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Metrics-Based Process MappingSHS Webinar – February 17, 2009

© 2009 Karen Martin & Associatees. All Rights Reserved.1

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Metrics-Based Process Mapping (MBPM)

Society for Health Systems WebinarFebruary 17, 2009

© 2009 Karen Martin & Associates 2

Learning Objectives

The key time and quality metrics for designing Lean processes.The difference between a value stream map and metrics-based process map.The step-by-step approach for creating current and future state metrics-based process maps.How to use the metrics-based process map as a standard work and process monitoring tool.




Key Lean Metrics: Time

Process time (PT)The time it takes to actually perform the work, if one is able to work on it uninterruptedIncludes task-specific doing, talking, and thinkingaka “touch time,” work time, cycle time

Lead time (LT)The elapsed time from the time work is made available until it’s completed and passed on to the next person or department in the chainaka throughput time, turnaround time, elapsed time


Islands of value-adding activitiesAll other time is “waste.”

Adding Value

Rework

First Step Last Step

Typical Current State Findings

Lead Time




% ActivityThe percentage of time work is being done to the patient/item/data passing through the process/system(PT ÷ LT) × 100100 – % Activity = Idle time of the “product” passing through the process/systemGoal – ID barriers to flow

Summary Metrics: Time


Key Lean Metric: Quality

%Complete and Accurate (%C&A)% time downstream customer can perform task without having to “CAC” the incoming work:

Correct information or material that was suppliedAdd information that should have been suppliedClarify information that should or could have been clear

This output metric is measured by the immediate downstream customer and all subsequent downstream customers.




Rolled First Pass Yield (RFPY) = %C&A × %C&A × %C&A × … The percentage of occurrences where the information/data/people being processed pass through the entire process with no rework requiredExample: (0.95 x 0.60 x 0.85 x 0.75) x 100 = 36.3% RFPYHint: the RFPY will always be lower than the lowest %C&A for an individual step.

Summary Metrics: Quality


The Work We Do:Degrees of Granularity

Value Stream

Process Process Process

Step Step Step

Value Stream Map

In the Weeds

(Tactical)

30,000 ft View

(Strategic)

Metrics-Based Process Map



Current State Value Stream Map Outpatient Imaging Services

CT Scans

Demand = 15 per day

Customer Demand:15 patients per Day

(Takt Time 1920 seconds)8 hours per day

Referring Physician

% C&A = 65 %

Check-in Patient

(Admitting)

Cycle Time = 2 mins.% C&A = 90 %

5

Send Reports

(Imaging)


6

Hospital

5 mins.

ScheduleAppointment

Cycle Time = 11 mins.Lead Time = 12 mins.% C&A = 98 %

6

Pre-register Patient


5

CT=Cycle Time LT=Lead Time %C&A=% Complete & Accurate

0.0833 hrs.

2 mins.

0.0833 hrs.

1 mins.

0.75 hrs.

10 mins.

0.5 hrs.

15 mins.

0.0833 hrs.

3 mins.

4.13 hrs.

15 mins.

6.08 hrs.

5 mins.

16 hrs.

1 mins.

1.83 hrs.

1 mins.

2 hrs.

3 mins.

LT = 32.5 hrs.

CT = 56 mins.CT/LT Ratio = 2.87%

Lead Time = 12 mins.Lead Time = 990 mins.

PrepPatient(Tech)


2

Check-inPatient

(Imaging)


3

CompleteExam(Tech)


2

TransmitImages(Tech)


2

Read/DictateExam

(Radiologist)


2

TranscribeReport (MDI)


6

ReviewDraft/Sign

(Radiologist)


2

PrintReports

(Imaging)


230 mins. 5 mins. 248 mins. 365 mins. 960 mins. 110 mins. 120 mins.45 mins.

E Pay

Excel

ADS

Symposium

Internet

Waiting RoomManagement

System

Fax OrderSolutions

PACS

5 mins.

Lead Time = 24 days

Meditech

1234

5 6 7 8 9 10 11 12 13 14

Auto Fax 50% Us Mail 25%MD Mailbox 25%

Rework Loop via Fax 25% of the time

Rolled First Pass yield = 29%

Future State Value Stream Map Outpatient Imaging Services

Referring Physician

% C&A = 85 %

Send Reports

(Imaging)


6

Hospital

Schedule apptPre-register


6

CT=Cycle Time LT=Lead Time %C&A=% Complete & Accurate

0.0833 hrs.

1 mins.

0.583 hrs.

10 mins.

0.333 hrs.

10 mins.

0.0833 hrs.

2 mins.

2 hrs.

15 mins.

7 hrs.

1 mins.

0.0333 hrs.

1 mins.

0.5 hrs.

3 mins.

LT = 11.3 hrs.

CT = 43 mins.CT/LT Ratio = 6.32%

Lead Time = 45 mins.Lead Time = 15 days

PrepPatient(Tech)


2

Check-inPatient

(Imaging)


3

CompleteExam(Tech)


2

TransmitImages(Tech)


2

Read/DictateExam

(Radiologist)


2

ReviewDraft/Sign

(Radiologist)


2

PrintReports

(Imaging)


220 mins. 5 mins. 120 mins. 420 mins. 2 mins. 30 mins.35 mins.

E Pay

Excel

Symposium

Internet

Waiting RoomManagement

System

Fax OrderSolutions

PACS

5 mins.

Set-upReduction

Remove Check in

and ReduceSystem Access

Work Balancing

StandardWork

Pull System(Supplies Kanban)

VisualWorkplace

Voice Recognition

Batch Reductions

5S

Co-locate

StandardWork

Work Balance

ContinuousFlow

Value StreamAlignment

Auto Fax 80% Us Mail 15%MD Mailbox 5%

Rolled First Pass yield = 40%

Rework Loop via Fax 10% of the time

Customer Demand:15 patients per Day

(Takt Time 1920 seconds)8 hours per day

123

4 5 6 7 8 9 10 11

Risk Reduction

(Joint Commision)

Meditech




MetricCurrent

StateProjected

Future State%

ImprovementLead Time 32.5 hrs 11.3 hrs 65%Process Time 56 mins 43 mins 23%% Activity 2.9% 6.3% 117% Rolled First Pass Yield

29% 40% 38%

# Handoffs 14 11 21%Tech turnover(annual)

100% 25% 75%

Outpatient ImagingProjected Results

% Activity = Process Time/Lead Time x 100 Rolled First Pass Yield = %C&A x %C&A x %C&A…

1 2 3 4 5 6 7 8 9 10 11 12

1 Increase %C&A from 65% to 85% KE Sally G.

2 Reduce LT and improve efficiencies PROJ Claudia J.

4 Remove duplicate check-in PROJ Bob S.

5 Standardize patient prep process KE Sally G.

5 Reduce stockouts & inventory expense KE Sally G.

6 Maximize machine efficiency and reduce patient time on site KE Bruce E.

JDI Bruce E.

PROJ John R.

10 & 11 Reduce report release batching PROJ Maria G.Shift physicians to autofax

Future State Implementation PlanValue Stream

Value Stream ChampionValue Stream Mapping Facilitator

Paul Smith 8-Aug-08 10-Oct-08Executive Sponsor

Date Created

Implementation Plan Review Dates

22-Aug-08 24-Oct-08

Outpatient Imaging

Doris JonesBruce Tollman 12-Sep-08 7-Nov-087/18/2008 26-Sep-08 21-Nov-08

Mode* Owner Implementation Schedule (weeks) Date Complete

Block# Goal / Objective Improvement Activity

Create standard work job aids for referring physicians

Signature:

Date: Date: Date:

Signature: Signature:

Value Stream Mapping Facilitator

Approvals

Executive Sponsor Value Stream Champion

Merge scheduling & pre-registration functions; create standard work

Eliminate transcription; Install voice recognition

Install kanban

Reduce setup and balance work

Install visual queue board & simplify system access

Transfer copay collection function to Imaging front office

Create standard work & determine KPIs

8 & 9 Reduce LT in read and release steps; reduce batching

* Mode: JDI = Just do it; KE = Kaizen Event; PROJ = Project




Traditional Mapping Method:Process Flow Chart

Where’s the quality? Where’s the time?


What is a Metrics-Based Process Map (MBPM)?

A visual process analysis tool, which integrates:

Functional orientation of traditional swim lane process mapsKey Lean time and quality metrics

Tool which highlights the disconnects / wastes / delays in a process at a micro levelServes as standard work for workforce training and process monitoring



Metrics-Based Process Mapping (MBPM)


When Do We MBPM?

Value Stream DrivenVSM is the strategic tool that identifies when we need to perform a more detailed analysis of a processMBPM is a tactical tool used to flesh out the details at each step to see the “waste behind the waste”

Enables a team to “drill down” from a few targeted blocks on the VSMOften the first activity in a service/office Kaizen Event




Mapping Prep

Select a skilled, objective facilitatorDefine the scope

Select the fence posts (first and last steps).Select a specific situation or set of conditions.

There are no decisions points in an MBPM.Select the team

No more than 10Include representatives from all functions within the fence postsInclude people who currently do the workIf too many people involved, narrow your scopeIf room, include objective “outside eyes”Don’t avoid including critical players – e.g. physicians, patients, physician office staff, etc.


Documenting the Current State

Step 1 – Label the map in the upper right hand corner.

Include process name, conditions mapped, date, and facilitator name and/or team members.



Step 1: Label the map

Process Name Included/Excluded Conditions

Current State MBPM Date

Facilitator and/or Team Names

36” wide white paper with 6” swim lanes.



Step 2 – Label the swim lanes with the functions involved.

Include external functions, if appropriate (e.g. customers, suppliers/contractors, etc.)



Step 2: List functions

Process Name Included/Excluded Conditions

Current State MBPM Date

Facilitator and/or Team Names

Use 36” wide white paper with 6” swim lanes (hand drawn, chalk lines, or pre-printed).

Function A

Function B

Function C

Function D

Function E

Function F



Step 3 – Document all activities/steps on 3 x 6” post-its.

Use verb/noun format; clear and conciseInclude function.Separate tasks that have different quality outputs or timeframes; combine tasks otherwise.Place post-its in appropriate swim lane, sequentially.



MBPM Post-it Conventions

Activity (Verb / Noun)

Function that performs the

task



Step 4 – Number the activities.Number the activities sequentially from left to right.For parallel activities, add “A,” “B,” etc.

Example: Step 8A, Step 8B, etc.




Step #Activity

(Verb / Noun)Function that performs the

task

FunctionsStep

1Step

2 ParallelSteps





Step 5 – Add activity-specific information:Key metrics – include units of measure

Process Time (PT) - often minutes or hoursLead Time (LT) – often hours or daysPercent Complete & Accurate (%C&A)

Barriers to flow – batches, shared resources, equipment downtime, etc.Number of staff involved (if relevant)


# Staff (if relevant)

Barriers to flow (if relevant)

PT (process time)

LT (Lead time)% Complete & Accurate




Metrics Tips

Typically obtained via interview; questions must be high qualityPT & LT notes

You can “chunk” these metrics for a series of post-its when necessaryWhen wide variation, do one of three things:

Narrow your scope (pick a specific circumstance)Use the medianIndicate the variation, but use the median for the timeline

%C&A notesDetermined by immediate downstream customer and all subsequent downstream customersResponse is placed on the post-it for the output step0% at a particular step is not rare



Step 6 – Define the “Timeline Critical Path”Longest LT unless “dead-end” stepUse colored marker



Step 6: Define the “Timeline Critical Path”

For parallel activities: Chose the longest LT unless a “dead-end” activity



Step 7 – Create the timelineBring down the PT & LT from the critical path step.



Step 7: Create the Timeline



Step 8 – Calculate the summary metricsTimeline PT SumTimeline LT Sum% Activity

(Total PT/Total LT) x 100Rolled First Pass Yield (RFPY)

%C&A x %C&A x %C&A…Include ALL post-its, not just critical path



Metric Current StateProjected

Future StateProjected %

Improvement

Timeline PT

Timeline LT

% Activity

Rolled First Pass YieldTotal Process TimeLabor requirementsFreed capacity

Document Summary Metrics


Total PTSum of all activities, not just timeline

Labor Requirements

Summary Metrics: Labor Requirements

Total PT (in hrs) X # occurrences/year# FTEsAvailable work hrs/year/employee

=

* FTE = Full-time Equivalent (2 half time employees = 1 FTE)

Freed Capacity = CS FTEs - FS FTEs





Step 9 – Identify the value-adding and necessary non-value-adding activities

Use small colored post-its labeled with “VA” or “N”.NOTE – this is the first of two “bridge steps” between current state documentation and future state design.


Step 9: Label the value-adding (VA) andnecessary non-value adding (N) activities





Step 10 – Circle (with a red marker) the step-specific metrics that indicate the greatest opportunity for improvement.

Low step-specific %activity, low %C&A, etc.This is the second of the two steps that provide the bridge between current state documentation and future state design

Step 10: Circle the data that indicates the greatest need for improvement




Future State Design

GoalsReduce overall LT & PTImprove quality (increase RFPY)Increase % activity

Note: this may actually decrease during the first round of improvement

Improve LT, PT, and %C&A at individual stepsHow?

Eliminate non-value-adding activities stepsReduce handoffsEliminate reworkReduce batchingReduce queuing and work-in-processReduce transportation and motion

The Improved State Becomes Standard Work0

10

156-1

0Activity PT LT %C&A Activity PT LT %C&A Activity PT LT %C&A Activity PT LT %C&A Activity PT LT %C&A

1 Fax PO to Sales Rep 0 0 45%

2

Review PO; clarify with

customer as needed

20 2 90% Fax PO to warehouse 10 4 90%

5

6

Check inventory levels; notify Sales Rep re:

status

5 4 95% Fax PO to Sales Rep 5 0.33 90%

0 20 10 5 50 2 4 4 0.33

45% 90% 90% 95% 90%0 20 10 5 5

Rolled %C&ACritical Path LT

Total PT

Critical Path PT

5431 2

Mary Townsend

Hours Worked per Day Sally DampierOccurrences per Year Sam Parks

Current State Metrics-Based Process Map

Dave Morgan25-Jun-088 Facilitator

Process Details

Michael Prichard

Order FulfillmentProcess NameSpecific Conditions Domestic orders through sales force

37,500

Date Mapped

Sean Michaels

Sales Rep

Ryan AustinDiane O'SheaMapping Team

LT Units

Function / Department

PT Units

Step # ►

Customer

Finance

Warehouse / Shipping

Seconds

Minutes

Hours

Days

Seconds

Minutes

Hours

Days




Metric Current StateProjected

Future StateProjected %

Improvement

CP PT

CP LT

AR

RFPY

Total PT

Labor requirementsFreed capacity

Step 8 (continued):Document Results


Translating Your Results into Organizational Benefit

Ability to attract and retainTalented admin and clinical staffTalented providersPatients

Clinical qualityStandard work = predictable results

FinancialQuicker billing = quicker paymentFreed capacity = better marginsMarket share gains = higher revenue




MBPM Tips

Team-based activity!10 people max per team; use same people for both current and future state

Use a skilled, impartial facilitatorDocumenting the current state takes 33-50% longer than designing the future stateAvoid gaps between current and future state mappingTypical teams need 5-10 blocks to truly understand what you’re asking in terms of the metricsUse 36” wide white paper with 6” swim lanes; 3 x 6” post-its


Learning Objectives

The key time and quality metrics for designing Lean processes.The difference between a value stream map and metrics-based process map.The step-by-step approach for creating current and future state metrics-based process maps.How to use the metrics-based process map as a standard work and process monitoring tool.




Karen Martin, Principal7770 Regents Road #635

San Diego, CA 92122858.677.6799

[email protected]

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