Mapping Clinical Value Streams: 1st Edition (Paperback) book cover

Mapping Clinical Value Streams

1st Edition

By Thomas L. Jackson

Productivity Press

123 pages | 202 B/W Illus.

Purchasing Options:$ = USD
Paperback: 9781466551848
pub: 2013-05-20
Hardback: 9781138431799
pub: 2017-07-27

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Tens of thousands of patients die unnecessarily every year as a result of errors and defects in our healthcare processes. Those that survive often pay too much for the privilege. The value stream mapping methods described in Mapping Clinical Value Streams will help you achieve more efficient health care processes and will pave the way to an improved medical system with significantly reduced medical errors and other costly waste.

Part of the Lean Tools in Healthcare series, this user-friendly book will help you understand how to use value stream mapping to provide quality, patient-centered care. Value stream mapping is a powerful tool for observing and depicting processes as they truly are—and for envisioning and reconfiguring the same processes to eliminate errors and other waste. With this book, you’ll learn how to:

  • Map current-state processes
  • Create a future-state map with processes streamlined through "flow" and "pull"
  • Manage the rollout of your future state with "A3" project plans

Presented in a highly organized and easy-to-assimilate format, the book includes examples from actual healthcare processes, plus numerous illustrations and margin assists that call your attention to key points. Value stream mapping icons make it easy to see and understand the ebb and flow of healthcare processes. Each chapter also includes a summary for quick review. Throughout the book you will be asked to reflect on questions that will help you apply these concepts and techniques to your own workplace.

To be competitive in today’s marketplace, you cannot afford to leave processes unexamined, or let them become haphazard. You must apply conscious, quality attention to continuously see and fix your healthcare processes. In Mapping Clinical Value Streams, Shingo Prize-winning author Thomas L. Jacksonshows you how.

Table of Contents

Getting Started

The Purpose of This Book

What This Book Is Based On

Two Ways to Use This Book

How to Get the Most out of Your Reading

Become Familiar with This Book

Become Familiar with Each Chapter

How a Reading Strategy Works

Using the Margin Assists

An Overview of the Contents

Chapter 1: Getting Started

Chapter 2: The Production Processes and Operations of Healthcare

Chapter 3: Value Streams and the Mapping Process

Chapter 4: Map the Current State

Chapter 5: Map the Future State: Phase I—Flow

Chapter 6: Map the Future State: Phase II—Pull

Chapter 7: Implement the Future State

Chapter 8: Reflections and Conclusions

The Production Processes and Operations of Healthcare

The Industrial Origins of Lean Healthcare

Production, Process, and Operation

Principles of Lean Healthcare Management

Standard Work


Flow Production


Socratic Method



Value Streams and the Mapping Process

Mapping Clinical Value Streams

What Is Value?

The Seven Wastes and the Purpose of Value Stream Mapping

Patient as Customer versus Participant

What Is a Value Stream?

The Value Stream Mapping Process

Using Value Stream Mapping Icons



Map the Current State

The Power of Direct Observation

Building a Current-State Map

Choose a Service Family

Identify the Patient

Walk the Value Stream and Gather Data

Identify Sequential Operations in the Process

Identify Operational Metrics

Identify Waits between Operations

Document How Work Is Prioritized

Identify Manual and Electronic Information Flows

Identify External Patient Flows

Build a Process Time Line and Calculate Summary Statistics

Another Example



Map the Future State: Phase I—Flow

Principles of Flow Production in Healthcare

Building a Future-State Map with Flow

Produce Services to Takt Time

Eliminate Waits to Flow the Process

Create Continuous Flow with Clinical Cells



Map the Future State—Phase II: Pull


If You Cannot Flow, Pull

Link Separate Processes with FIFO Lanes

FIFO Lanes and Reaction Plans

Where to Use FIFO Lanes

Is FIFO Consistent with Patient Safety?

Pull Production with Buffers

When to Use Buffers

Examples of Buffers

Push Me, Pull You

Pull to the Pacemaker

Level the Production Volume

Level the Case Mix



Implement the Future State


Loop the "Loops"

Hoshin Kanri, A3-Ts, and PDCA

Plan: Write an A3-T for Each Loop

Do: Conduct Kaizen Workshops

Check and Act: Develop Leader Standard Work

Where to Begin?



Reflections and Conclusions

Reflecting on What You Have Learned

Applying What You Have Learned

Possibilities for Applying What You Have Learned

Applying Value Stream Mapping in Your Organization

Your Personal Action Plan

Opportunities for Further Learning



Further Reading about Value Stream Mapping

Further Reading about Lean Healthcare

Useful Websites

About the Author

Tom Jackson, JD, MBA, PhD is the former CEO of Productivity, Inc. and Productivity Press. He is also a member of the influential Ford Lean Advisory Group. Tom has been a student of Lean enterprise since 1988, when he copyedited Hiroyuki Hirano’s JIT Factory Revolutionfor Productivity Press and reworked two chapters of Yasuhiro Monden’s groundbreaking Japanese Management Accounting. Looking at pictures of Japanese factories and reading about how differently the Japanese count their money, Tom became so fanatical about Lean that he left his comfortable position as a professor of business at the University of Vermont to start his own Lean consulting company – in Malaysia! There he learned that the powerful techniques of Lean enterprise – JIT, SMED, TPM, kanban, etc. – only half the story of Toyota’s great success. The other half of the story was hoshin kanri(aka the "balanced scorecard") and a revolution in the structure of modern business organization. In 2005, Tom started applying Toyota’s operational and management methods in healthcare in a small rural clinic in Seward, Alaska. In 2008, Tom decided to trade his Levi Dockers for a pair of black scrubs and joined Mike Rona, former President of Seattle’s Virginia Mason Medical Center, as a partner in the Rona Consulting Group, where he and Mike are "transforming healthcare and pursuing perfection." In 2007, Tom was awarded a Shingo Prize for his book, Hoshin Kanri for the Lean Enterprise.

About the Series

Lean Tools for Healthcare Series

Learn more…

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Quality Control
BUSINESS & ECONOMICS / Industries / Service Industries
MEDICAL / Administration