Mapping Clinical Value Streams

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
     Autonomation
     Flow Production
     PDCA
     Socratic Method
Summary
Reflections

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
Summary
Reflections

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
Summary
Reflections

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
Summary
Reflections

Map the Future State—Phase II: Pull
Introduction
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
Summary
Reflections

Implement the Future State
Focus
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?
Summary
Reflections

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
Conclusions

Appendix
Further Reading about Value Stream Mapping
Further Reading about Lean Healthcare
Useful Websites