Value Stream Mapping also known as “Material & Information Flow Mapping”, is a lean management method that analyzes the current and future state for the series of events that takes a product or service from the beginning of the specific process until the end.
These value stream maps show the flow of both materials and information as they progress through the process. It is used to
- identify waste,
- reduce process cycle times, and
- implement process improvement
Value Stream Mapping(VSM) is a visual representation of the series of steps and information that is useful to understand the status of the process at a glance, while identifying areas of possible improvement. It is a type of process map that enables the leadership to see where the actual value is added in the process, allowing them to improve overall efficiency.
How to create a Value Stream Map (VSM)?
The main drive of value stream mapping in healthcare is to understand how value is delivered to the patients. For this it is necessary to understand what value means to the various stakeholders like patients, service users and carers along with those involved in the value stream.
Once the team has been created the next step is to map what is happening at the moment, the current state. Once the current state has been mapped the focus is shifted to mapping the future state which represents significant changes from the current state. Lastly, an implementation plan is developed to make the future state a reality.
Common system measurements that can viewed using VSM in healthcare:
- Cycle Time (CT)– the time that elapses from the time a patient finishes a point in the process to the time the next patient finishes the same point in the process
- Value Added Time (VA)– the time that actually adds value to the patient’s journey
- Changeover Time (CO)– the time taken for the patient to switch from one process to the next, commonly known as handoff time
- Number of People (NP)– needed to undertake a particular process
- Available Working Time (AT)– of staff involved in part of the process. It is the time that the staff are actually available i.e. the shift time minus the break time
- Lead Time (LT)– the time it takes a patient to move all the way through the process or value stream
“ Creating a VSM for the process of medication refill for a patient in a pharmacy”
Patient’s with long term or chronic diseases are commonly treated with medication. These medications although necessary for management of the disease for long periods of time, they are usually dispensed as smaller batches by the pharmacy.
Here is a typical process map when a patient visits a pharmacy for refill of medication.
A Value Stream Map (VSM) of the medication refill process provides a glimpse of the major steps in the process,
- With additional information on the flow of information;
- The steps which add value to the patient, steps that don’t add value to the patient and steps that don’t directly add value to the patient but are important;
- And information on different measurements of time in the process such as cycle time (CT), change over time (CO), lead time (LT) and value added time (VA)
Once the current state of the value stream is mapped, it can be used to identify potential areas of improvement. In this VSM three process steps can be modified to reduce the waiting time of the patient. Possible solutions to the identified improvement areas:
- Have an automated reminder prompt to the pharmacy’s order system of patient’s medication refill
- The order entry technician confirms the physician’s prescription order, initiates order, prints label
- If the patient requires doctor’s consultation before refill of medication a message is sent to the patient
- The patient is sent a message reminder to come to collect medication at the pharmacy
- The fill technician fills the medication, checks the order and keeps it ready before the patient arrives
If this protocol is adapted the patient arrives at the pharmacy, meets with order entry technician who takes the patient’s details, and the process continues from the pharmacist counting the medication and doing quality checks. This moves few steps which does not require the actual presence of the patient to before the patient arrives essentially reducing the total lead time.
What is the power of Value Stream Mapping?
The value stream map is useful during quality improvement to identify the wastes during the lean process, and identify the root cause of the problem . The process of VSM helps in identifying the issues and problems that add value perspective to the patient/consumer.
Quality improvement approaches start with defining the problem/issue, then measure, then analyze, improve and control which is commonly known as DMAIC framework as per the Six Sigma methodology.
Value Stream Mapping is tool that is mainly used to analyze the data to identify wastes in the system and the root causes. For example, the patient has to wait for a long time at the pharmacy. Using the value stream map it may be possible to understand that the problem is it takes too long for the fill technician to find the medication. On analyzing this further we can reach to the root cause of the problem, that is the medication is not stocked in a systematic manner. Now that the root cause is identified, the medication can be arranged using a Kanban 2-bin system improving overall efficiency.