Value Stream Mapping (VSM) is one of the essential Lean tools used to document, analyze and improve the flow of information, materials or people required to provide services and create value for patients and other stakeholders. By incorporating fundamental Lean concepts, VSM helps identify the sources of waste in a value stream, differentiate between valued-added and non-value-added activities, optimize decision making, provide common language, and streamline critical processes across organizational or departmental boundaries. VSM can also include value-enabling activities that do not directly create value as specified by patients and other stakeholders, but have to be performed in order to enable effective functioning of the processes, maintain financial stability of an organization, and meet legal and regulatory requirements. For example, accounting, payroll processing, recruitment, capital planning, preventive maintenance, and purchasing processes are generally considered value enabling activities that cannot be completely eliminated from a system. In essence, VSM represents a blueprint for action and starting point for system optimization and collaborative process improvement efforts. For the sake of simplicity, the basic value stream mapping steps are presented below as distinct elements. However, in practical applications VSM employs an iterative process with overlapping and interconnected steps.
While there are no guarantees with VSM, adherence to the following guidelines will significantly increase the likelihood of success:
- Select a value stream, identify key stakeholders and establish interprofessional improvement team
- Reach team agreement on the improvement goals, scope of work and project boundaries
- Ensure appropriate representation from all departments, units and functions that work in the selected value stream
- Provide new perspectives and ways of thinking by having a “fresh pair of eyes” on the team
- Establish a sense of common purpose and be clear on what represents value from the viewpoint of patients and other stakeholders
- Conduct an initial walkthrough of the entire value stream to understand the flow and get a snapshot of the actual processes
- Begin mapping at the end of the value stream where processes are linked directly to the patients and continue working further upstream
- Use a pencil, photos and sticky notes to capture essential information and map process steps and activities on a large sheet of paper
- Conduct another but more detailed walkthrough of the value stream and collect data that accurately reflect current reality
- Facilitate conversation with front line staff and engage in active listening
- Consolidate all available information, document assumptions, identify areas for further investigation, and create a current state map
- Verify accuracy of the current state map through additional data collection, feedback and repeated process observations
- Analyze the current state map and identify the sources of waste, non-value-added activities and process bottlenecks
- Perform Root Cause Analysis (RCA) and prioritize problems according to their risk level and impact on patients and other stakeholders
- Identify opportunities for improvement and develop an ideal future state map to create a shared vision
- Identify and consider existing organizational, financial and technological constraints
- Develop a realistic future state map to provide a roadmap for short-term improvements
- Continue to improve the value stream maps as increasingly detailed, accurate and specific information becomes available
- Resist the temptation to finalize the future state maps before achieving complete understanding of the current state
- Break down functional silos, involve front line staff and develop an integrated action plan to move toward the desired future state
- Develop and implement a robust monitoring and control system to minimize risks and identify variances from the action plan
- Use a balanced mix of indicators to establish baselines, measure performance and evaluate the impact of change
- Report progress on a regular basis and take preventive and corrective actions as required
- Recognize, reward and celebrate successes
VSM may appear similar to a flowchart and other visual process improvement tools that show process steps, tasks, activities, and decision points in sequential order. Unlike the traditional flowcharts that lack the element of time and tend to concentrate on a single process, VSM is a graphical representation of the entire value stream that captures time elements and often involves a large number of interconnected processes. Taking a broader view of the system makes it possible to drive strategically important improvements while minimizing the risk of system suboptimization that could result from making isolated improvements within the boundaries of individual departments. VSM displays a wide range of useful information that may include cycle time, processing time, lead time, changeover time, waiting time between process steps, takt time, yield, inventory, safety stock, defects, required human resources, equipment downtime, improvement opportunities (“kaizen bursts”), and other pertinent data. Information flow is typically drawn in the top half of the VSM and it shows main communication channels among departments, patients, individual healthcare providers, and various information systems. The process steps that outline the flow of patients, healthcare providers, products, materials, and equipment are shown in the bottom part of the VSM. However, the level of detail, icons used, format, and overall appearance of the VSM are often customized to address specific circumstances, reflect the level of work complexity, and meet organizational needs and team preferences. An example of the customized, high-level Current State VSM for Interventional Radiology (IR) patients is provided below.