CRC - Mapping Clinical Value Streams

Organization: CRC
Publication Date: 20 May 2013
Page Count: 117


Since the publication of To Err Is Human: Building a Safe Health System by the US Institute of Medicine in 1999, the healthcare industry has been struggling to reform its clinical processes to make patients safe. Unfortunately, despite a flurry of publications and conferences, and with the exception of a few notable institutions-such as the Virginia Mason Medical Center, Park Nicollet Health Services, and Thedacare-little has been accomplished. Tens of thousands of patients die unnecessarily every year as a result of inadvertent errors and defects in our healthcare processes. Those that survive pay too much, perhaps far too much, for the privilege.

The value stream mapping method described in this book provides a powerful tool for observing and depicting processes as they truly are-and for imagining the same processes without medical errors and other costly waste. Moreover, value stream mapping accomplishes this feat from the patient's perspective. It permits clinicians to re-envision their work as if they had "a patient on their shoulder." As we will see in Chapter 4, we achieve this patient-centered perspective by following real, live patients as they experience the entire course of their diagnosis and treatment. (Actually, we often follow the process until the patient receives the final, correct bill, but that is a topic for another book on administrative value steam mapping. Until then, see Keyte and Locher's, The Complete Lean Enterprise [New York: Productivity Press, 2004].)

Value stream maps are also an excellent tool for establishing the vision and strategy to develop your business. They help you understand how your healthcare business actually works and how it might work better. The observation that the healthcare industry's costs are too high and quality too low is a very old maxim. But why is it true? And why does it remain true more than 10 years after the publication of To Err Is Human? Perhaps it is because we do not yet have a complete diagnosis. Judging from the healthcare industry's high costs and poor quality record, the patient's perspective is not necessarily contemplated in our schools of medicine, nursing, or healthcare management. Mapping Clinical Value Streams has been written specifically to help your organization apply the concepts of value, flow, and pull, which have been highly effective in the improvement of manufacturing processes, to healthcare processes.

As a Lean evangelist in the world of healthcare, I am reminded daily that healthcare is different from manufacturing. This is true. It has also led to a number of problems translating the manufacturing language of value stream mapping into a natural-sounding healthcare idiom. Several difficulties arise because patients play a dual role: (1) patient as customer and (2) patient as participant in the system. From the patient-as-customer perspective, it is patently obvious that clinicians must be patient centered, kind, and compassionate. From the patient-as-participant perspective, it is not so clear.

And patients become participants in healthcare processes in the sense that they are key "inputs" to those processes. Once a patient signs a consent form, she consigns herself to becoming an input more or less like any other. This does not mean that patients sign away their right to be treated as human beings. Rather, it means that patients recognize that healthcare services are performed upon the human body, without which no medicine or procedure can take effect. Healthcare professionals are not comfortable viewing the patient in this way; but patients will likely tell you that the healthcare industry does not hesitate to treat them this way. Patients neglected in a waiting room are like so many parts on a shelf.

Ironically, perhaps, in the act of viewing the patient as a key participant in the processes of healthcare (that is, by viewing the patient as an input instead of a customer), we gain the patient's perspective that has been lacking for so long. In mapping the processes of healthcare, we will follow-literally-real patients as they wait in the doctor's office, as they receive their diagnoses, and as they travel to the lab for tests, to preop, to surgery, to recovery, and home. By viewing the patient as a key participant, we will learn firsthand why it is that 70% or more of healthcare defects occur in the hand-offs from doctor to nurse, from hospital to lab, and from nurse to patient. And we will observe many opportunities to make the healthcare system function much more effectively for patients and clinicians alike.

Another set of difficulties arises because patients frequently do not know what to ask for when they first enter a healthcare process. In other words, customer requirements are unclear. This is what the diagnostic process is intended to reveal. In a sense, although the patient may have consented to be a key participant (patient as input) the patient as customer still retains the right to "change her mind," as it were. Consequently, as clinicians learn more about the condition of a patient, there can be unexpected changes in the schedules for the production of healthcare services. Fortunately, the value stream mapping language of "pull production" is robust enough to accommodate the need to reschedule production for all types of reasons.

The information in Mapping Clinical Value Streams is presented in a highly organized and easy-to-assimilate format. There are numerous illustrations to reinforce the text. Margin assists call your attention to key points and other important features. Value stream mapping icons make it easy to see and understand the ebb and flow of healthcare processes. And throughout the book you are asked to reflect on questions that will help you apply these concepts and techniques to your own workplace. Each chapter has a summary for quick review.

To be competitive in today's marketplace, you absolutely cannot afford to leave processes unexamined or let them be haphazard or become customary by default. You must apply conscious, quality attention to see and fix your healthcare processes. Mapping Clinical Value Streams shows you how.