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Hi and welcome to Be The Flagship with our podcast host Jeff Parsons.

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This is where we tackle the day-to-day talent management challenges you face, particularly

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in hospice and small healthcare organizations.

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And now over to our host.

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Take it away Jeff.

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Hello.

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I'm Jeff Parsons, your podcast host for Be The Flagship.

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To refresh your memory, this month is Healthcare Process Improvement Month, or at least as

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far as I'm concerned.

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So all of our episodes in January are focused on how to improve your processes, how to be

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more effective and efficient within your healthcare organization.

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And to help me accomplish that, I have Terry Norris, a Lean Healthcare Expert.

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He's been with me this month for our episodes.

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Our first episode focused on what Lean Healthcare is, and then the second episode on why it

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fails and it does fail and what we can do to prevent failure and achieve success.

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And for the remainder of the month, we're going to focus on specific tools you can use

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to improve your processes in healthcare.

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So Terry Norris, but first, a commercial break.

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At Flagship Talent, we work with our clients to find and place the right talent.

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What do we mean by the right talent?

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We mean we find talent who will commit to your organizational goals and align with your

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values and behavior expectations.

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Talent who will perform to your expectations.

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Talent who will stay and grow with your organization.

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How are we different from our competitors?

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We offer the lowest fee structure in the industry.

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We offer the best talent guarantee in the industry.

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We provide selection and interviewing support to our clients at no additional fee.

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We want to save you money, deliver high quality talent, become an extension of your organization,

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and be your preferred provider of talent acquisition solutions.

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To learn more, contact Jeff Parsons by email at jeff at flagshiptalent.com or by phone

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at 1-800-530-4189, extension 101.

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Okay.

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So Terry, thank you for joining us again.

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We're glad to have you.

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Thank you.

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Yes, my pleasure.

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Good.

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And just to recap where we've been on this Lean Healthcare journey to this point, the

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first episode of this month focused on what Lean Healthcare is, what it looks like, and

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you did a great job describing Lean Healthcare.

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The second episode, last week's episode, focused on why Lean initiatives fail, and they often

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do fail.

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So you focused on that and what organizations can do to prevent failure.

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So that was a great episode.

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This week, we're going to get into some of the meat of Lean.

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We're going to get into the tools so that when you're ready to make a process improvement,

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Lean tools, I envision a toolbox, right?

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You might have in your garage or that sort of thing.

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And when you have a job to do, you open up toolbox and hopefully you use the right tool.

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Now, oftentimes I'll pull out a screwdriver to do a hammer's work, but you want to use

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the right tool to accomplish your objective.

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And so these next episodes, I believe we're going to talk about the various Lean tools

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you can use and why they're appropriate and how you can use them.

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So again, thank you for your time today, Terry.

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So let's start with the concept of a rapid improvement event.

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So what is a rapid improvement event?

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Okay.

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Thanks, Jeff.

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So the general idea of a rapid improvement event is to make, you know, it's kind of implied

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in how you say it, it's to make an improvement quickly that if you did it through traditional

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project management or just not even a really good project management, but the way things

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normally work, it may take six or seven or eight or nine months to do something that

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you could do in a week or 30 days with a rapid improvement event.

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So they're designed to turn things around quickly.

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And I may have mentioned in some of the previous, or talking about, you know, Lean takes some

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time to build a culture for sure, but you can make some really, really big improvements

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quickly using a rapid improvement event.

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Okay.

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So is a rapid improvement event the same thing as a Kaizen event?

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Yes.

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And I thought about mentioning that because one of the things I've got away from, I mean,

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early on in my Lean journey was using Japanese words.

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However, there are a few that you just can't get away from and that's one of them, you

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know, Gimba and Kaizen.

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But Kaizen is a Japanese word, if you break it down, it just means good change.

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So it's continuous improvement, more loosely interpreted, but yes, it is the same thing.

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Okay.

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We're just using a little more modern wording for it then.

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English, yes.

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Excellent.

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So we're talking about Kaizen events.

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Again, they're rapid improvement events.

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And so there are various tools that you can use when you begin a rapid improvement event.

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And one of those is value stream mapping.

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So can you first give us an overview of what that is?

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And then I have a question or two for you before you break it down into detail.

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Okay, for sure.

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So the overall idea is to capture all the steps in a process.

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So you have to know what your first step is and what your last step is and then what are

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the steps in between.

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And almost everything, you know, everything is a process or there's processes within a

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bigger process.

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But a lot of times people don't recognize it that, you know, that is a process that

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could be improved.

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So that's why I always sort of emphasize, you know, there's what is the first step of

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this thing we're looking at in the last step and then we want to map out a flow chart,

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almost kind of that idea, capture all the steps in between.

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So you capture all the steps, but this is different than a process flow chart, right?

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I mean, I can take a process and I can take an eight and a half by 11 piece of paper and

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I can sort of document, well, this process feeds into this process, which feeds into

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that process.

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Here are your inputs and here are your outputs to the process.

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I can do that.

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But I do recall in some of the rapid improvement events I've been a part of in the past, we

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would have an entire conference room wallpapered with the large flip chart paper.

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So it goes in a lot more detail than just what you can write down on an eight and a

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half by 11 slip of paper.

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Is that right?

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Yes.

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And you nailed it when you said it, it provides more information.

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So the biggest difference between a flow chart and a value stream map is information.

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So a good value stream map will show how the supplies are entered, if there are supplies

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involved, show the communication.

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It will show barriers to flow.

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Different maps have different data, but it may have your manual touch time for each step,

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your flow time for each step.

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But the big point is that it does provide a lot more information than just a flow chart.

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So there are various types of value stream maps, correct?

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Yes.

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So what are those types, Terry?

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Well there's three primary, there's really two primary.

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I have a practice of using three and really four, but not to make this confusing, but

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there's this current state mapping, what's your current state, right?

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How are you doing things now?

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And your future state map, what do you want it to look like in the future once you've

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incorporated some improvement?

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Those are really the two main ones.

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I use something called a site clock, which I can explain in a little bit if you'd like,

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but that's sort of a pre-work.

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And then occasionally, most of the time actually in my work, I do an ideal state map before

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the future state.

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But honestly, that I've seen anyway, almost nobody uses that one.

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However, it can be wildly beneficial, it can be super helpful.

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Okay.

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So when you're putting together a value stream map, that's more of a team exercise, isn't

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it?

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Yes, it should be.

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And it should be done by the people that are actually doing the work.

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And I always recommend having more than one person, like a specialty.

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So for example, if you're doing something in the operating room, the OR, you would have

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two OR nurses, not just one.

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That way you get the different perspectives of how that actually is happening.

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Okay.

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And when you're pulling together a current state map, isn't it important to try to understand

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where the obstacles are in the process or the bottlenecks or that sort of thing?

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Yes, and that's really one of the overall primary reason of doing a map is so you can

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build a better future, have some improvement.

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But the reason to help you get to that with the current state map, yes, you want to identify

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barriers to flow, things that slow down the process, where's the waste, things like that

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we want to identify.

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I refer to them as barriers to flow, things that slow things down.

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And that helps us understand what we need to work on to make it better.

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And you need to do that before you can get to the future state.

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Right?

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I mean, I can envision having a wall covered with this map with all the barriers and you

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really can't even envision what the future state would look like until you understand

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really where you are today, right?

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And what needs to improve.

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For sure, for sure.

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And there's a quote by Einstein.

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Hopefully I'll get it right here, but I use it frequently.

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But he said basically, if I had an hour to solve a problem, I would spend 55 minutes

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thinking about the problem and five minutes thinking about the solution.

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And that's so counterintuitive to have most of us, including me, before I got into this,

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how we think, where we usually what's the problem and then we spend the rest of the

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time.

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But to really get your to you get your really good improvements, you need to understand,

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really understand the current state.

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And not always, but most of the time, once you understand the current state, really understand

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it, it starts, it starts becoming quite obvious on the things that need to be improved.

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Yeah.

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And it really helps you, as you mentioned, you know, understand your process.

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And oftentimes we make assumptions about it, right?

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Or we say, well, this worked last time we had a problem.

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So let's just do this again.

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Right.

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And you find yourself using the shotgun approach, you know, hoping that, you know, you'll hit

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a target at some point, at some point in time, or using your intuitiveness rather than really

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understanding the process and what the true barriers are.

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And then, and then having that shorter discussion, I guess, on what you can do to get rid of

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those barriers.

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Right.

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Yeah.

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Oh, that happens frequently.

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Yes, sir.

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For sure.

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So the overall idea of value stream mapping is if you were talking to someone about, we

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really need to do a value stream map.

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What would you tell them in terms of the value it brings?

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Well, it helps us understand how things are happening now, which most people really, really

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don't want to spend any time on until they understand, until they've done it once or

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twice and then like, oh, and then the lot comes on, but it helps us improve things.

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It helps us make things better.

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Value stream mapping is a very, very powerful tool in helping identify ways things that

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are slowing down things, barriers to flow.

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And then some other tools along with it helps us build a future state to make it much, much

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better.

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And earlier you mentioned, you called it a SIPOC map, an S-I-P-O-C. So what in the world

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is that, Terry?

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Can you talk more about that?

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Yes.

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And it's like a 30,000 foot view of the process.

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So each of those letters stands for something.

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The S is for suppliers, the I is for inputs, the P is for process, the O is for output,

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and then the C is for customer.

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So we use this tool.

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I use it three or four weeks in advance of a rapid improvement event.

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And I only work the P part, the process.

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I'll say, okay, you know, we know what our first step is and our last step because we

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figured that out using the A3, a different tool.

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But then we map out, you know, six, seven, eight, five, seven, whatever, depends on how

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big the process is, but just the big steps in the process in between the first and the

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last step.

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We do that under process, under the P. Then we go to the S over on the left-hand side

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and we say, okay, well, who provides the input for that step and for that step and that step?

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And through that exercise, a few weeks out, it helps us understand who needs to be on

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the team because we identify everyone that has an engagement, you know, that touches

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that process.

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So that's how I use it in advance and then generally finish it up on day one, the morning

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of the rapid improvement event with the full team.

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There are exceptions to that, but that's generally how I like to do it.

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So just a quick question.

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On average, based on your experience, how long does a rapid improvement event last?

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You know, it's funny, I've seen this over the years changed.

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I don't know if it's with culture, I'm not really sure, but it started out really four

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and a half days.

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During the week, you're doing a rapid improvement event.

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You know, it's a process that's not, you know, teeny tiny.

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It's not necessarily giant either, but it's just an average size process.

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And then I don't honestly, and this is across industry, well, I say across industry, it's

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across companies that I worked with.

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But now pretty much everyone wants to do them in three days, Tuesday, Wednesday, Thursday.

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So in general, on average, I would say right now there are three days, just again, there's

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exceptions to everything.

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And occasionally you have really, really small processes with a small scope that you literally

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can do in a day.

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You're doing all the same steps, but the process is just so small that you're able to work

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through it quickly, you know, much more, much more quickly.

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I see.

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You know, it's interesting.

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Again, I go back to my corporate days and walk into a conference room and I see the

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entire walls in the conference room wallpapered with the value stream map.

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And the reaction was interesting, especially when we had visitors.

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You know, if we had the CEO step in, pardon me, the CEO step in or something like that,

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and they would take a look at it.

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And it was great for visual management.

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It was great to understand that, wow, you know, we're really getting our arms around

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the process and what we need to do to do better.

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But it was, you know, it could impress visitors.

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So we tend to leave them on the walls for a while.

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I thought that was humorous.

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Tell you what, Terry, let's take a quick break.

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And when we come back, how about giving us some more information on the current state

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value stream map?

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To learn more, contact Jeff Parsons by email at jeff at FlagshipTalent.com or by phone

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Okay, we're back, Terry.

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Let's wrap up today's episode with a discussion on value stream mapping the current state.

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So can you give us your thoughts on current state value stream mapping?

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Sure.

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And just to kind of piggyback on what you said, one of the things that's interesting

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and you can almost, you can anticipate it, because once a team builds, they map out their

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current state and they've never done it before, almost always somebody, if not multiple people,

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will say, I had no idea that it took this many steps to do that one thing.

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So it's always, I mean, almost always an opener for the team.

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So it's interesting in that as well.

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But to the, a couple of big points for current state mapping, and I've had to do them through

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swim lanes.

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I've done a single line.

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I've done vertical.

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I've done horizontal.

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And people get caught up on that a little bit.

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But to me, it doesn't matter.

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You know, whatever format, if I'm working for it as a contract and they're like, do

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it this way, fine.

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There's two important components to doing a current state map, I believe.

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And that's capturing all the steps in between that first and that last step.

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So you want to capture all the steps.

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And some people say, well, what level of detail do you get in?

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And I always say error on the side of too much detail than error on the side of leaving

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out steps.

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So use judgment, map out all the steps and be honest.

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Those are the two biggies.

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And when I say be honest, people don't generally just come to tell falsehoods and to lie, but

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they come in and they're like, well, they know how it's supposed to be.

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I've had people bring in their standard operating procedure kind of things.

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We're just going to write.

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I said, no, don't put that away.

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I want to know how you're actually doing it now, right now.

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And we do, along with current state mapping, we do observations in addition to that.

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So we go out and watch the process ourselves.

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So when we do come back in and we map it out, even if it's a process I know nothing about,

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after I've observed it for a few hours, I can be like, that's not what I saw.

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You know what I mean?

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So we want to make sure we get all the steps and we're honest about how it's happening

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right now.

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And you're, you know, going back to your earlier comment, you're right.

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It is an eye opener for the people who are involved in the process.

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And I've seen some active debate among members of the team around processes and barriers

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and waste and all those types of things.

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It creates some interesting, most of the time, very productive discussion around what the

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organization is really doing versus what they thought they were doing.

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So let's wrap this episode up today.

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And I'd like to wrap it up with a quote.

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But first, thank you again, Terry, for your contribution this week and I'll see you next

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time.

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Thank you.

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Yes, my pleasure.

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Yes.

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And I look forward to next week's episode where we will further the discussion on value

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stream mapping and get into some other lean concepts that will help our listeners improve

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their organization's processes, effectiveness and efficiency.

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So let's end this episode with a quote.

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And again, our topic for discussion is process improvement.

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So this quote is relevant, I think.

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And it is, we cannot become what we want to be by remaining what we are.

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And that's by Max Dupree.

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Again, we cannot become what we want to be by remaining what we are.

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And so that's the definition of being the flagship, right?

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We'll see you next time.

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Thank you for listening to this episode of Be the Flagship with Jeff Parsons.

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We hope you enjoyed it.

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If you did like it, please subscribe and share with others.

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Until next time, take the step to become the flagship in your marketplace.

