If you make the decision to embark on a Lean journey, you will need to begin taking into consideration the magnitude of this change, because it is enormous. Lots of your present practices will change to are more centered on patient care (the reasons why you experienced healthcare) and much less on the daily aggravations of searching for all your things you will need to supply that care. You need to have a great framework to assess the progress of your lean efforts. First, as you think about the changes coming, you must:
Let’s begin by defining exactly what a hospital value stream is: a Value Stream is a collection of interconnected processes to supply value to a customer. A price stream example in a hospital describes the care of a patient that arrived to the hospital via the Emergency Department, was admitted to the Telemetry unit, and was discharged home. Another value stream example describes the flow of patients that can come to the hospital for outpatient surgeries:
Each process advances the care of the patient. The sum total of the processes delivers value to the in-patient and is what we call a Value Stream. There are lots of value streams in a hospital and all of them must mature coming to perfection, as that is our goal and the target of any Lean initiative. How can we track the progress of the Lean implementation on a particular value stream? We do this by establishing a five-level framework to measure the progress.
Engagement. By this we mean a high level of involvement by the whole staff. Simply improving isn’t sufficient in a Lean Value Stream. Without the active involvement by everyone in the job of process improvement, it will be difficult to improve fast enough in today’s competitive environment.
Level 1: Identify the Value Stream and assign ownership. The first logical step in improving a value stream is to spot and document it. This maturity level involves naming a french-streaming value stream, assigning a value stream owner to it, and creating both current and future state value stream maps. We will also want to establish performance metrics for the value stream: Discharge performance, Medication Administration performance, productivity, quality, and so on.
Level 2: Patient Flow and Pull. The largest opportunity when moving from the traditional work environment to a Lean environment is the introduction of flow and pulls methods. Patient wait amount of time in traditional environments can represent around 70% of the sum total patient length of stay. In cases when you flow products, like Sterile Processing of Instrument sets, experience has shown that cycle time relates to a lengthy set of related benefits, including improved productivity, better quality, less space on the floor, improved flexibility, and higher on-time delivery of the Instrument sets back to the OR Suite.
Level 3: Standardization. Once we have harvested the lower hanging fruit of flow and pull, we must continue with the job of training the certifying the staff in Standard Work. We need to involve the whole staff in defining the main one best way to do work, and to train them to do the work that way. Remember that standard work does not limit creativity or improvement, but it will determine the way the work ought to be done for the present time.
Level 4: Engagement. The stage of engagement is what separates the Lean pros from the amateurs, once we are assessing value stream maturity. Until we have the ability to involve the whole workforce in the creative work of continuous improvement, our Lean efforts will continue being vulnerable to outside competitors simply copying what we have done. Once we are generating hundreds and tens and thousands of small improvement suggestions annually, it will be very difficult for your competition to keep up.
Level 5: Sustained Performance. Until we have the ability to incorporate flow, pull, standard work and employee engagement into our hospital culture, things will inevitably backslide. We can claim that we are at Level 5 on the value stream maturity scale when we have the ability to shown that we have maintained continuous improvement for a period of at least 36 months.
The starting point, obviously, is always to map your primary value streams. As the Value Stream Mapping concept is well-know, in fact few organizations (hospitals or factories) have actually taken that first step. If you’re willing to go forward with the effort, get some good expert help from mentoring organizations like Leonardo Group Americas. Getting training and insight from individuals who have done this before often times is extremely valuable.