Mapping Clinical Value Streams  book cover
1st Edition

Mapping Clinical Value Streams

ISBN 9781466551848
Published May 20, 2013 by Productivity Press
124 Pages 202 B/W Illustrations

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Book Description

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. Jackson shows 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

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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 Revolution for 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.