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 FacultyLean Enterprise Academy


Lean ThinkingA 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 StateGP Practice

Lead Time = 65.5 daysProcess 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

OutPatient

Appoint-ment

Pre OpAssess-

ment

Admission(Day Case) Procedure Discharge Follow Up

National Choose & Book

Local BookingService

List 2 wksBefore

Appointment

18 Week target

Max 6 MonthsMax 13 Months

Patient

GetDate

Consultant Secretary

Letter to PatientLetter to GP &

Patient &Consultant

Letter to GP

Follow upDate

Daily List

Come In List

List 2 WeeksBefore

Appointment

Letter to GP

I I I I I I

ProcessBox

DataBox

Inventory or

Delays

“Push”

C/T = 7 MinC/O = 0 min.Uptime = 100%2 Shifts27,000 sec av.


Value Stream Mapping is Fractal

Supply Chain Ideal State

Supply Chain Network & Value Stream

Alpha MotorsPlatform A

ApexWheels

Beta wipers

EpsilonFuel Pumps

CosmicBrakesEclipseEngine

Computers

Gamma Stampers

AmpersandMagnetsUtopia

Castings

MichiganSteel

OdysseyFasteners

Smith HeatTreatment

Supply Chain Future StateSupply Chain Current State

Begin Heree.g. Cardiology Current State e.g. Cardiology Future State

Future State by AreaPRODN.

CONTROL Weekly

Schedule

Prod’nPlan

ForecastDaily

Call In

ForecastWeekly

Call InWeekly

Suppliers Customer

Mon.+ Wed.

PRESS ASSEMBLY SHIPI IC/T = 30 sec.

C/O = 30 min.

3 shifts

2% Scrap

C/T = 90 sec.

C/O = 5 min.

2 shifts

3% Scrap

600 pieces2 Day

300 pieces1 Day

30 sec2 days

90 sec 1 dayTotal lead time 3 daysVA time 2 mins

Current State by AreaPRODN.

CONTROL Weekly

Schedule

Prod’nPlan

ForecastDaily

Call In

ForecastWeekly

Call InWeekly

Suppliers Customer

Mon.+ Wed.


C/O = 30 min.

3 shifts

2% Scrap

C/T = 90 sec.

C/O = 5 min.

2 shifts

3% Scrap

600 pieces2 Day

300 pieces1 Day

30 sec2 days


e.g. 2ndary Care Current State e.g. 2ndary Care Future State

Current State by Org’nPRODN.

CONTROL Weekly

Schedule

Prod’nPlan

ForecastDaily

Call In

ForecastWeekly

Call InWeekly

Suppliers Customer

Mon.+ Wed.


C/O = 30 min.

3 shifts

2% Scrap

C/T = 90 sec.

C/O = 5 min.

2 shifts

3% Scrap

600 pieces2 Day

300 pieces1 Day

30 sec2 days


Future State by Org’nPRODN.

CONTROL Weekly

Schedule

Prod’nPlan

ForecastDaily

Call In

ForecastWeekly

Call InWeekly

Suppliers Customer

Mon.+ Wed.


C/O = 30 min.

3 shifts

2% Scrap

C/T = 90 sec.

C/O = 5 min.

2 shifts

3% Scrap

600 pieces2 Day

300 pieces1 Day

30 sec2 days


Action Plans


Examples: Elective Surgery


Examples: GP ReferralAdmission to Home Discharge


Examples: Consumable Stockto 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

WorkerMovement

Waste

Net Work

Value AddedWork

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



• 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



• 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 StandardiseWork 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

gainsWithout a Standard there can be NO Kaizen

Plan

Do

Act

Check



Background/current situationHistorical/organisational/

business context

Analysis/detailed Current StateThe specifics of the issues

FishbonesCauses5 Whys

Requirements, constraints & alternatives


RecommendationsWhat will we do to

enact the Future State

Measures/ReviewHow we will know if the

actions make the planned difference

Follow Up

Plan/ScheduleWhat 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

Ian Glenday & David Brunt

Senior FacultyLean Enterprise Academy

Education

The Principles of Lean Value Stream Design