Value Stream
Mapping
Its application in Indian Healthcare
Table of
Contents
01 Definition
02 Benefits
03 Application in Healthcare
04 Example
05 Case Study & Conclusion
Value Stream
Mapping
A lean manufacturing technique to analyze, design, and
manage the flow of materials and information required to
bring a product to a customer.
Also known as "material and information-flow mapping"
Items are mapped as adding value or not adding value
from the customer’s standpoint, with the purpose of
rooting out items that don’t add value.
Benefits of VSM
By creating a value stream map, you can visualize how end-to-end operations work,
track actual performance, and find ways to make your processes even more efficient.
Identify waste
Identify bottlenecks
Make processes efficient
Improve cross-functional collaboration
Improve end-product quality
Healthcare Value Streams that
support clinical events
ED: Emergency Department throughput, capacity, triage
OR: Operating room scheduling and capacity
Pharmacy : from order (physician), assembly (pharmacists), delivery (technician) to
administrator (nurse)
Material Managemrnt : purchasing, inventory control, delivery systems, supply chain
management
Diagnostics and Therapeutic reports: Imaging, clinical and anatomic pathology,
diagnostic and therapeutic procedures (eg: physical medicine, endoscopy,
cardiovascular, diabetes management, cardiac rehab)
Length of stay: appointment, procedure, admission, scheduling and discharge
Example
When used within healthcare, one obvious application for VSM is mapping a patient’s
path to treatment to improve service and minimize delays.
To map a patient’s path to treatment, a current state map can be created in a VSM tool
to act as a baseline and to identify areas for improvement.
The first step a patient takes is to visit his general physician (abbrev. “GP”), and this is
represented as a rectangular process shape in the VSM.
The time the patient spends at this step can be broken down into value-added (“VA”)
and non value-added (“NVA”) cycle times.
VA is time the customer is willing to pay for: that is, the 20 minutes spent consulting
with the GP. NVA is the time the customer is not willing to pay for, i.e., the 20 minutes
spent in the waiting room before the appointment.
The dotted line arrow between process steps is called a push arrow. This shows that
once a patient completes a step, they are “pushed” to the next step. This is inefficient,
and a more efficient process can be designed by changing push steps to continuous
flow or “pull” steps.
The yellow triangles indicate the time a patient spends waiting for the next process.
These steps are a non-value added action for the patient.
Case Study
Case study performed in an Orthopedic Hospital at Nagpur
General information about the hospital :
Processes Cycle time (min)
1. Orthopedic hospital having Radiology,
pathology, physiotherapy Registration 5
departments and operation hall having
10 bed capacities. Evaluation 15
2. Working shifts are three, 6 hrs, 6hrs
and 12 hrs. X-ray & Evaluation 15
3. First shifts and second shifts have 4
staff members each and last shift Plater 30
have 2 nurses.
4. There are one main doctor and an Physiotherapy 20
assistant doctor.
The weekly process and cycle time required for each
process
Takt Time Analysis
Takt time is the important tool needed for the assessment of current system.
The hospital as explained above works in three shifts. The lunch breaks as well as other necessary breaks for the working
staff are covered by another staff. So the total available time is 24 hrs a day which equals to 1440 min.
In average, the daily hospital visits is 45 and available time is 1440 min. so the Takt Time for the process of service is
calculated below.
After collecting the information needed with the regard to the patient flow , On the basis of weekly data available we can draw
VSM for the current state to analyze the current process
arrival of the patient in the
hospital
Registration
Evaluation by the doctor
X-ray
No fracture, If fracture, Plaster done
Discharge
Physiotherapy
Problem
Identification
Loop 1 (Patient & X- ray Evaluation) Loop 2 (Physiotherapy)
Only one doctor is in operation for patient and Space utilization is not proper in
X-ray evaluation. physiotherapy department which leads to
Bottleneck occurs between the two less patients get served weekly.
processes i.e. patient evaluation and X-ray Not standard location for equipments.
evaluation which increases waiting time.
Combine patients creates waiting time for
further process.
Proposed Plan
For loop 1 For loop 2
A new doctor in radiology or X-ray proper space utilization was carried
department was appointed who can out by using the “5S” tool for proper
read the X-ray report which before got space utilization and placing of
read and evaluated by the main doctor equipments which are used on
or utilized the doctor doing plaster and regular
look after the surgical patient in the X- basis.
ray department for X-ray reading and
evaluation
Improvements
moving forward
Conclusion
the Value Stream Mapping is an ideal tool to expose the waste in
a value stream and to identify tools for improvement. The
development of future state map is not the end of a set of value
steam activities. It should be stressed that the value
steam should be revisited until the future becomes the present.
