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Your Value Stream Map Looks a Little Different...

by Aaron Hunt
April 26, 2016

Your Value Stream Map Looks a Little Different...

by Aaron Hunt
April 26, 2016 | Comments (9)

The tools of lean are exciting to introduce and apply. At Washington Health System, we actually started our journey with a tools-based approach to lean (it doesn’t really work, but you knew that already…).  We learned a valuable lesson through that approach – that as exciting as lean tools are, it’s important that creating the perfect tool doesn’t become your only focus. Often the phrase “I think it made things better” is a common answer regarding results; but now the question “What is the problem we’re trying to solve?” probably causes more frustration than anything else.

I remember one occasion when we were working on educating and coaching key team members and one of them said, “Your value stream map looks different than what I’ve seen in the past.” Since VSM wasn’t one of the tools that had been rolled out (attempting “Rapid Improvement Workshops” without VSM is an entirely different discussion), I figured this comment stemmed from some other previous experiences or self-study. Our conversation basically led us down the path of doing VSM the way I started in manufacturing, with the very standard symbols and using Visio to “make it look like a VSM.”

The event we were discussing was for a Nuclear Medicine clinical procedure, but it was focused primarily on the communication between the various functions as our patients went from being scheduled for the procedure at the doctor’s office, through registration, and then through the procedure.  The key components we needed on that map were the process steps, the cycle time, the percent complete and accurate, the information flows, and the wait times.  We used post-it notes on dry-erase to create our basic map.

Then we focused on the opportunities, which led us to brainstorming, and onto creating an action plan to resolve the problems. So no, the VSM we created didn’t look exactly like one from Learning to See, but it did allow us to see what we needed to see.  Our team was not going to change the clinical procedure, but we were able to reduce 90 percent of the “rework” that occurred in the scheduling process.  We eliminated 75 percent of the support calls needed in Nuclear Medicine to correct information in the software system, 100 percent of the late starts in the morning which put the team (and patients) behind schedule all day long, and they eliminated 100 percent of the delays from patients that called the wrong number when returning calls due to using caller ID. We also found some patient comfort items which are hard to quantify, and weren’t needed to be quantified because they were just “the right thing to do.”  Altogether, our relatively good patient satisfaction scores have risen higher.

What did we learn from all this? When embracing an improvement mindset, it is very important to understand the “why” of what you’re doing. What is the problem you’re trying to solve, and then, why are you choosing to use a certain tool? What is the result you hope to attain (while refraining from identifying the solution you hope to implement)? How do you envision the tools selected from the lean toolbox helping make the improvements? And if you think there’s a different way of applying a tool, ask, “Are we changing the tool to prevent us from changing the organization, or to better ensure change happens?” 

What lean tools have you seen applied a little differently, and did it help move the organization forward? Or was it done out of convenience and comfort, resulting in little real change?

The views expressed in this post do not necessarily represent the views or policies of The Lean Enterprise Institute.
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9 Comments | Post a Comment
Dan Cashman April 26, 2016

Great post Aaron!

I also work in healthcare and find myself in many situations like this. What always resonated with me (and was drilled into me by senseis) about Learning to See was to focus exactly on what the name implies - the map helps you SEE waste. A VSM is not a magical tool and in and of its self does not solve anything. It simply allows you to SEE the waste at the Value Stream level, and then like any map helps you decide where to go. That being said, and as you point out, in keeping with A3 Thinking it is always best to spend time agreeing on what the problem is you are solving for. This then allows you to understand which tool or map will best help you see the predominant waste. 

In your case a VSM helped you see the waste in the flow of Nuclear Medicine patients. In assessing inpatient flow I've often found swim lane maps helpful to show the sheer number of roles, handoffs, loopbacks, "if thens", etc... it takes to get 1 patient from the ED into a bed 1 time. I've found Pareto Charts extremely helpful in uncovering the true cause of delays and interruptions that previously resulted in finger pointing between disciplines. And of course spaghetti diagrams with 6lbs of spaghetti when understanding the daily motion of nurses.

As you point out one size does not fit all. Pick the right tool for the right problem and build the map that helps you see where to go.

 

Reply »

Aaron Hunt April 28, 2016

Thanks for your thoughtful reply, Dan. I agree that swim lane diagrams can be very enlightening; every handoff likely introduces some waste and risk. It is amazing how a simple spaghetti diagram can reveal things that logically border on insanity.  You've just got to find a way to see it first. 

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Beau Keyte April 28, 2016

Good story, Aaron, and I wish others could be as open to adapting this great tool and it's flexibility.  The technical purpose of VSM is to visualize work, point to problems, and focus direction.  Nothing more.  How and what you visualize should depend on the problem you are trying to solve.  There is a major university out here that still insists that takt time be on every student's value stream map even if it's not relevant in solving the problem at hand.  I'm also aware of several excs who insist that all maps look the same......so THEY can easily understand what the map is saying.  Purpose is not met!   

Why SHOULD all value stream maps look different?  In part because the problems they want to solve are wildly different.  And, in part because it's supposed to tell a story as seen by the authors - and the authors are different.  I've seen seperate teams draw a current state map of the same process, and they are all different.  Different sets of eyes and experiences. 

So much for the technical side.  The focus on the "looks" of the map also misses the "other purpose" of mapping: creating a social intervention inside a value stream among people from different functions who might be blaming each other for problems when they should be blaming a broken process.  There is tyically as much good energy about working with folks from different disciplines (for the first time) as there is about understanding what is going so wrong in a process that should be working much better.

Great story, thanks for sharing. 

Reply »

Aaron Hunt April 28, 2016

Beau,

You are absolutely correct about the good energy.  I had the pleasure of meeting Stephen Covey and hearing him talk about trust today.  I had the realization that Trust is the basis for the "magic" that happens culturally when we apply the various lean tools to improve the organization. I was never able to put my finger on it until now.  Trust is the ultimate creator of good energy in an organization, and simple tools applied as needed for the organization builds trust.

Every VSM, every organization, every person is different. To expect otherwise leads us away from the core principle of Respect for People. 

Thanks for taking the time to share your thoughts. 

Reply »

Ken Hunt April 29, 2016
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Hi Aaron,

Good post. While we're talking about different looks of VSMs, it drives me crazy (and I've expressed this before) when I see Forum questions asking where one can find software to do a VSM. Classic example of looking for convenience and comfort. The interaction between team members from different contributers to the process being mapped in SO important, not only in "getting it right", but as a learning experience for all.

Paper, Post-its, and string. An electronic version (Visio etc.) can be created later if needed.

Thanks for starting this conversation.

Ken

 

Reply »

Aaron Hunt May 02, 2016

Ken,  

 

Funny you mention that.  Around 2009, I was getting frustrated by the "need" to put our VSM into Visio to share with executives outside the facility.  I felt like we had significant NVA inside our own process of improving processes.  Then the iPad was released in 2010, and I created a template set for use on the iPad to do VSM.  

 

It worked, but it wasn't as powerful for cultural change.  The technology seemed to exclude a large portion of our team from participating.  Today, we still just take a picture and share it that way.  Quick and easy, and allows us to focus on the improvement and not the map.  The map doesn’t do anything to change to organization without the actual work of doing the improvements. 

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Ken Hunt April 29, 2016
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Karen Martin May 01, 2016

Good post, Aaron! You've discovered an important point: there's the "science" of value stream mapping and the "art" of value stream mapping. We often like to remind our clients that no two value stream maps for the same value stream will look exactly the same. And that's OK.

Where people often get tripped up is the level of the "process" that value stream maps are intended to be used. I see many so-called value stream maps that are swimlane value stream maps. Adding to Beau's good points, VSM is most powerful when used to see high level disconnects, delays, etc. Process-level maps (and we prefer functional swimlanes for most process maps) are often needed as a second step when actual improvements are being designed and tested and standard work written when the improvement is solid. Think strategic vs. tactical. 

Here's a webinar I gave that could be helpful for anyone who'd like to gain clarity about VSM vs. process maps - https://vimeo.com/149407030. Other mapping webinars are available at www.ksmartin.com/webinars.

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Jay Johnson May 06, 2016

The purpose of all improvement tools is generally the same.

To enable meaningful conversation and action that would not have occurred otherwise.

Reply »

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