A way of thinking underlies the tools & system
– We learn the thinking through doing
• Understand & define the problem
• Apply the thinking (logic) to your circumstances
in order to redesign value streams that flow
Ref: John Shook: Lean Enterprise Institute Senior Advisor

The Principles of Lean Value Stream Design

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