Robert Martin, PsyD Performance Excellence UCLA Health

1. Housestaff Lean AcademyModule 3: Examining the Current State (Process Mapping, Observations, and Waste) Robert Martin, PsyDPerformance ExcellenceUCLA Health

2. Where does this module fit into the curriculum?

3. Module 1 Summary Use these concepts to focus your improvement project • Use the A3 and PDCA methodology (i.e. scientific method for improvement) to manage and communicate your improvement project • Use these concepts to maximize your improvement project’s chance for success

4. Module 2 Summary

5. Documenting the Current State is beneficial • Idea collection, observations, and discussions of “pain points” engages staff , improves shared understanding and teaming • Illustrates a process or patient pathway from both the staff and patient’s perspectives • The resulting documentation (a process map, observation sheets, spaghetti charts, etc.): • Is easy to understand, highly visual, and aids the change process • Help to identify steps that don't directly contribute to patient care (bottlenecks, constraints, problems/issues = waste) • Help to identify steps that do contribute to patient care (value-added)

6. Process Mapping • A simple language not taught in medical school • Organized visualization of interrelated activities which combine to form a process, patient pathway, or process of care • There are more symbols, but these are the most important: • Process Mapping can be mapped in several ways!

7. Process Mapping (Cross-Functional, or “Swim Lanes”)

8. Process Mapping (Linear/Phased) Where activity takes the longest on this map? This might required a more detailed map or Time Observation Sheets

9. You can use TOS or more detailed Process Mapsto further understand problems Using Time Observation Sheets* Multiple Observations Running clock is used Calculations can be done after (i.e. 8:20 – 8:02 = 18 mins) Remarks can be captured for further analysis *Template is available

10. You can use Spaghetti Charts to show the impact of motion and movement, and to improve flow Using Spaghetti Charts* Steps can be copied over from Time Obs. Sheets Distance can be measured 1 4-8 10 2 3 9 *Template is available

11. While doing observations, you can find more “waste” when you examine with a model*: Process Maps Time Observation Sheets Spaghetti Charts The 8 Wastes *Template for practicing 8 wastes is available

12. You can use TOS or more detailed Process Mapsto further understand problems Using Time Observation Sheets* Waiting: Why18 minutes waiting for the Care Coordinator to do consent forms! Not utilizing Talent: Can another function help when CC is doing Plan of Care Scheduling? Overproduction: Are all of the forms necessary? Defects & Extra Processing: Why are their defects? What type? What is the impact of defects? *Template is available

13. Once the Current State is understood, you can analyze the “root causes” of the waste (next module) to eliminate them The 8 Wastes Pareto Cause & Effect Diagrams 5 Why Analysis

14. What module is next?* * Thank you! Please complete your post-questions