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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.
© 2009 Karen Martin & Associates 3
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
© 2009 Karen Martin & Associates 4
Islands of value-adding activitiesAll other time is “waste.”
Adding Value
Rework
First Step Last Step
Typical Current State Findings
Lead Time
© 2009 Karen Martin & Associates 5
% 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
© 2009 Karen Martin & Associates 6
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.
© 2009 Karen Martin & Associates 7
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
© 2009 Karen Martin & Associates 8
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)
Cycle Time = 3 mins.% C&A = 90 %
6
Hospital
5 mins.
ScheduleAppointment
Cycle Time = 11 mins.Lead Time = 12 mins.% C&A = 98 %
6
Pre-register Patient
Cycle Time = 30 mins.Lead Time = 990 mins.% C&A = 100 %
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)
Cycle Time = 10 mins.% C&A = 100 %
2
Check-inPatient
(Imaging)
Cycle Time = 1 mins.% C&A = 98 %
3
CompleteExam(Tech)
Cycle Time = 15 mins.% C&A = 90 %
2
TransmitImages(Tech)
Cycle Time = 3 mins.% C&A = 100 %
2
Read/DictateExam
(Radiologist)
Cycle Time = 15 mins.% C&A = 95 %
2
TranscribeReport (MDI)
Cycle Time = 5 mins.% C&A = 75 %
6
ReviewDraft/Sign
(Radiologist)
Cycle Time = 1 mins.% C&A = 95 %
2
PrintReports
(Imaging)
Cycle Time = 1 mins.% C&A = 99 %
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)
Cycle Time = 3 mins.% C&A = 90 %
6
Hospital
Schedule apptPre-register
Cycle Time = 11 mins.Lead Time = 45 mins.% C&A = 98 %
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)
Cycle Time = 10 mins.% C&A = 100 %
2
Check-inPatient
(Imaging)
Cycle Time = 1 mins.% C&A = 98 %
3
CompleteExam(Tech)
Cycle Time = 10 mins.% C&A = 90 %
2
TransmitImages(Tech)
Cycle Time = 2 mins.% C&A = 100 %
2
Read/DictateExam
(Radiologist)
Cycle Time = 15 mins.% C&A = 95 %
2
ReviewDraft/Sign
(Radiologist)
Cycle Time = 1 mins.% C&A = 95 %
2
PrintReports
(Imaging)
Cycle Time = 1 mins.% C&A = 99 %
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
© 2009 Karen Martin & Associates 11
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
© 2009 Karen Martin & Associates 13
Traditional Mapping Method:Process Flow Chart
Where’s the quality? Where’s the time?
© 2009 Karen Martin & Associates 14
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)
© 2009 Karen Martin & Associates 16
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
© 2009 Karen Martin & Associates 17
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.
© 2009 Karen Martin & Associates 18
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.
© 2009 Karen Martin & Associates 20
Documenting the Current State
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
© 2009 Karen Martin & Associates 22
Documenting the Current State
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
© 2009 Karen Martin & Associates 24
Documenting the Current State
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.
MBPM Post-it Conventions
Step #Activity
(Verb / Noun)Function that performs the
task
FunctionsStep
1Step
2 ParallelSteps
© 2009 Karen Martin & Associates 27
Documenting the Current State
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)
MBPM Post-it Conventions
# Staff (if relevant)
Barriers to flow (if relevant)
PT (process time)
LT (Lead time)% Complete & Accurate
© 2009 Karen Martin & Associates 29
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
© 2009 Karen Martin & Associates 30
Documenting the Current State
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
© 2009 Karen Martin & Associates 32
Documenting the Current State
Step 7 – Create the timelineBring down the PT & LT from the critical path step.
Step 7: Create the Timeline
© 2009 Karen Martin & Associates 34
Documenting the Current State
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
© 2009 Karen Martin & Associates 36
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
© 2009 Karen Martin & Associates 37
Documenting the Current State
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.
© 2009 Karen Martin & Associates 38
Step 9: Label the value-adding (VA) andnecessary non-value adding (N) activities
© 2009 Karen Martin & Associates 39
Documenting the Current State
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
© 2009 Karen Martin & Associates 41
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 Work
© 2009 Karen Martin & Associates 43
Metric Current StateProjected
Future StateProjected %
Improvement
CP PT
CP LT
AR
RFPY
Total PT
Labor requirementsFreed capacity
Step 8 (continued):Document Results
© 2009 Karen Martin & Associates 44
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
© 2009 Karen Martin & Associates 45
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
© 2009 Karen Martin & Associates 46
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.
© 2009 Karen Martin & Associates 47
Karen Martin, Principal7770 Regents Road #635
San Diego, CA 92122858.677.6799
Additional Questions?