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chadstewart.com.au
Better, Faster, Cheaper
Increasing productivity &
profitability through business
process improvement.
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“Nidja Noongar boodjar noonook nyininy”
[this is Noongar country you/we are sitting in]
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Define
Measure
Analyse Improve
Control
Process Improvement
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Process Improvement & Profitability
Lower production or service costs
from improved cycle time and
reduction of waste in the value
stream.
Increased efficiency.
Improved use of equipment and
company resources.
Improved use of human resources.
Lower level of capital expenditure
required to support the operations
of the business.
Lower service and support costs
from eliminated waste, rework and
non-value-added activities.
Increased sales related to the
combination of better-on-time
delivery and reduced cycle time.
More competitive pricing,
reliability and conformance.
Improved gross margins from
lower product/service costs due
to reduced errors, rework, scrap
and non-value added activities.
Improved operating margins from
lower administration costs due to
elimination of waste/ non-value
added activities, reducing the
level of asset investment required
to support the business, reduced
errors and defects especially for
downstream internal customers.
Effective Process
Improvement
Increased Productivity Increased Profitability
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Foundations of Process Improvement
Lean
• Focused on delivery value
to the customer.
• Interrogates every process
to remove waste.
• Focused on reducing
process cycle times.
• Using root cause analysis
to eliminate problems.
Six Sigma
• Data driven approach to identify
inputs that affect an output.
• Seeks to reduce the number of errors
and variation in key processes.
• Deliver more consistent outcomes,
usually at less cost.
• More rigorous approach to RCA.
Delays
Defects
Deviation
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Define
articulate the problem.
identify the customers.
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Review Performance Measures
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Identify Customer Value Drivers
How marketing
pictured it.
How manufacturing
made it.
What the customer
actually wanted.
How the process
was documented.
Product Price Access Service Experience
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Voice of the Customer
2. Identify the customers
1. Define the process of interest
3. Ask the questions
4. Assess the results
• Customer vs. stakeholder
• Internal vs external
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Measure
elicit the Voice of the Customer.
map the current processes.
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Map the Process
Business Process Mapping Notation (BPMN)
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Example: Process Map C
ha
d S
tew
art
Pat
ien
t Jo
urn
ey
Spe
cia
list
Ad
min
Nu
rsin
gSu
pp
ort
Se
rvic
es
Gastroent. books
endoscopy
Patient takes specialist form
to Hospital reception.
Patient attends hospital on day of procedure.
Patient is assessed by Nurse who checks info.
on form.
Patient dresses for surgery and is moved to seated
wait area.
Orderly transports
patient to prep room.
Orderly transports patient
to operating theatre.
Anaesthetist visits patient,
checks information and preps.
Gastoent. Visits patient for post-
op talk.
Patient leaveshospital
Orderly moves patient to
recovery room.
Reception provide paper pre-admission
form to patient.
Patient completes and returns paper
form.
Patient completes
admission form for clerk.
Nurse moves patient to post-op room when
conscious.
Nurse checks patient is ok
to be discharged.
Patient provided
sandwiches and hot beverage.
Carers contact NOK
to collect patient
Gastroent. conducts
procedure.
Anesthetist sedates patient
Patient moved to recovery
lounge.
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Analyze
look for delays, defects
& deviation
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Medical Specialist - Responsibilities C
ha
d S
tew
art
Pat
ien
t Jo
urn
ey
Spe
cia
list
Ad
min
Nu
rsin
gSu
pp
ort
Se
rvic
es
Gastroent. books
endoscopy
Patient takes specialist form
to Hospital reception.
Patient attends hospital on day of procedure.
Patient is assessed by Nurse who checks info.
on form.
Patient dresses for surgery and is moved to seated
wait area.
Orderly transports
patient to prep room.
Orderly transports patient
to operating theatre.
Anaesthetist visits patient, checks
information and preps.
Gastoent. Visits patient for post-
op talk.
Patient leaveshospital
Orderly moves patient to
recovery room.
Reception provide paper pre-admission
form to patient.
Patient completes and returns paper
form.
Patient completes
admission form for clerk.
Nurse moves patient to post-op room when
conscious.
Nurse checks patient is ok
to be discharged.
Patient provided
sandwiches and hot beverage.
Carers contact NOK
to collect patient
Gastroent. conducts
procedure.
Anesthetist sedates patient
Patient moved to recovery
lounge.
chadstewart.com.au chadstewart.com.au
Finance – Responsibilities C
ha
d S
tew
art
Pat
ien
t Jo
urn
ey
Spe
cia
list
Ad
min
Nu
rsin
gSu
pp
ort
Se
rvic
es
Gastroent. books
endoscopy
Patient takes specialist form
to Hospital reception.
Patient attends hospital on day of procedure.
Patient is assessed by Nurse who checks info.
on form.
Patient dresses for surgery and is moved to seated
wait area.
Orderly transports
patient to prep room.
Orderly transports patient
to operating theatre.
Anaesthetist visits patient, checks
information and preps.
Gastoent. Visits patient for post-
op talk.
Patient leaveshospital
Orderly moves patient to
recovery room.
Reception provide paper pre-admission
form to patient.
Patient completes and returns paper
form.
Patient completes
admission form for clerk.
Nurse moves patient to post-op room when
conscious.
Nurse checks patient is ok
to be discharged.
Patient provided
sandwiches and hot beverage.
Carers contact NOK
to collect patient
Gastroent. conducts
procedure.
Anesthetist sedates patient
Patient moved to recovery
lounge.
chadstewart.com.au chadstewart.com.au
Nursing – Responsibilities C
ha
d S
tew
art
Pat
ien
t Jo
urn
ey
Spe
cia
list
Ad
min
Nu
rsin
gSu
pp
ort
Se
rvic
es
Gastroent. books
endoscopy
Patient takes specialist form
to Hospital reception.
Patient attends hospital on day of procedure.
Patient is assessed by Nurse who checks info.
on form.
Patient dresses for surgery and is moved to seated
wait area.
Orderly transports
patient to prep room.
Orderly transports patient
to operating theatre.
Anaesthetist visits patient, checks
information and preps.
Gastoent. Visits patient for post-
op talk.
Patient leaveshospital
Orderly moves patient to
recovery room.
Reception provide paper pre-admission
form to patient.
Patient completes and returns paper
form.
Patient completes
admission form for clerk.
Nurse moves patient to post-op room when
conscious.
Nurse checks patient is ok
to be discharged.
Patient provided
sandwiches and hot beverage.
Carers contact NOK
to collect patient
Gastroent. conducts
procedure.
Anesthetist sedates patient
Patient moved to recovery
lounge.
chadstewart.com.au chadstewart.com.au
Corporate Services - Responsibilities C
ha
d S
tew
art
Pat
ien
t Jo
urn
ey
Spe
cia
list
Ad
min
Nu
rsin
gSu
pp
ort
Se
rvic
es
Gastroent. books
endoscopy
Patient takes specialist form
to Hospital reception.
Patient attends hospital on day of procedure.
Patient is assessed by Nurse who checks info.
on form.
Patient dresses for surgery and is moved to seated
wait area.
Orderly transports
patient to prep room.
Orderly transports patient
to operating theatre.
Anaesthetist visits patient, checks
information and preps.
Gastoent. Visits patient for post-
op talk.
Patient leaveshospital
Orderly moves patient to
recovery room.
Reception provide paper pre-admission
form to patient.
Patient completes and returns paper
form.
Patient completes
admission form for clerk.
Nurse moves patient to post-op room when
conscious.
Nurse checks patient is ok
to be discharged.
Patient provided
sandwiches and hot beverage.
Carers contact NOK
to collect patient
Gastroent. conducts
procedure.
Anesthetist sedates patient
Patient moved to recovery
lounge.
chadstewart.com.au chadstewart.com.au
Interrogating the Process
D elay
O ver-production
W aste
N on-value add processing
T ransportation
I nventory
M otion
E mployee underused potential
Source: Jay Arthur
chadstewart.com.au chadstewart.com.au
Who is responsible for the whole process?
Ch
ad
Ste
wa
rt P
atie
nt
Jou
rney
Spec
ialis
tA
dm
inN
urs
ing
Sup
po
rt
Serv
ices
Gastroent. books
endoscopy
Patient takes specialist form
to Hospital reception.
Patient attends hospital on day of procedure.
Patient is assessed by Nurse who checks info.
on form.
Patient dresses for surgery and is moved to seated
wait area.
Orderly transports
patient to prep room.
Orderly transports patient
to operating theatre.
Anaesthetist visits patient,
checks information and preps.
Gastoent. Visits patient for post-
op talk.
Patient leaveshospital
Orderly moves patient to
recovery room.
Reception provide paper pre-admission
form to patient.
Patient completes and returns paper
form.
Patient completes
admission form for clerk.
Nurse moves patient to post-op room when
conscious.
Nurse checks patient is ok
to be discharged.
Patient provided
sandwiches and hot beverage.
Carers contact NOK
to collect patient
Gastroent. conducts
procedure.
Anesthetist sedates patient
Patient moved to recovery
lounge.
(i.e. who is responsible for the delays?)
chadstewart.com.au chadstewart.com.au
Determine Non- Value Add Activities
NVA - Customer unwilling to pay for, doesn’t
change the product/service, not right first time.
Business Value-Add
(BVA)
Value-Add
Non-Value Add
VA – Activity the customer is willing to pay for and
which changes the product/service in a tangible way.
BVA - A change to the product/service needed for the
next step or to comply with compliance rules.
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Patient
1. Registration 2. Assessment 3. Preparation 4. Treatment 5. Recovery 6. Post recovery 7. Discharge
3Verify Ins min
4Update Info min
3Process min
1transport min
5vitals min
5Info check min
4Pat change min
3transport min
5Info check min
3Prep canul min
4assess min
5transport min
10sedation min
5preparation min
15procedure min
5movement min
10observation min
45recovery min
5assess min
5movement min
2Food request min
10Food provide min
2Assessment min
5Contact NOK min
20Wait for NOK min
4Transport min
10 mins 15 mins 15 mins 35 mins 60 mins 17 mins 31 mins
20 mins 20 mins 20 mins 10 mins 10 mins 25 mins
20 mins 20 mins 20 mins 10 mins 10 mins 25 mins
Chad Stewart Value Stream Map
Cycle time =288 minutes
Wait time = 105 minutes
Value-added time = 135 minutes
Non-value add time = 153 minutes
Prop. of total cycle time that is NVA = 53%
Value Stream Mapping
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Spaghetti Diagram Root Cause Analysis
Waiting room Day
Surgery Admin
Assessment
Prep waiting room
Preparation room
Recovery room
Post-recovery waiting room
Recovery Lounge
Theatre
Admission desk
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Improve
make the change.
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7 R’s of Process Innovation
Rethink is there a different way?
Reconfigure can we eliminate or consolidate activities?
Re-sequence can activities be done concurrently?
Relocate can activities be moved to related activities?
Reduce Can the frequency of the activity be reduced?
Reassign Can staff be cross-trained for contingency planning?
Retool can we automate the process or improve skills?
Source: Stephen Shapiro
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Control
sustain the results.
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Embedding Continuous Improvement
1. Establish a few key process performance metrics.
2. Ensure the process is being managed and monitored properly.
3. Focus on one or two big ticket items at a time.
4. Build the improvement team around the person who identified the problem.
4. Keep focused on four priorities of Lean:
• Value: Determine what steps are required (are of “Value”) to the customer
• Flow: Remove waste in the system to streamline the process.
• Pull: Ensure the process responds to customer demand (“Pull” = want)
• Perfection: Continuously pursue “Perfection” within the process.
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From Functional to Process View
Functions drive
the business
Processes are acknowledged
but Functions dominate
Processes drive
the business
Accounts
Payable
Ware
ho
usin
g
Lin
e M
anag
em
ent
Procurement Office
Procurement Office
Procurement Office
Accounts
Payable
Ware
ho
usin
g
Lin
e M
anag
em
ent
Accounts
Paya
ble
Ware
housin
g
Pro
cure
ment O
ffic
e
Procure to pay
Order to Cash
Recruit to Retire
Cu
sto
mer
chadstewart.com.au
p 07 5602 8261
m 0409 378 301
t @ChadSConsulting
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