I'm now going to tell you about the last type of process map, Value Stream Mapping. As you can see, it is very different than the other two types. You don't see any decision points, you don't see any arrows that go backwards any loops in time. This is just the high level depiction of the general 80% or more flow of the process. It has very high level blocks that are labeled. It even has little triangular icons in between and that just represents that there might be wait time or things or people that are waiting and you can include things like information technology computer systems. But, it is a very simple process that could be mapped out in much shorter period of time than the other two, because it doesn't have the detail and the complexity of the other two. It is a visual depiction of the thing, the person, the information, the product traveling through the process. So, is from the perspective of that item that is going through and experiencing the process. It shows the flow, whether it's information, and it also can include items for performance, metrics, any measurements that you're taking on the process as you go. The real thing you have to let it happen is for the map to do the talking. Because it is going to be a visual story that will evolve over time. A value stream is all of the actions, some of them valuable, some of them non valuable, that are required to bring that product or service to the customer. So, is the things that happen in that flow, in that value change from a starting point to a defined end point, in the terms of the customer's perspective. Now, it is a proven technique to build in a short period of time, a team's perspective of the process that is consistent with that group, because it's a high level, and it has not only the process but also process and information and shows the relationships of all of those into one very simple, visual document. The pitfalls you have to worry about is that there are some times you're going to try to look at a process without experiencing it lately. You shouldn't do a process map just from a conference room. You really should go to that gemba, go to the real place where the action is happening, and then you can map it out. The problem, the pitfall, is mapping without observing the actual process. You may be an excellent person, a subject matter expert, but if you haven't been there lately, you may have missed some of the things when you're making your value stream map. So here are the steps. The first, you have to define the start and the finish point, the measurable points. When did it really begin? When did it end? The patient walked into the clinic and the patient walking out of the clinic. It has to be an operational definition so is consistent and measurable. Also you have to identify that process in four to eight steps. Again, this is a very high level document. So, you don't have all the details. Each one of those steps is really just an interaction. You're going to have, maybe, a conversation or an interaction with a particular individual. That's why registration might be one step all by itself, even ignoring all of the details because you were having one conversation with one person and then probably waiting until you go to the next step of your experience, where you're talking with another individual. Again, very high level. Now, going to the gemba, after you've identified those steps, observe the process, as I've said before. You want to map that process flow using very simple diagrams as we've shown, and I'll show you another one in just a little bit. And, in that process flow, include any of the queues or areas where things are waiting. Because as we've decided before, waiting is a terrible waste in all processes. Also, identify information systems more than just the flow of the entities that you see. Because, knowledge and information can be as much of a delay as any other part of the process. Now, identifying data as you go to be captured because this isn't just to map for mapping sake. You are going to be use this as a evolving tool. And so, having the benefit of data being added later will be a benefit to your improvements when you go further on down in your process. And finally, and very importantly, when you complete this map, please validate it with the people who actually live the process rather than running off on your own or sharing it with their supervisors or anyone else. Really, keep them included in the entire process. Now, here is an evolved process map, a value stream. You can see it has just five steps. But, it has information that's been added that has the time that it takes for each one of the blocks and it shows wait times in between as the patient experiences going through all of the steps, including transport and including the technology, the information that's in the center of the map. So, this is part of the evolution of the living document of the value stream map. So, in summary, we've now covered three types of process maps, each that has its own benefits. The Traditional and the Swim Lane, very detail oriented that can identify handoffs and also too many complex steps and decision points, and the Value Stream at a higher level, can show things that will look at delays and give you a broader perspective of the process. It would be a great idea to start with a value stream and get a broader vision of your entire process and then once you've identified any bottlenecks in the process, you can then use the Swim Lane or the Traditional maps. Now, that you have identified a smaller scope of your project, you could then put forth the effort that it would take for the detailed analysis just in those areas, rather than doing a full process map of a Swim Lane and entire process just in the blocks that you have defined before.
