Lean management refers to application of techniques and principles that enable companies to add value to the products they create and services they offer, by paying much attention to processes that yield positive results and eliminating processes that do not add value to the production process (Dickson et al., 2008). Value stream mapping is a method of lean management that drive businesses to analyze their current states and make future improvements that will enable them to produce products that customers are willing to pay for. Many people have argued whether companies that offer services such as hospitals require value stream mapping like those that offer tangible products. According to Graban (2007), hospitals are continuously faced with unique pressures such as limited space and shortages of skilled positions that can effectively be solved through lean management, specifically, value stream mapping.
In their research, Schwarz et al., (2011) have implemented value stream mapping techniques with the aim of improving operating room (OR) capacity utilization in a healthcare setting. These authors have analyzed changes in four different process metrics to determine whether there is any improvement in operating room (OR) capacity utilization. The four metrics include flow time, value added time, waste, and percent value added time. In this paper, the three symbols h, ’, & ”, stand for hours, minutes, and seconds respectively. Flow time, also known as throughput time or lead time, refers to average time that a product requires to undergo through all steps in a production process. This is calculated by adding the time taken by both value-adding and non-value adding (waste) processes. From figure 1 (Schwarz et al., 2011), flow time is gotten by: 1h 35’ 24” + 55’36”=2 h 31’.
Value added time refers to the time taken by process steps that actually transform a product to what customers are willing to pay for. From figure 1 (Schwarz et al., 2011), value added time is gotten by: 1’11”+8’28”+1’58”+6’31”+13’37”+47’49”+8’31”+4’20”+3’1”=1h 35’24”. Waste on the other hand refers to the time take by process steps that do not add any value to a product. From figure 1 (Schwarz et al., 2011), waste is gotten by: 4’3”+6’30”+8’6”+2’10”+5’10”+11’16”+2’19”+6’42”+3’13”+6’7”=55’36”. Percent value added time refers to the percentage of flow time and a function of meaningful operations. This is obtained by: (value added time/flow time) X 100. From figure 1 (Schwarz et al., 2011), percent value added time is gotten by: (1h 35’24”/ 2 h 31’) X 100= (5,724 seconds/9,060 seconds) X 100 =63.18 percent.
Following implementation of value stream mapping to project management, Schwarz et al. (2011) have observed tremendous improvements in the operating room process. This improvement is indicated by the changes in the four process metrics: flow time, value added time, waste, and percent value added time. As Dickson et al. (2008) point out, the major goal of lean management is to persistently increase the value of either a product or a service offered to customers. In most organizations, value of a product is measured by dividing the quality of a product by its price. In a health care organization however, patient cannot estimate the price of services, and they are unable to quantify the quality of the healthcare service. Due to these problems, value of a service in a healthcare organization can effectively be measured by calculating changes in different process metrics as done by Schwarz et al. (2011).
After implementing value stream mapping as a lean management method, the processes that take place in an operating room have been reduced from ten to seven. In addition, waiting time has reduced to 26 percent from 36 percent and the value adding activities have increased by approximately 10 percent. Waiting time is part of waste that takes place in an operating room. These improvements have significantly sped up the operation processes in the operating room. Prior to implementation of value stream mapping in the healthcare setting, the flow time was 2 hours 31 minutes which is equivalent to 151 minutes. After implementation of the new techniques, flow time has reduced from 151 minutes to 120 minutes (2 hours) which is equivalent to 21 percent change in flow time. This is a significant improvement in the operating room processes which has led to optimization of operation procedures (Schwarz et al., 2011).
Similarly, the weak points (waste) in the operation room processes have been reduced significantly following implementation of value stream mapping in the healthcare setting. The wastes have reduced from 55 minutes and 36 seconds to 31 minutes and 17 seconds. This is equivalent to a percentage decrease of 44 percent. Value added time has also improved from 1h 35’24” to 1h 28’43”, an indication that less time than before is now required to provide services that customers are willing to pay for. This is identified as a 10 percent increase in value added time. Furthermore, implementation of the new method has resulted into an increase in percent value added time from 63.18 percent to 73.93 percent. This new value has been gotten by: (1h 28’43”/2h) X 100 (Schwarz et al., 2011).
As a result of these changes, the healthcare setting can now consider one additional operation per operating room theatre every day. From an average of three beds per operating room per day, the healthcare setting can now increase utilization of operating room by using an average of four beds per room per day. This will result in a significant increase in the number of procedure performed in the health care setting to 1820 per year. Even with the increase in the number of procedures performed per annum, the health care setting will not be requires to employ any additional staff. It is therefore evident that implementation of lean process in a healthcare organization can lead to improved capacity utilization while assisting the company to minimize costs (Schwarz et al., 2011).
The improvements observed by Schwarz et al. (2011) following implementation of value stream mapping as a method of lean management are similar to the ones documented by Graban (2007) and Dickson et al. (2008). According to Graban (2007), lean implementation improves turnaround time in laboratory procedures. For turnaround time to be faster than usual, there must be a reduction in waste and an improvement in the value added time. This helps to reduce the time required for laboratory results to be availed to the physician. According to Dickson et al. (2008), incorporation of lean management into emergency department of a healthcare organization results into significant improvements in patient flow and patient satisfaction. These improvements increase the number of patient visits to the healthcare organization. Consequently, implementation of value stream mapping assists a healthcare organization to manage additional number of patients without increasing operation costs.
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