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Transcript of Valuestream Mapping
By Natalie Wald & Beth Earthman
Select symbols that are relevant to your process
Value Stream Mapping (VSM)
A Lean Thinking Approach
The principles of VSM stem from the ideas of Taichi Ohno ( 1988 ) who developed the production system at Toyota.
It is based on the premise of a Lean system, where all wastes must be eliminated.
Traditionally, VSM has been used in manufacturing companies, but has recently been employed by a variety of other industries, including healthcare.
A type of flow diagram recommended for lean improvement projects
Illustrates process and information flow within a system
Utilizes a timeline below the process map to show:
the processing time for each operation
the transfer delays between operations
non-value-adding steps, or waste
Come to consensus on which symbols will be used for mapping
Select an appropriate time metric for the flow map
Create a current state stream map
Enter all preceding and succeeding steps of the selected process into the flow map
Assign the time necessary for each step to create a timeline that corresponds to the flow map
Value Stream Map
Identify areas of potential waste
Common areas of waste
Potential waste highlighted from our example
Decrease or eliminate waste
from the process
Identify interventions to improve patient flow through the ED
Goal: Reduce the time from door to evaluation by QMP
1. Change process so that RN triage and QMP assessment occur simultaneously and before bed assignment
2. QMP will order labs/xrays/ treatment in triage
Future State Value Stream Map
The use of VSM in healthcare can result in improved quality of care and patient satisfaction by reducing waste in the system and making the process more efficient.
Value Stream Mapping in Healthcare
How to address wait times
in the Emergency Department
Leaned process results
Reduction in minutes
from Door to QMP Diagnosis
Agency for Healthcare Research and Quality. (2011). Improving Patient Flow
and Reducing Emergency Department Crowding. Retrieved from
Gill, P.S. (2012). Application of value stream mapping to eliminate waste in an
Journal Global Journal of Medical Research
. 12, 51-56.
Hall, R., Belson, D., Murali, P. &, Dessouky, M. (2006). Modeling patient flows through
the healthcare system. In patient flow: Reducing delay in healthcare delivery (R. W. Hall, ed.). 1, 1-45. New York: Springer.
Koelling, C. P., Eitel, D., Mahapatra, S., Messner, K., & Grove, L. (2005). Value stream
mapping the emergency department.
Society for Health System Conference 2005.
Lean Manufacturing Tools. (2014).
Creating a value stream map.
Retrieved from http://
Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L. & Provost, L. P.
(2009). The improvement guide (2nd ed.). San Francisco: Jossey-Bass.
Poksinska, B. (2010). The current state of Lean implementation in health care: Literature
Quality Management in Health Care.
(19), 4, 319-329.
Wickramasinghe, N. (2014). Lean thinking for healthcare. Springer New York.
Wait times between processes
for bed assignment to see QMP
Select the process you wish to map, or problem you want to address
Excessive wait times in the Emergency Department
Process to be mapped:
Patient flow in the Emergency Department
Collect data on the current state of the process
Collaborate with those involved in the process to ensure each step is captured
Arrival to ED
Set boundaries for the process
Door to diagnosis by qualified medical professional (QMP)
Determine start and end points to the process
Manufacturing VSM symbols
Unnecessary motion or waiting
Complexity or confusion
Inventory (location, amount)
Defects (errors= more work)
Brainstorm possible interventions for improvement
Omit unnecessary steps
Organization must fully adopt principles of lean thinking
Key staff members must have extensive knowledge and experience in VSM philosophies
Continuous evaluation and feedback from everyone involved is required
Success depends on the competency of frontline workers
Provides a means to streamline hospital processes
Results in improved patient care and satisfaction
A review by Poksinska, 2010 showed VSM to be a viable tool in the healthcare setting, citing improvements in two areas:
Reduced wait times
Increased attention of employees to waste
A more proactive attitude to problem solving
Step 9: Create a future state stream map
The new value stream map should reflect omission of any areas of waste and implementation of any improvement strategies identified in the previous step
Final Steps for VSM