Process Improvement in Healthcare : Utilizing Observations and Process Mapping to Identify Waste

As an intern at the Jewish Healthcare Foundation, I had the opportunity to witness how health care organizations have been able to utilize Toyota Lean Methodology to improve processes and eliminate waste, a practice which can ultimately improve a patient’s experience and allow health care providers to be more efficient in their work. 

JHF coaches a variety of health care professionals who work in a wide range of health care settings in the practice of observing and mapping processes with the goal of identifying sources of non-value added time. Generally, a few observers are tasked with timing each stage of the patient care process - noting what tasks are involved in each stage of the process. In order to accomplish this, each observer follows a single flow unit (the patient) through the patient care process. After each observer has been able to collect information for a few individual patients, the group works to create a visual value stream map of the process. This involves calculating the average duration of each task in the process as well as the average wait time between tasks. Then, unnecessary non-value added time is calculated as a percentage of the total process time which allows one to evaluate the overall efficiency of a process. JHF’s process mapping practice also includes a step where observers identify of strengths and opportunities for improvement that were noted during the process. This is helpful in the next step of the process improvement exercise, where you may conduct a root cause analysis to determine the reason for the existence of non-value added time in certain parts of the process.

Sometimes, the mapping may continue into another phase where the observers create a “Spaghetti Diagram” to accompany the value stream map. This diagram illustrates the path of each individual observed during the entire process. It is extremely helpful in seeing and understanding the movement of the health care providers and allows one to identify non-value added movement that increases non-value added time and leads to less efficient work. Some medical offices or hospitals utilize RFID tags that are worn by providers and placed on important supplies or diagnostic machinery. The RFID tags track the movement of these people and machinery electronically – which allows for more simple creation of these spaghetti diagrams. Since this practice has proven effective in health care – would RFID tagging and tracking movement of products through a supply chain be a good means of analyzing and identifying non-value added movement through a supply chain?

(To read an additional blog entry about JHF’s involvement in health care quality improvement – read Phillip Cynn’s blog for this week titled “JHF and Lean Methodology”)