Value Stream Mapping in Healthcare – Does it Differ?
A reader, Dan, asked a great question on the MoveToHealthcare.ning.com site (since closed), re-used here with his permission:
I recently attended a 2-day Lean Healthcare Training and Project Report Out session. When they covered the VSM material, I was surprised at the simplicity. Their VSMs were not VSMs as I had come to know in the mfg environment….detail on times, computer screens req'd, defect rates, etc. Not a bad thing, just surprised me – and perhaps wasn't needed.
There were none of the VSM conventions of customer and suppliers on the maps, no distinction of information vs. pt/material flows. Rather, they were very basic process maps just outlining the steps, sequence and who the person or functional area was for that step, as well as what was VA vs. NVA.
VSMs should alway be developed according to purpose of course. Perhaps there is just so much low hanging fruit that the additional detail was of no interest at that point. It just seemed to me that there was a lot of info that would've been helpful in understanding the performance of the process that no one gathered.
So I wonder, is this typical of hospital process mapping?
By the way, I was very impressed at the speed and breadth of which Lean is being deployed at this facility. They have great Lean leadership and a lot of enthusiasm. It served to reinforce to me that this is what I want to be doing! I was fortunate to have been invited to attend.
Here was my response and you can check back on Ning to see if there are more comments or you can add comments here for the larger blog audience:
Hi Dan — there's probably a ton of variation in how VSM is being used in healthcare and that's probably not completely unlike manufacturing practice.
I've seen cases where hospitals do process maps and call them VSM because that's the trendy term.
To me, to be called a VSM it must:
1) start with a customer request — patient or physician typically. Doesn't need to be the typical factory looking icon
2) have both “material” (or patient) flow AND information flows. Sometimes the “product” is information (such as a referral request), but treat that as the product (creating an appointment) and then also document the information flows involved in creating that information (phone calls, computer systems etc.)
3) focus on both the actual process steps AND the waiting time in between. VSM analysis focuses primarily on the “white space”
4) have some amount of data that comes from real gemba observation AND information systems. Hospitals are often very lacking in real data that you would want for a VSM.
So long story short, I think what you saw was not best practice and also not really typical. But not unheard of.
Also, Cindy Jimmerson has a book coming out from Productivity Press real soon:
Value Stream Mapping for Healthcare Made Easy
She certainly teaches more along the way you and I are suggesting, Dan, with the information flows and data boxes, etc. Her book has A LOT of examples of real value stream maps.
It's also taught that way in the LEI course on Value Stream Mapping for Healthcare:
(FTC blogger conflict of interest disclosure: the book link and others on this blog are Amazon Affiliate program links, for which I receive a commission on purchases. Cindy's book is published by the same publisher as my book. Also, I am an employee of the LEI, the provider of the course).