Now we're going to cover the heart of TPS or lean, Value Streams, Part 1. In our last four sessions, you learned how to draw a standard worksheet, enter and calculate time intervals using a time observation sheet. Draw a standard work combinations sheets. And create a percentage load chart. Now I want to teach you how to use the most important tool for improving standardized work, the value stream map. How do we define a value stream? I like the following definition. The sequence of all the steps in a process to create the final product or service. Just like a free flowing stream, there should be no obstructions or resistance to flow, bottlenecks or barriers. And no need for portages, no work arounds. We want the stream shown in the upper image not the lower image. What is a value stream map? Is the drawing depicting the product or information flows of one service or product. To draw a value stream map the observer needs to walk with the patient through the processes required to treat a specific disease or to perform a specific test. Or walk with a nurse, physician, or other healthcare worker as they perform a service for a patient or to create a product. Before you draw your map, you will have to decide at what level of detail are you going to map. Are you mapping at 50,000 feet? That's what high-level administrators may be interested in doing. Or at 500 feet, most frontline administrators and providers are interested in this view. Value street maps are very helpful in both circumstances. And as we will discuss in a later session, these maps can identify specific bottlenecks and other process issues that may require further analysis using rapid improvement events and process mapping. We are going to draw a value scene for a very small process, this is a 100 foot view. Generally, this is of finer detail than the average value stream map, but I'm using this example because it is simple, and allows me to clearly explain to you how to use this important tool. We're going to map our bedside nurse Wendy administering medications to patient number three and number two as shown in our standard worksheet. We'll be mapping the ideal future state rather than present state. For your homework, you will be watching a video of Wendy's present state and as you will quickly realize the present state is very different than the ideal future state we are mapping in this session. Our first task is to fill out the first process box, what is a process box? Each process box describes a single work cycle. To determine if you need to fill out a process box, ask when is the patient or the product interacting with a staff? Looking at our time observation sheet, step one, gathering the medications for patient number three, represents the first work cycle, the product medication is interacting with the staff, the nurse. Fill in the content of each prospect process box, first create a heading that describes the step. Our bedside nurse Wendy is collecting medications for patient number three from the Medication Chest, a simple short title can be used, Get meds. In the large square, briefly described the activity. We can write collect medications from the Med Chest for patient number 3. Also the process box lists the person or persons responsible for forming this activity. A circle with a smile symbol beneath, it is a symbol used for people. In this case, we have a single person for this process box but other process boxes may include more than one person. Below the process box, is the data box that includes cycle time, in this process, 280 seconds. The change over time, in our process, there is no change over. Examples of change over might be restocking of an operating room between operations or the cleaning of a clinic examining room between patients. The next two boxes, value added and non-value added, are very important for identifying waste within each process. Remember, value is defined as what is important and a benefit to the patient. To decide what parts of a process are value-added, ask the following questions. Will the patient truly benefit? Would or should the patient be willing to pay for this? Was the process performed correctly the first time? If the answers to these questions are yes, the process is value added. If the answer is no, it is not a value or a nonvalue-added. In our example, all of Wendy's activity collecting medications for patient number three is a value. Therefore, the value added box includes the entire work cycle time of 280 seconds. And the value added activity represents 100% of the work cycle. Next, fill in the time required to walk to patient's number three's room, to administer the medications. Walking and waiting are filled out in the upper horizontal line, between each process box. And walking to the patient's bedside took 30 seconds, as shown on the right side of this image. Before moving to the next process box, we need to determine the work in progress, or WIP. This is defined as the number of patients or products at or between each step in the process. WIP represents a snapshot of the process at each time point. In our medications example, the WIP between process one and two is the four patients waiting to receive medications and one patient, patient number three who is between processes 1 and 2. Therefore WIP, in this circumstance is 5. In this illustration you see two process boxes, Get Meds and Give Meds, and there's a triangle in between with the number 5 designating the WIP. Here is the entire value stream map form that includes eight process step boxes. This PDF form is available to download for free in our course website, I personally created this form using Microsoft Excel and it is not copy righted. In my view, value stream map templates should be an open resource to encourage everyone in a health career to use this valuable tool without economics barriers. However, when I searched the Internet, everyone of the forms I found was proprietory. Either being associated with a consulting firm, or a health system organization. In filling out the forms during our class, I have typed in the values. But you can fill out these values on the downloaded form using a pencil. I recommend a pencil because after reanalysis you may need to change some of your values. Remember, value stream maps are a dynamic working document. As I have discussed in this session, the value stream map illustrates every process in detail, it describes each process, who is involved and includes an assessment of the value added, nonvalue added activities. It documents walk times, wait times and includes Work in Progress, WIP. In the next video, we will complete our map by filling in the other steps in our medication administration process. Thank you.
