Whenever you make the decision to embark on a Lean journey, you need to start thinking about the magnitude of this change, as it is huge. Many of your current practices will change to focus more on patient care (the reason you entered medical care) and much less on the daily hassles of looking for all the things you need to provide that care. You must have a solid framework for evaluating the progress of your lean efforts. First, as you think about the changes to come, you should:

• Appeal to the rational mind: communicate a clear picture of the future state and its benefits to patients and staff.
• Appeal to the emotional mind: Reason gives you direction, but emotion gives you the energy to make the change. Staff must be emotionally invested in the change, or they will not own or sustain it.
• Clear the way: Great ideas that are difficult to implement are doomed from the start. Focus on making processes and procedures easy to understand, execute, and document.

This article focuses on a way to engage the rational mind by providing a framework for evaluating the progress of your Lean journey against a specific value stream.

Let’s start by defining what a hospital value stream is: a value stream is a collection of interconnected processes to deliver value to a customer. An example of a value stream in a hospital describes the care of a patient who came to the hospital through the Emergency Department, was admitted to the Telemetry unit, and was discharged. Another example of value stream describes the flow of patients arriving at the hospital for outpatient surgeries:

Registry -> Pre-surgical care -> Procedure -> PACU I -> PACU II -> Discharge

Each process advances in patient care. The sum total of these processes adds value to the patient and is what we call value stream. There are many streams of value in a hospital and each of them must mature on its way to perfection, as that is our goal and the goal of any Lean initiative. How do we track the progress of Lean implementation in a specific value chain? We do this by establishing a five-tier framework to measure progress.

There are several dimensions that we look for when evaluating the maturity of an entire Value Stream, which are not seen at the level of individual processes:

• Linked processes. Most of the delays in patient care (sometimes more than 95%) in a value stream occur between processes, in transfers from one person to another or from one department to another. We don’t have this visibility if we just look inside the process.

• Existence of Flow and Pull. Flow and attraction go hand in hand in a Lean environment, so it makes sense to look for formal methods of flow and attraction. Without formal extraction systems, patient care will lag at Value Stream.

• Commitment. By this we mean a high level of involvement of all staff. Simply improving is not enough in a lean value chain. Without everyone’s active participation in the process improvement task, it will be difficult to improve fast enough in today’s competitive environment.

The value stream maturity scale is used to assess the maturity of a value stream, with the interest of creating or modifying a process improvement plan. A value stream that is at level 0 or level 1 represents a great opportunity. After all, if you have survived that long (apparently) with low maturity
Value Stream, imagine what you can do when you reduce patient flow times by 50%! Below is a brief description of each maturity level on the Value Chain Maturity Scale.

Level 1: Identify the value stream and assign ownership. The logical first step in improving a value stream is to identify and document it. This maturity level involves naming a value stream, assigning it a value stream owner, and creating current and future state value stream maps. We also want to establish performance metrics for the value chain: high performance, drug delivery performance, productivity, quality, etc.

Level 2: Patient flow and traction. The biggest opportunity when moving from a traditional work environment to a Lean environment is the introduction of flow and extraction methods. Patient waiting time in traditional settings can account for up to 70% of the total length of patient stay. In cases where product flows, such as sterile processing of instrument sets, experience has shown that cycle time is related to a long list of related benefits, including improved productivity, better quality, less space in the floor, greater flexibility and greater delivery on time. from instrument sets to the OR suite.

Level 3: Standardization. Once we have harvested the ripe fruits of flow and pull, we must continue with the task of training certifying personnel in Standard Work. We need to involve all staff in defining the best way to do the job and train them to do it that way. Remember that standard work does not limit creativity or improvement, but it does determine how the work should be done at the present time.

Level 4: Commitment. The engagement stage is what separates Lean professionals from hobbyists when we assess the maturity of the value chain. Until we can engage the entire workforce in creative continuous improvement work, our Lean efforts will remain vulnerable to outside competitors who simply copy what we’ve done. Once we generate hundreds and thousands of small suggestions for improvement a year, it will be very difficult for the competition to keep up.

Level 5: Sustained performance. Until we can incorporate flow, attraction, standard work, and employee engagement into our hospital culture, things will inevitably go backwards. We can affirm that we are at Level 5 on the value chain maturity scale if we can demonstrate that we have maintained continuous improvement for a period of at least 36 months.

The starting point, obviously, is mapping your top value streams. While the concept of Value Stream Mapping is well known, few organizations (hospitals or factories) have actually taken that first step. If you’re willing to go ahead with the effort, enlist the help of experts from mentoring organizations like Leonardo Group Americas. It is very valuable to get training and knowledge from people who have done this many times before.

A Value Chain Mapping effort will shed light on the many improvements that are necessary and possible, but before embarking on improvement projects, apply the Value Chain Maturity Scale. If you are not already at Level 3, you should devote your attention to achieving flow and standardizing the value chain processes. Otherwise, your efforts will be difficult or impossible to sustain.