1

Housestaff Lean Academy

Module 3: Examining the Current State (Process Mapping, Observations, and Waste)

Robert Martin, PsyD

Performance Excellence

UCLA Health

2

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)

Where does this module fit into the curriculum?

Module 1 Summary

3

Value

Waste

Scientific

Method

(PDCA / A3)

Empowered

Staff

Alignment

Use these concepts to focus your improvement project

Use these concepts to maximize your improvement project’s chance for

success

Use the A3 and PDCA methodology (i.e. scientific method for

improvement) to manage and communicate your improvement project

Module 2 Summary

4

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

Documenting the Current State is beneficial

• Idea collection, observations, and discussions of “pain points”

engages staff , improves shared understanding and teaming

• 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)

5

Tools

Process Maps

Time Observation

Sheets

Spaghetti Charts

Waste Analysis

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:

• Process Mapping can be mapped in several ways!

6

Tools

Process Maps

Time Observation

Sheets

Spaghetti Charts

Waste Analysis

Process Mapping (Cross-Functional, or “Swim Lanes”)

7

Tools

Process Maps

Time Observation

Sheets

Spaghetti Charts

Waste Analysis

Process Mapping (Linear/Phased)

8

Tools

Process Maps

Time Observation

Sheets

Spaghetti Charts

Waste Analysis

This might required a more detailed map

or Time Observation Sheets

Where activity takes the longest on this map?

Using Time Observation Sheets*

9

Tools

Process Maps

Time Observation

Sheets

Spaghetti Charts

Waste Analysis

You can use TOS or more

detailed Process Maps to

further understand problems

Running clock is used

Calculations can be done after (i.e. 8:20 – 8:02 = 18 mins)

Multiple Observations

Remarks can be captured for

further analysis

*Template is available

Using Spaghetti Charts*

10

Tools

Process Maps

Time Observation

Sheets

Spaghetti Charts

Waste Analysis

You can use Spaghetti Charts

to show the impact of motion

and movement, and to

improve flow

*Template is available

Spaghetti Diagram Date:

Area: Process: Distance:

Step Description Distance

1 Pt walks into Clinic   

                                                                                     

                                                                                     

2

 Scheduler/Registrar checks patient into CareConnect and

directs PT to waiting room 

                                                                                     

                                                                                     

3

 Patient waits for Care Coordinator  

                                                                                     

                                                                                     

4  Care Coordinator calls patient to the back  

                                                                                     

                                                                                     

5

 CC verifies PT in CareConnect  

                                                                                     

                                                                                     

6  Patient completes consent forms

 

                                                                                     

                                                                                     

7  CC reviews forms for errors and completion  

                                                                                     

                                                                                     

8

CC directs patient back to waiting room 

   

                                                                                     

                                                                                     

9

 Patient waits for Nurse  

                                                                                     

                                                                                     

10   Nurse calls PT back 

                                                                                     

                                                                                     

11

   

                                                                                     

                                                                                     

12

   

                                                                                     

                                                                                     

13

   

                                                                                     

                                                                                     

14

   

                                                                                     

                                                                                     

21

   

                                                                                     

                                                                                     

1

23

4-8

9

10

Steps can be copied over from

Time Obs. Sheets

Distance can be

measured

5) Transport

• Is there any transport waste?

6) Inventory

• Is there any inventory waste?

7) Motion

• Is the PT being moved too

much?

8) Extra-Processing

• Is there any rework from defects

or other waste?

While doing observations, you can find more “waste” when you examine with a model*:

11

Tools

Process Maps

Time Observation

Sheets

Spaghetti Charts

Waste Analysis

1) Defects

• How many defects are the Care

Coordinator finding? What is

the impact?

2) Overproduction

• Are there any unnecessary

forms we ask the patient to fill

out?

3) Waiting

• 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?

Process Maps Time Observation Sheets Spaghetti Charts

*Template for practicing 8 wastes is available

The 8 Wastes

Using Time Observation Sheets*

12

Tools

Process Maps

Time Observation

Sheets

Spaghetti Charts

Waste Analysis

You can use TOS or more

detailed Process Maps to

further understand problems

Waiting: Why 18 minutes waiting for the Care

Coordinator to do consent forms!

Not utilizing Talent: Can another function help when CC

is doing Plan of Care Scheduling?

Defects & Extra Processing:

Why are their defects? What

type? What is the impact of

defects?

Overproduction: Are all of the

forms necessary?

*Template is available

Once the Current State is understood, you can analyze the “root causes” of the waste (next module) to eliminate them

13

Tools

Process Maps

Time Observation

Sheets

Spaghetti Charts

Waste Analysis

Pareto Cause & Effect Diagrams 5 Why Analysis

The 8

Wastes

14

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)

What module is next?*

* Thank you! Please complete your post-questions

15