Metrics-Based Process Mapping (MBPM)

Transcription

1 Metrics-Based Process Mapping (MBPM) Society for Health Systems Webinar February 17, 2009 Company LOGO

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 Karen Martin & Associates 2

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 uninterrupted Includes task-specific doing, talking, and thinking aka 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 chain aka throughput time, turnaround time, elapsed time 2009 Karen Martin & Associates 3

4 Typical Current State Findings Islands of value-adding activities All other time is waste. Rework First Step Adding Value Last Step Lead Time 2009 Karen Martin & Associates 4

5 Summary Metrics: Time % Activity The percentage of time work is being done to the patient/item/data passing through the process/system (PT LT) % Activity = Idle time of the product passing through the process/system Goal ID barriers to flow 2009 Karen Martin & Associates 5

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 supplied Add information that should have been supplied Clarify information that should or could have been clear This output metric is measured by the immediate downstream customer and all subsequent downstream customers Karen Martin & Associates 6

7 Summary Metrics: Quality 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 required Example: (0.95 x 0.60 x 0.85 x 0.75) x 100 = 36.3% RFPY Hint: the RFPY will always be lower than the lowest %C&A for an individual step Karen Martin & Associates 7

8 The Work We Do: Degrees of Granularity 30,000 ft View (Strategic) Value Stream Value Stream Map Process Process Process In the Weeds (Tactical) Step Step Step Metrics-Based Process Map 2009 Karen Martin & Associates 8

9 Hospital 4 Lead Time = 24 days Pre-register Patient 3 5 Cycle Time = 30 mins. Lead Time = 990 mins. % C&A = 100 % Current State Value Stream Map Outpatient Imaging Services CT Scans Lead Time = 990 mins. Schedule Appointment 2 6 Cycle Time = 11 mins. Lead Time = 12 mins. % C&A = 98 % Lead Time = 12 mins. Referring Physician 1 % C&A = 65 % Customer Demand: 15 patients per Day (Takt Time 1920seconds) 8 hours per day Demand = 15 per day CT=Cycle Time LT=Lead Time %C&A=% Complete & Accurate Symposium E Pay Excel ADS Meditech Internet Waiting Room Management System Fax Order Solutions PACS Auto Fax 50% Us Mail 25% MD Mailbox 25% Rework Loop via Fax 25% of the time 5 mins. Check-in Patient (Admitting) 5 Cycle Time = 2 mins. % C&A = 90 % Check-in Patient (Imaging) 3 Cycle Time = 1 mins. % C&A = 98 % Prep Patient (Tech) 2 Cycle Time = 10 mins. % C&A = 100 % Complete Exam (Tech) 2 Cycle Time = 15 mins. % C&A = 90 % Transmit Images (Tech) 2 Cycle Time = 3 mins. % C&A = 100 % Read/Dictate Exam (Radiologist) 2 Cycle Time = 15 mins. % C&A = 95 % Transcribe Report (MDI) 6 Cycle Time = 5 mins. % C&A = 75 % Review Draft/Sign (Radiologist) 5 5 mins mins mins. 8 5 mins mins mins mins mins mins Cycle Time = 1 mins. % C&A = 95 % Print Reports (Imaging) 2 Cycle Time = 1 mins. % C&A = 99 % Send Reports (Imaging) 6 Cycle Time = 3 mins. % C&A = 90 % hrs. 2 mins hrs. 1 mins hrs. 10 mins. 0.5 hrs. 15 mins hrs. 3 mins hrs. 15 mins hrs. 5 mins. 16 hrs. 1 mins hrs. 1 mins. 2 hrs. 3 mins. LT = 32.5 hrs. CT = 56 mins. CT/LT Ratio = 2.87% Rolled First Pass yield = 29%

10 Future State Value Stream Map Outpatient Imaging Services Hospital 3 Work Balance Lead Time = 15 days Standard Work Schedule appt Pre-register 2 6 Cycle Time = 11 mins. Lead Time = 45 mins. % C&A = 98 % Co-locate Lead Time = 45 mins. Risk Reduction (Joint Commision) Referring Physician 1 % C&A = 85 % Customer Demand: 15 patients per Day (Takt Time 1920 seconds) 8 hours per day CT=Cycle Time LT=Lead Time %C&A=% Complete & Accurate Symposium E Pay Excel Meditech Internet Waiting Room Management System Fax Order Solutions PACS Auto Fax 80% Us Mail 15% MD Mailbox 5% Remove Check in and Reduce System Access Standard Work Pull System (Supplies Kanban) Set-up Reduction Work Balancing Visual Workplace Value Stream Alignment Continuous Flow Voice Recognition 5S Batch Reductions Rework Loop via Fax 10% of the time Check-in Patient (Imaging) Prep Patient (Tech) Complete Exam (Tech) Transmit Images (Tech) Read/Dictate Exam (Radiologist) Review Draft/Sign (Radiologist) Print Reports (Imaging) Send Reports (Imaging) 5 mins. 35 mins. 3 4 Cycle Time = 1 mins. % C&A = 98 % 2 Cycle Time = 10 mins. % C&A = 100 % 5 20 mins. 6 5 mins mins mins. 9 2 mins mins Cycle Time = 10 mins. % C&A = 90 % 2 Cycle Time = 2 mins. % C&A = 100 % 2 Cycle Time = 15 mins. % C&A = 95 % 2 Cycle Time = 1 mins. % C&A = 95 % 2 Cycle Time = 1 mins. % C&A = 99 % Cycle Time = 3 mins. % C&A = 90 % hrs. 1 mins hrs. 10 mins hrs. 10 mins hrs. 2 mins. 2 hrs. 15 mins. 7 hrs. 1 mins hrs. 1 mins. 0.5 hrs. 3 mins. LT = 11.3 hrs. CT = 43 mins. CT/LT Ratio = 6.32% Rolled First Pass yield = 40%

11 Outpatient Imaging Projected Results Metric Current State Projected Future State % Improvement Lead Time 32.5 hrs 11.3 hrs 65% Process Time 56 mins 43 mins 23% % Activity 2.9% 6.3% 117% Rolled First 29% 40% 38% Pass Yield # Handoffs % Tech turnover (annual) 100% 25% 75% % Activity = Process Time/Lead Time x 100 Rolled First Pass Yield = %C&A x %C&A x %C&A 2009 Karen Martin & Associates 11

12 Block # Future State Implementation Plan Value Stream Outpatient Imaging Implementation Plan Review Dates Executive Sponsor Paul Smith 8-Aug Oct-08 Value Stream Champion Doris Jones 22-Aug Oct-08 Value Stream Mapping Facilitator Bruce Tollman 12-Sep-08 7-Nov-08 Date Created 7/18/ Sep Nov-08 Goal / Objective Improvement Activity Mode* Owner Implementation Schedule (weeks) Date Complete Create standard work job aids for referring 1 Increase %C&A from 65% to 85% KE Sally G. physicians Merge scheduling & pre-registration 2 Reduce LT and improve efficiencies PROJ Claudia J. functions; create standard work Transfer copay collection function to 4 Remove duplicate check-in PROJ Bob S. Imaging front office 5 Standardize patient prep process Create standard work & determine KPIs KE Sally G. 5 Reduce stockouts & inventory expense Install kanban KE Sally G. 6 Maximize machine efficiency and reduce patient time on site Reduce setup and balance work KE Bruce E. 8 & 9 Reduce LT in read and release steps; reduce batching Install visual queue board & simplify system access Eliminate transcription; Install voice recognition JDI Bruce E. PROJ John R. 10 & 11 Reduce report release batching Shift physicians to autofax PROJ Maria G. Approvals Executive Sponsor Value Stream Champion Value Stream Mapping Facilitator Signature: Signature: Signature: Date: Date: Date: * Mode: JDI = Just do it; KE = Kaizen Event; PROJ = Project

13 Traditional Mapping Method: Process Flow Chart Where s the quality? Where s the time? 2009 Karen Martin & Associates 13

14 What is a Metrics-Based Process Map (MBPM)? A visual process analysis tool, which integrates: Functional orientation of traditional swim lane process maps Key Lean time and quality metrics Tool which highlights the disconnects / wastes / delays in a process at a micro level Serves as standard work for workforce training and process monitoring 2009 Karen Martin & Associates 14

15 Metrics-Based Process Mapping (MBPM)

16 When Do We MBPM? Value Stream Driven VSM is the strategic tool that identifies when we need to perform a more detailed analysis of a process MBPM 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 VSM Often the first activity in a service/office Kaizen Event 2009 Karen Martin & Associates 16

17 Mapping Prep Select a skilled, objective facilitator Define 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 10 Include representatives from all functions within the fence posts Include people who currently do the work If too many people involved, narrow your scope If room, include objective outside eyes Don t avoid including critical players e.g. physicians, patients, physician office staff, etc Karen Martin & Associates 17

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 Karen Martin & Associates 18

19 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.

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.) 2009 Karen Martin & Associates 20

21 Step 2: List functions Function A Function B Process Name Included/Excluded Conditions Current State MBPM Date Facilitator and/or Team Names Function C Function D Function E Function F Use 36 wide white paper with 6 swim lanes (hand drawn, chalk lines, or pre-printed).

22 Documenting the Current State Step 3 Document all activities/steps on 3 x 6 post-its. Use verb/noun format; clear and concise Include function. Separate tasks that have different quality outputs or timeframes; combine tasks otherwise. Place post-its in appropriate swim lane, sequentially Karen Martin & Associates 22

23 MBPM Post-it Conventions Activity (Verb / Noun) Function that performs the task

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 Karen Martin & Associates 24

25 MBPM Post-it Conventions Activity (Verb / Noun) Step # Function that performs the task

26 Functions Step 1 Step 2 Parallel Steps

27 Documenting the Current State Step 5 Add activity-specific information: Key metrics include units of measure Process Time (PT) - often minutes or hours Lead Time (LT) often hours or days Percent Complete & Accurate (%C&A) Barriers to flow batches, shared resources, equipment downtime, etc. Number of staff involved (if relevant) 2009 Karen Martin & Associates 27

28 MBPM Post-it Conventions # Staff (if relevant) Barriers to flow (if relevant) % Complete & Accurate PT (process time) LT (Lead time)

29 Metrics Tips Typically obtained via interview; questions must be high quality PT & LT notes You can chunk these metrics for a series of post-its when necessary When wide variation, do one of three things: Narrow your scope (pick a specific circumstance) Use the median Indicate the variation, but use the median for the timeline %C&A notes Determined by immediate downstream customer and all subsequent downstream customers Response is placed on the post-it for the output step 0% at a particular step is not rare 2009 Karen Martin & Associates 29

30 Documenting the Current State Step 6 Define the Timeline Critical Path Longest LT unless dead-end step Use colored marker 2009 Karen Martin & Associates 30

31 Step 6: Define the Timeline Critical Path For parallel activities: Chose the longest LT unless a dead-end activity

32 Documenting the Current State Step 7 Create the timeline Bring down the PT & LT from the critical path step Karen Martin & Associates 32

33 Step 7: Create the Timeline

34 Documenting the Current State Step 8 Calculate the summary metrics Timeline PT Sum Timeline LT Sum % Activity (Total PT/Total LT) x 100 Rolled First Pass Yield (RFPY) %C&A x %C&A x %C&A Include ALL post-its, not just critical path 2009 Karen Martin & Associates 34

35 Document Summary Metrics Metric Current State Projected Future State Projected % Improvement Timeline PT Timeline LT % Activity Rolled First Pass Yield Total Process Time Labor requirements Freed capacity

36 Summary Metrics: Labor Requirements Total PT Sum of all activities, not just timeline Labor Requirements # FTEs = Total PT (in hrs) X # occurrences/year Available work hrs/year/employee Freed Capacity = CS FTEs - FS FTEs * FTE = Full-time Equivalent (2 half time employees = 1 FTE) 2009 Karen Martin & Associates 36

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 Karen Martin & Associates 37

38 Step 9: Label the value-adding (VA) and necessary non-value adding (N) activities 2009 Karen Martin & Associates 38

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 2009 Karen Martin & Associates 39

40 Step 10: Circle the data that indicates the greatest need for improvement

41 Future State Design Goals How? Reduce overall LT & PT Improve quality (increase RFPY) Increase % activity Note: this may actually decrease during the first round of improvement Improve LT, PT, and %C&A at individual steps Eliminate non-value-adding activities steps Reduce handoffs Eliminate rework Reduce batching Reduce queuing and work-in-process Reduce transportation and motion 2009 Karen Martin & Associates 41

42 The Improved State Becomes Standard Work

43 Step 8 (continued): Document Results Metric Current State Projected Future State Projected % Improvement CP PT CP LT AR RFPY Total PT Labor requirements Freed capacity 2009 Karen Martin & Associates 43

44 Translating Your Results into Organizational Benefit Ability to attract and retain Talented admin and clinical staff Talented providers Patients Clinical quality Standard work = predictable results Financial Quicker billing = quicker payment Freed capacity = better margins Market share gains = higher revenue 2009 Karen Martin & Associates 44

45 MBPM Tips Team-based activity! 10 people max per team; use same people for both current and future state Use a skilled, impartial facilitator Documenting the current state takes 33-50% longer than designing the future state Avoid gaps between current and future state mapping Typical teams need 5-10 blocks to truly understand what you re asking in terms of the metrics Use 36 wide white paper with 6 swim lanes; 3 x 6 post-its 2009 Karen Martin & Associates 45

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 Karen Martin & Associates 46

47 Additional Questions? Karen Martin, Principal 7770 Regents Road #635 San Diego, CA Karen Martin & Associates 47