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57 8 Beyond the Simple Value Stream Map: Adding More Information .. 65 Part II CaSE StudIES Case Study 1 Scheduling Meeting Rooms ....................................................... ...... 75 Case Study 2 Employee Continuing Education Tuition Reimbursement ............... 81 Case Study 3 Routine Medication Ordering (Physician Order) ............................. 85 Case Study 4 Assignment of Transporters for Daytime Inpatient Radiology ....... 89 Case Study 5 Patient Pre-Registration for Day Surgery ....................................... . 93 Case Study 6 Trauma Patient Flow in a Busy Emergency Room ........................... 97 x Contents Case Study 7 Total Joint Replacement Scheduling (Operating Room Back-Table Set-Up) ............................................................. ............ 103 INDEX .......................................................................... ........................ 109 ABOUT THE AUTHOR ............................................................... ............113 xi acknowledgments The basic work for this book was developed through study and practice by the author, mentoring by manufacturers, healthcare workers, and educators from around the world, and the generous support of the National Science Foundation, grant 0115352 (20012004). More importantly, with gratitude the author thanks the staffs and leaders of more than 60 healthcare organizations who have used this simple but powerful method of looking at work differently as their first st ep toward improving healthcare delivery. It is their feedback and suggestions that have contributed to the diverse applications of value stream mapping (VSM) for healthcare. The following individuals have added specific simplicity and elegance to make VSM a straightforward practice even for the beginning student of lean thinking: Vicki Baum Amy Jimmerson Susan Sheehy Durward Sobek Jayne Ottman Dorothy Weber While some of the VSMs in Part II have been slightly altered to make a teaching point, each one of the examples is taken from real work done by real people in the course of recognizing problems and improving the delivery of care. In par ticular, the following organizations have contributed experience and enthusiasm to the case studies in Part II of this book. The author acknowledges them with deep gratitude: Community Medical Center, Missoula, Montana Northern Arizona Health, Flagstaff, Arizona Centennial Medical Center, Nashville, Tennessee St. Vincent Hospital, Billings, Montana St. Patrick Hospital and Health Center, Missoula, Montana A very special thanks to Dilesh Patel (GumshoeKI, Inc.) for his detailed contributions to this text. The mastery of simple Value Stream Mapping inevitably lead

s to the creative addition of more valuable information and the need to share the work well done. Dilesh's contributions will undoubtedly launch the expansion of simple mapping skills. xiii Introduction My experience with value stream mapping (VSM) for healthcare resulted from a very fortunate opportunity provided by the National Science Foundation in 2000. Through a grant awarded to Montana State University (MSU) (NSF grant 0115352, Applying the principles of the Toyota Production System to healthcare, 20002002), coinvestigated by myself and Dr. Durward Sobek, a professor at the engineering school at MSU, I was funded for 3 years to explore the possibility of using concepts and practices of the Toyota Production System (TPS) in a healthcare setting. It was a goal from the outset to apply these principles and methods in every department of the host healthcare organization. To attempt to do this, the application needed to be easy to learn, easy to teach, and relevant to all kinds of work. These requirements, coupled with Dr. Sobek's studies and personal experience at Toyota, led our exploration to the then-emerging work of Steven Spear. At the conclusion of research for his doctoral work in 1999, Harvard PhD candidate Steven Spear, with Harvard Business School professor Kent Bowen, described the concepts of ideal and the four rules in use. [The concept of ideal is originally credited to Dr. Russell L. Ackoff in T. Lee and T. Woll, Reflections on the Idealized Design Planning Process, CQM Journal 11, no. 2 (2003).] In their landmark paper, Decoding the DNA of the Toyota Production System [S. Spear and H. Kent Bowen, Harvard Business Review, September October (1999), pp. 97106], they concluded that these simple concepts and rules were the fundamental drivers of the Toyota culture of work. While simple in concept, the consistent practice of ideal and the four rules is applicable to an y business model, especially healthcare. toyota's role in lean When discussing continuous improvement it is impossible to overlook the contribution of the Toyota Motor Company. Their work has led to the development of this book and scores of others about Lean and process improvement.