Value stream mapping

1. Laboratory Outreach 2008 Value Stream Mapping (Anatomic Pathology) Hans Froehling, DBA/CMBB June 2008

2. Part A: The Value Stream Map How to Create a Value Stream Map

4. Key messages No. 2 “ The hardest part of leaning out a process is living through change” Adapted from Michael Hammer “Reengineering the Corporation”

8. How does lean contribute to defect reduction? Batch Production Inspection Feedback with delayed Action One Piece Flow – Immediate Feedback with Immediate Action Input Defect-free output Defective output

9. How does lean contribute to improved speed? Batch Production Batch Production Input Output Input Defect-Free Output Defective output Constant Bottleneck First-In => Anytime Out One Piece Flow Constant Flow First-In => First Out

12. Lean and Value Stream Management

14. Value Stream “ A Value Stream is an end-to-end collection of activities that create or achieve a result for a customer of the enterprise.”

15. Value Stream Mapping is a tool that helps you to see and understand the flow of material and information as a “product” makes its way through their value stream. You then look for opportunities to eliminate or reduce wasted time or activities in the process. Value Stream Mapping

16. Value is meaningful when expressed in terms of the service which meets the client’s price at a specific time. Specify Value

26. At What Level Do You Start a Value Stream? Total Value Stream: Enterprise vs. Operation Enterprise Operational Strategy Operations Operational Tactics Enterprise/Business Unit Level Operations Level Action Our Focus in this part of the workshop is here. Action Action Action Action Action Action

30. Basic Structure of a Value Stream Map Management Control (2) Customer (1) Supplier (3) Information Flow (8) Information Flow (8) Activities/ Measurements (4) Transportation Line (6) Summary Measures (7) Defect Rate/Timeline (5)

34. Key Value Stream Symbols Customer/Supplier Process/ Measurements Information Flow Inventory/ Work In Progress Specimen Flow Transportation Pick up Schedule People First-In-First-Out Work Cell Go-And-See Physician/Patient 1x Daily

39. Delivery (Specimen/Tissue)

41. Map the Production Process Create a box for each process step

43. Production Lead Time (PLT = TAT) The time it takes a specimen to move all the way through the process or value stream from order to report (start to finish). Cycle Time (CT) The time it takes a technician/assistant to go through all work elements before repeating them. Value-Added Time (VAT) The time of those elements that actually transform the product in a way that the customer is willing to pay for. Non-Value Added Time (NVAT) The time of those elements that to do not add value Percent Value Added Time = Production Lead Time/Value Added Time Note: Time spent due to government regulations are called business value added time ; counted as “value added time.” Key Terms of Time

44. Additional Summary Lines TIMELINE The timeline gives important information about the distribution of time within the process. In particular, it shows total cycle time vs. value-added time for each process step. Shown on next page TRAVEL DISTANCE The travel distance gives important information about the distances traveled between the various process steps. They give indication where unnecessary movements occur. Shown on final value stream map

46. Communication Arrows Represents phone call Information Flow Product Flow Information Flow

47. Push Arrows (With Inventory Signs) Push Arrow With Inventory Sign Inventory signs are important to understand where bottlenecks occur.

48. Completed Current State Value Stream Map Process Flow + Key Information Defect Rates/Timelines Travel Distance Line 600 feet

49. Add the sign of a “Kaizen Blitz” to show “Kaizen” or “ Lean Six Sigma” interventions that help you move from the current to the future state Moving To The Future: Kaizen Events

50. Moving To The Future

51. Value Stream Mapping: Summary Draw Customer Box Draw Customer Requirements Draw Production Control Box Draw Supplier Box Draw Transport to Production Draw Production Flow Draw Communication Arrows Draw Push/ Pull Systems Finalize Measurements Analyze Value Stream Map Identify Kaizen Opportunities Develop Future State Map

55. 5S Rules for Sorting Dispose Useless Sorting Keep & Monitor Unknown Useless Item Keep & Store Useful Useful ABC Storage

58. Situation Before: Solution: % Improvement: Space Inventory Lead Time Quality Safety Productivity N/A Toolbox totally disorganized with many unnecessary tools. There were three personal toolboxes like these. Created 3 shadow boards for workstations. Eliminated 2 of 3 personal tool-boxes. N/A N/A N/A N/A N/A The Visual Workplace

72. The goal is to get to Scheduled Maintenance Breakdown Maintenance Maintenance Prevention Corrective Maintenance Reactive Scheduled Maintenance Total Productive Maintenance (TPM) Proactive

73. Poka Yoke – Dual Focus Defects Mistakes Process Prevention Poka-Yoke that focuses here works on mistake prevention or making mistakes impossible. Detection Poka-Yoke that focuses here works on mistake detection, or making sure mistakes do not turn into defects. People and systems do make mistakes. A portion of mistakes turn into defects.

74. There Are 2 States of a Defect: Error About to Occur Defect About to Occur (Prediction) Warning Signal Control/Feedback Shutdown (Stop Operation ) Error Has Occurred Defect Has Occurred (Detection) Warning Signal Control/Feedback Shutdown } MISTAKE-PROOF FUNCTION Mistake Proofing – Poka Yoke

75. 1 6 5 4 3 2 7 8 Mistake Proofing – Examples

76. Part B: Case Study: Apply Value Stream Mapping to reduce errors and improve TAT in commercial Anatomic Pathology Lab.

77. Next Section: Case Study DEFINE: Define the Project Goal IMPROVE: Implement Solutions & Evaluate Results A B C D ANALYZE: Analyze to Identify Causes CONTROL: Standardize & Make Future Plans MEASURE: Measure the Current Situation =1.0 =3.0 IMPROVE: Implement Solutions & Evaluate Results CONTROL: Standardize & Make Future Plans

79. Project Charter - Kaizen Week Business Case: Opportunity Statement: Physicians complain that TAT for commercial anatomic pathology reports takes too long and is unpredictable. This results in lost goodwill. Improve work flow; Reduce Defect. Defect Definition: A “workload” that is not in the hands of the pathologist within one business day. Goal Statement: Project Scope: Reduce TAT from 2 days to 1 day. Process Start Point: Specimen is delivered by transportation to accessioning in the accessioning room. Process End Point: Workload is handed off to transportation (off-site) or handed to pathologist for review (on-site).

80. Generic Process Map and Project Scope High Level Work Flow Project Scope: From accession to distribution of tissue stains to pathologists.

81. Process Performance - Example Before The process is in control, but has high variability. Be aware that a process can actually become more erratic if it is not in control before you start the Kaizen events Note: Example data

83. Current State Map Value Stream Map represents the current flow of tissue specimens and information through the process.

86. Lost in “Spaghetti World” (Womack) Carrier Drop Off Accession  Label Print Label Print  Gross Gross  Cover slip Oven  Distribution to pathologists Start End

87. Embed (30 per hour) Cut (60 per hour) Embed Classical Work Set up - Linear Lean Set Up - Cell Design Summary Data - Work Flow Design 60 units 30 units Cut 30 units Cut E M B E D E M B E D Work Cell (U shaped)

92. Identify Kaizen Interventions Problem : How will you prioritize the kaizen interventions? Answer : Use a toolkit based on theory of constraints, lean principles and continuous quality improvement techniques. Value Stream Management Lean Principles Six Sigma Quality Theory of Constraints

100. Future State Map The process was simplified by creating a work cell design for embed/cut/stain/mount/process/prepare for delivery. Work Cell

101. Process of Conducting Kaizen Events Developing Future State Map and conducting kaizen events can Become an interactive process.

102. Kaizen Newspaper Make sure to conduct follow up meetings (weekly) to ensure the changes become implemented!

105. Value Stream Management: A Win-Win