Housestaff Lean Academy
Module 3:
Examining the Current State (Process
Mapping, Observations, and Waste)
Robert Martin, PsyD
Performance Excellence
UCLA Health
1
Where does this module fit into the curriculum?
Module #
Module Description
1
Lean Principles for Physicians (Important Concepts)
2
Using A3* and PDCA Methodology for your improvement project(s)
3
Examining the Current State (Process Mapping , Observations, & Waste)
4
How to use Root Cause Analysis
5
Organizing & Using Data
6
Identifying Improvements & Actions (A3 Simulation)
7
Working as a Team (Frontline Empowerment & Engagement)
8
Sustaining Improvements through Standard Work
9
Understanding & Leading Change
10
UCLA Operating System - Supporting Infrastructure (ADM, Huddles,
A3/A4 Methodology)
2
Module 1 Summary
Value
Use these concepts to focus your
improvement project
Waste
Scientific
Method
(PDCA / A3)
Use the A3 and PDCA methodology (i.e.
scientific method for improvement) to
manage and communicate your
improvement project
Empowered
Staff
Alignment
Use these concepts to maximize your
improvement project’s chance for success
3
Module 2 Summary
A3-Problem Solving
(11 x 17)
Use for:
• Complex problems
• Gaining consensus
• Communicating
• Managing the project
Use if:
• Root Causes to problems
are unknown
• Solutions aren’t obvious
Requires Planning (PDCA)
and data collection &
analysis
4
Documenting the Current State is beneficial
• Idea collection, observations, and discussions of “pain points”
engages staff , improves shared understanding and teaming
Tools
• Illustrates a process or patient pathway from both the staff and
patient’s perspectives
• The resulting documentation (a process map, observation sheets,
spaghetti charts, etc.):
•
Is easy to understand, highly visual, and aids the change process
•
Help to identify steps that don't directly contribute to patient care (bottlenecks,
constraints, problems/issues = waste)
•
Help to identify steps that do contribute to patient care (value-added)
Process Maps
Time
Observation
Sheets
Spaghetti
Charts
Waste
Analysis
5
Process Mapping
•A simple language not taught in medical school
•Organized visualization of interrelated activities
which combine to form a process, patient
pathway, or process of care
•There are more symbols, but these are the most
important:
Tools
Process Maps
Time
Observation
Sheets
Spaghetti
Charts
•Process Mapping can be mapped in several ways!
Waste
Analysis
6
Process Mapping (Cross-Functional, or
“Swim Lanes”)
Tools
Process Maps
Time
Observation
Sheets
Spaghetti
Charts
Waste
Analysis
7
Process Mapping (Linear/Phased)
Where activity takes the longest on this map?
Tools
Process Maps
This might required a
more detailed map or
Time Observation
Sheets
Time
Observation
Sheets
Spaghetti
Charts
Waste
Analysis
8
You can use TOS or more
detailed Process Maps to
further understand
problems
Using Time Observation Sheets*
Multiple Observations
Tools
Running clock is used
Calculations can be done after (i.e. 8:20 – 8:02 = 18 mins)
Remarks can be captured
for further analysis
Process Maps
Time
Observation
Sheets
Spaghetti
Charts
Waste
Analysis
*Template is available
9
Using Spaghetti Charts*
Spaghetti Diagram
Area:
Step
Date:
Steps can be copied over
from Time Obs. Sheets
Description
1
Pt walks into Clinic
2
Scheduler/Registrar checks
patient into CareConnect and
directs PT to waiting room
Process:
Distance
Distance:
Distance can be
measured
5
6
7
8
Patient waits for Care Coordinator
Care Coordinator calls patient to
the back
CC verifies PT in CareConnect
1
10
Time
Observation
Sheets
Patient completes consent forms
CC reviews forms for errors and
completion
4-8
CC directs patient back to
waiting room
10
2
3
9
Patient waits for Nurse
Nurse calls PT back
Tools
Process Maps
3
4
You can use Spaghetti
Charts to show the impact
of motion and movement,
and to improve flow
9
Spaghetti
Charts
11
12
Waste
Analysis
13
14
21
*Template is available
10
While doing observations, you can find more
“waste” when you examine with a model*:
Process Maps
Time Observation Sheets
Spaghetti Charts
Tools
Process Maps
1) Defects
• How many defects
are the Care
Coordinator
finding? What is
the impact?
5) Transport
• Is there any
transport waste?
2) Overproduction
• Are there any
unnecessary
forms we ask the
patient to fill out?
6) Inventory
• Is there any
inventory waste?
• Patient is waiting
at least 24
minutes. Is the
MD waiting? Other
bottlenecks?
4) Not Utilizing
Talent
• Can the registrar
be trained to do
consent if the
Care Coordinator
isn’t available?
7) Motion
8) Extra-Processing
3) Waiting
• Is the PT being
moved too much?
*Template for practicing 8 wastes is available
• Is there any
rework from
defects or other
waste?
Time
Observation
Sheets
Spaghetti
Charts
Waste
Analysis
11
You can use TOS or more
detailed Process Maps to
further understand
problems
Using Time Observation Sheets*
Tools
Waiting: Why 18 minutes waiting for the Care
Coordinator to do consent forms!
Process Maps
Not utilizing Talent: Can another function help
when CC is doing Plan of Care Scheduling?
Overproduction: Are all of
the forms necessary?
Defects & Extra Processing:
Why are their defects?
What type? What is the
Time
Observation
Sheets
Spaghetti
Charts
impact of defects?
Waste
Analysis
*Template is available
12
Once the Current State is understood, you can analyze the
“root causes” of the waste (next module) to eliminate them
Tools
Process Maps
Pareto
Cause & Effect Diagrams
5 Why Analysis
Time
Observation
Sheets
Spaghetti
Charts
Waste
Analysis
13
What module is next?*
Module #
Module Description
1
Lean Principles for Physicians (Important Concepts)
2
Using A3 and PDCA Methodology for your improvement project(s)
3
Examining the Current State (Process Mapping , Observations, & Waste)
4
How to use Root Cause Analysis
5
Organizing & Using Data
6
Identifying Improvements & Actions (A3 Simulation)
7
Working as a Team (Frontline Empowerment & Engagement)
8
Sustaining Improvements through Standard Work
9
Understanding & Leading Change
10
UCLA Operating System - Supporting Infrastructure (ADM, Huddles,
A3/A4 Methodology)
* Thank you! Please complete your post-questions
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