In our Value Streams Part Two, we will be completing our first value stream map. In our last video, we filled out steps one, getting medications, and two, walking to patient number three's bedside. Now let's fill out the administration of medications to patient number three, step three in our standard worksheet, shown by the black arrow, the end of the work cycle one; as well as getting the medications for patient number two, step number five on our standard worksheet and the beginning of work cycle number two. We will use the mode times on our time process sheet, starting with step three shown by the arrow. The title for the second process box on the left-hand side of this image is "Give Meds", the process description: "Administer meds to patient number three." This process was performed by our bedside nurse Wendy. The cycle time was 250 seconds, and all 250 seconds were value-added. The time to walk back to the medication chest was 30 seconds. The process box on the right of this image is entitled "Get Meds", the description: "Collect medications from the medication chart for patient number three." This work cycle took 300 seconds and was all value-added. WIP is now four patients because patient number 3 has received her medications, leaving four patients requiring administration of medicines. Filling out the next process box, "Give Meds", "Administering medications to patient number two." took 315 seconds and was all value-added. This completes work cycle number two. Putting these process boxes together on a single form looks like this. On the bottom right, there is a summary data box. See the black arrow. In this box, the lead time is filled in, and from the beginning of the medication collection to completing administration and medications for all five patients is to be completed within 60 minutes or 3,600 seconds. The process time for our observation was 1,145 seconds is determined by totaling the process box cycle times. As we have already discussed, all of this time was value-added. The takt time is also calculated as we have previously done by dividing the available time, 3,600 seconds, by the demand, administering of medications to five patients, giving a takt time of 720 seconds. Now we can add other helpful symbols to show what the patient is experiencing. We can add push and pull arrows. A push process is depicted by an arrow pointing to the right and indicates that the process is activated, whether or not the downstream person is ready. A pull process is depicted by an arrow pointing to the left and indicates the process is activated only when the downstream person is ready or the downstream cycle work has been completed. Whenever possible, you should aspire to pull. There are two types of arrows that can be used to demonstrate the different types of flow. One, supplies, equipment, and non-electronic information are shown using a straight arrow. And two, electronic information flow is shown as a lightning-like arrow. Use of a computer system could be shown as a schematic drawing of a computer shown at the bottom of this slide. Here we see the electronic information flowing to a computer. This is shown because the bedside nurse is using a barcode scanner both when she collects the medications and when she administers them to the patient. This electronic information is going directly to her computer. Comments on opportunities for improvement can also be added to the value stream. The conventional symbol is a thunder cloud with a lightning bolt, as shown in the middle of this slide. Many inexperienced value stream mappers want to include potential fixes for the defective step. However, only observations, not solutions, should be included in these clouds. For example, if the observer notices that the nurse performs a process in many different ways, the comment should be highly variable – this would be appropriate – rather than, need to write a standardized operation description for this process – that is a solution and should not be included. Now this is how the value stream map looks with the comments and information flow indicators. In summary, value stream mapping provides a rich picture of what the patient and/or the staff member are experiencing. The map assesses the type of flow, push or pull; documents work in process, WIP; shows the type of information transfer, nonelectronic or electronic; and shows where computers are being used. The Value stream map provides a shared mental model for all participants and encourages the strategic targeting of improvement efforts. The value stream map is the very heart of Lean. Thank you.
