I was going back through my notes from the First Global Lean Healthcare Summit and thankful for the many wonderful thoughts and tidbits that I learned or re-learned.

One was a nice way of summarizing the different forms of a process:

1. What we THINK it is
2. What it REALLY is
3. What it SHOULD be

The gap between 2 and 3 is waste. Often, the gap between 1 and 2 can be just as great. That’s why we have to “genchi gembutsu” — go and see. We have to go to the “gemba,” the actual place where the work is taking place to see what REALLY is happening.

At the summit, I heard a lot of talk about creating Value Stream Maps, both the current state and the future state. I heard many talking about getting big cross-functional groups together in a conference room to the create the map, starting with the current state. The current state map should represent #2, what REALLY is. But, the risk is that you document #1 instead of #2.

If you don’t combine the Value Stream Map creation exercise with a healthy dose of “Ohno Circle” style process observation, you run the risk of documenting an inaccurate view of reality. Working toward perfection first requires an accurate and realistic view of the current situation. Be sure to NOT shortchange that process in your haste to create the map.

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.