Hi and welcome to Be The Flagship with our podcast host Jeff Parsons.
This is where we tackle the day-to-day talent management challenges you face, particularly
in hospice and small healthcare organizations.
And now over to our host.
Take it away Jeff.
Hello.
I'm Jeff Parsons, your podcast host for Be The Flagship.
To refresh your memory, this month is Healthcare Process Improvement Month, or at least as
far as I'm concerned.
So all of our episodes in January are focused on how to improve your processes, how to be
more effective and efficient within your healthcare organization.
And to help me accomplish that, I have Terry Norris, a Lean Healthcare Expert.
He's been with me this month for our episodes.
Our first episode focused on what Lean Healthcare is, and then the second episode on why it
fails and it does fail and what we can do to prevent failure and achieve success.
And for the remainder of the month, we're going to focus on specific tools you can use
to improve your processes in healthcare.
So Terry Norris, but first, a commercial break.
At Flagship Talent, we work with our clients to find and place the right talent.
What do we mean by the right talent?
We mean we find talent who will commit to your organizational goals and align with your
values and behavior expectations.
Talent who will perform to your expectations.
Talent who will stay and grow with your organization.
How are we different from our competitors?
We offer the lowest fee structure in the industry.
We offer the best talent guarantee in the industry.
We provide selection and interviewing support to our clients at no additional fee.
We want to save you money, deliver high quality talent, become an extension of your organization,
and be your preferred provider of talent acquisition solutions.
To learn more, contact Jeff Parsons by email at jeff at flagshiptalent.com or by phone
at 1-800-530-4189, extension 101.
Okay.
So Terry, thank you for joining us again.
We're glad to have you.
Thank you.
Yes, my pleasure.
Good.
And just to recap where we've been on this Lean Healthcare journey to this point, the
first episode of this month focused on what Lean Healthcare is, what it looks like, and
you did a great job describing Lean Healthcare.
The second episode, last week's episode, focused on why Lean initiatives fail, and they often
do fail.
So you focused on that and what organizations can do to prevent failure.
So that was a great episode.
This week, we're going to get into some of the meat of Lean.
We're going to get into the tools so that when you're ready to make a process improvement,
Lean tools, I envision a toolbox, right?
You might have in your garage or that sort of thing.
And when you have a job to do, you open up toolbox and hopefully you use the right tool.
Now, oftentimes I'll pull out a screwdriver to do a hammer's work, but you want to use
the right tool to accomplish your objective.
And so these next episodes, I believe we're going to talk about the various Lean tools
you can use and why they're appropriate and how you can use them.
So again, thank you for your time today, Terry.
So let's start with the concept of a rapid improvement event.
So what is a rapid improvement event?
Okay.
Thanks, Jeff.
So the general idea of a rapid improvement event is to make, you know, it's kind of implied
in how you say it, it's to make an improvement quickly that if you did it through traditional
project management or just not even a really good project management, but the way things
normally work, it may take six or seven or eight or nine months to do something that
you could do in a week or 30 days with a rapid improvement event.
So they're designed to turn things around quickly.
And I may have mentioned in some of the previous, or talking about, you know, Lean takes some
time to build a culture for sure, but you can make some really, really big improvements
quickly using a rapid improvement event.
Okay.
So is a rapid improvement event the same thing as a Kaizen event?
Yes.
And I thought about mentioning that because one of the things I've got away from, I mean,
early on in my Lean journey was using Japanese words.
However, there are a few that you just can't get away from and that's one of them, you
know, Gimba and Kaizen.
But Kaizen is a Japanese word, if you break it down, it just means good change.
So it's continuous improvement, more loosely interpreted, but yes, it is the same thing.
Okay.
We're just using a little more modern wording for it then.
English, yes.
Excellent.
So we're talking about Kaizen events.
Again, they're rapid improvement events.
And so there are various tools that you can use when you begin a rapid improvement event.
And one of those is value stream mapping.
So can you first give us an overview of what that is?
And then I have a question or two for you before you break it down into detail.
Okay, for sure.
So the overall idea is to capture all the steps in a process.
So you have to know what your first step is and what your last step is and then what are
the steps in between.
And almost everything, you know, everything is a process or there's processes within a
bigger process.
But a lot of times people don't recognize it that, you know, that is a process that
could be improved.
So that's why I always sort of emphasize, you know, there's what is the first step of
this thing we're looking at in the last step and then we want to map out a flow chart,
almost kind of that idea, capture all the steps in between.
So you capture all the steps, but this is different than a process flow chart, right?
I mean, I can take a process and I can take an eight and a half by 11 piece of paper and
I can sort of document, well, this process feeds into this process, which feeds into
that process.
Here are your inputs and here are your outputs to the process.
I can do that.
But I do recall in some of the rapid improvement events I've been a part of in the past, we
would have an entire conference room wallpapered with the large flip chart paper.
So it goes in a lot more detail than just what you can write down on an eight and a
half by 11 slip of paper.
Is that right?
Yes.
And you nailed it when you said it, it provides more information.
So the biggest difference between a flow chart and a value stream map is information.
So a good value stream map will show how the supplies are entered, if there are supplies
involved, show the communication.
It will show barriers to flow.
Different maps have different data, but it may have your manual touch time for each step,
your flow time for each step.
But the big point is that it does provide a lot more information than just a flow chart.
So there are various types of value stream maps, correct?
Yes.
So what are those types, Terry?
Well there's three primary, there's really two primary.
I have a practice of using three and really four, but not to make this confusing, but
there's this current state mapping, what's your current state, right?
How are you doing things now?
And your future state map, what do you want it to look like in the future once you've
incorporated some improvement?
Those are really the two main ones.
I use something called a site clock, which I can explain in a little bit if you'd like,
but that's sort of a pre-work.
And then occasionally, most of the time actually in my work, I do an ideal state map before
the future state.
But honestly, that I've seen anyway, almost nobody uses that one.
However, it can be wildly beneficial, it can be super helpful.
Okay.
So when you're putting together a value stream map, that's more of a team exercise, isn't
it?
Yes, it should be.
And it should be done by the people that are actually doing the work.
And I always recommend having more than one person, like a specialty.
So for example, if you're doing something in the operating room, the OR, you would have
two OR nurses, not just one.
That way you get the different perspectives of how that actually is happening.
Okay.
And when you're pulling together a current state map, isn't it important to try to understand
where the obstacles are in the process or the bottlenecks or that sort of thing?
Yes, and that's really one of the overall primary reason of doing a map is so you can
build a better future, have some improvement.
But the reason to help you get to that with the current state map, yes, you want to identify
barriers to flow, things that slow down the process, where's the waste, things like that
we want to identify.
I refer to them as barriers to flow, things that slow things down.
And that helps us understand what we need to work on to make it better.
And you need to do that before you can get to the future state.
Right?
I mean, I can envision having a wall covered with this map with all the barriers and you
really can't even envision what the future state would look like until you understand
really where you are today, right?
And what needs to improve.
For sure, for sure.
And there's a quote by Einstein.
Hopefully I'll get it right here, but I use it frequently.
But he said basically, if I had an hour to solve a problem, I would spend 55 minutes
thinking about the problem and five minutes thinking about the solution.
And that's so counterintuitive to have most of us, including me, before I got into this,
how we think, where we usually what's the problem and then we spend the rest of the
time.
But to really get your to you get your really good improvements, you need to understand,
really understand the current state.
And not always, but most of the time, once you understand the current state, really understand
it, it starts, it starts becoming quite obvious on the things that need to be improved.
Yeah.
And it really helps you, as you mentioned, you know, understand your process.
And oftentimes we make assumptions about it, right?
Or we say, well, this worked last time we had a problem.
So let's just do this again.
Right.
And you find yourself using the shotgun approach, you know, hoping that, you know, you'll hit
a target at some point, at some point in time, or using your intuitiveness rather than really
understanding the process and what the true barriers are.
And then, and then having that shorter discussion, I guess, on what you can do to get rid of
those barriers.
Right.
Yeah.
Oh, that happens frequently.
Yes, sir.
For sure.
So the overall idea of value stream mapping is if you were talking to someone about, we
really need to do a value stream map.
What would you tell them in terms of the value it brings?
Well, it helps us understand how things are happening now, which most people really, really
don't want to spend any time on until they understand, until they've done it once or
twice and then like, oh, and then the lot comes on, but it helps us improve things.
It helps us make things better.
Value stream mapping is a very, very powerful tool in helping identify ways things that
are slowing down things, barriers to flow.
And then some other tools along with it helps us build a future state to make it much, much
better.
And earlier you mentioned, you called it a SIPOC map, an S-I-P-O-C. So what in the world
is that, Terry?
Can you talk more about that?
Yes.
And it's like a 30,000 foot view of the process.
So each of those letters stands for something.
The S is for suppliers, the I is for inputs, the P is for process, the O is for output,
and then the C is for customer.
So we use this tool.
I use it three or four weeks in advance of a rapid improvement event.
And I only work the P part, the process.
I'll say, okay, you know, we know what our first step is and our last step because we
figured that out using the A3, a different tool.
But then we map out, you know, six, seven, eight, five, seven, whatever, depends on how
big the process is, but just the big steps in the process in between the first and the
last step.
We do that under process, under the P. Then we go to the S over on the left-hand side
and we say, okay, well, who provides the input for that step and for that step and that step?
And through that exercise, a few weeks out, it helps us understand who needs to be on
the team because we identify everyone that has an engagement, you know, that touches
that process.
So that's how I use it in advance and then generally finish it up on day one, the morning
of the rapid improvement event with the full team.
There are exceptions to that, but that's generally how I like to do it.
So just a quick question.
On average, based on your experience, how long does a rapid improvement event last?
You know, it's funny, I've seen this over the years changed.
I don't know if it's with culture, I'm not really sure, but it started out really four
and a half days.
During the week, you're doing a rapid improvement event.
You know, it's a process that's not, you know, teeny tiny.
It's not necessarily giant either, but it's just an average size process.
And then I don't honestly, and this is across industry, well, I say across industry, it's
across companies that I worked with.
But now pretty much everyone wants to do them in three days, Tuesday, Wednesday, Thursday.
So in general, on average, I would say right now there are three days, just again, there's
exceptions to everything.
And occasionally you have really, really small processes with a small scope that you literally
can do in a day.
You're doing all the same steps, but the process is just so small that you're able to work
through it quickly, you know, much more, much more quickly.
I see.
You know, it's interesting.
Again, I go back to my corporate days and walk into a conference room and I see the
entire walls in the conference room wallpapered with the value stream map.
And the reaction was interesting, especially when we had visitors.
You know, if we had the CEO step in, pardon me, the CEO step in or something like that,
and they would take a look at it.
And it was great for visual management.
It was great to understand that, wow, you know, we're really getting our arms around
the process and what we need to do to do better.
But it was, you know, it could impress visitors.
So we tend to leave them on the walls for a while.
I thought that was humorous.
Tell you what, Terry, let's take a quick break.
And when we come back, how about giving us some more information on the current state
value stream map?
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Okay, we're back, Terry.
Let's wrap up today's episode with a discussion on value stream mapping the current state.
So can you give us your thoughts on current state value stream mapping?
Sure.
And just to kind of piggyback on what you said, one of the things that's interesting
and you can almost, you can anticipate it, because once a team builds, they map out their
current state and they've never done it before, almost always somebody, if not multiple people,
will say, I had no idea that it took this many steps to do that one thing.
So it's always, I mean, almost always an opener for the team.
So it's interesting in that as well.
But to the, a couple of big points for current state mapping, and I've had to do them through
swim lanes.
I've done a single line.
I've done vertical.
I've done horizontal.
And people get caught up on that a little bit.
But to me, it doesn't matter.
You know, whatever format, if I'm working for it as a contract and they're like, do
it this way, fine.
There's two important components to doing a current state map, I believe.
And that's capturing all the steps in between that first and that last step.
So you want to capture all the steps.
And some people say, well, what level of detail do you get in?
And I always say error on the side of too much detail than error on the side of leaving
out steps.
So use judgment, map out all the steps and be honest.
Those are the two biggies.
And when I say be honest, people don't generally just come to tell falsehoods and to lie, but
they come in and they're like, well, they know how it's supposed to be.
I've had people bring in their standard operating procedure kind of things.
We're just going to write.
I said, no, don't put that away.
I want to know how you're actually doing it now, right now.
And we do, along with current state mapping, we do observations in addition to that.
So we go out and watch the process ourselves.
So when we do come back in and we map it out, even if it's a process I know nothing about,
after I've observed it for a few hours, I can be like, that's not what I saw.
You know what I mean?
So we want to make sure we get all the steps and we're honest about how it's happening
right now.
And you're, you know, going back to your earlier comment, you're right.
It is an eye opener for the people who are involved in the process.
And I've seen some active debate among members of the team around processes and barriers
and waste and all those types of things.
It creates some interesting, most of the time, very productive discussion around what the
organization is really doing versus what they thought they were doing.
So let's wrap this episode up today.
And I'd like to wrap it up with a quote.
But first, thank you again, Terry, for your contribution this week and I'll see you next
time.
Thank you.
Yes, my pleasure.
Yes.
And I look forward to next week's episode where we will further the discussion on value
stream mapping and get into some other lean concepts that will help our listeners improve
their organization's processes, effectiveness and efficiency.
So let's end this episode with a quote.
And again, our topic for discussion is process improvement.
So this quote is relevant, I think.
And it is, we cannot become what we want to be by remaining what we are.
And that's by Max Dupree.
Again, we cannot become what we want to be by remaining what we are.
And so that's the definition of being the flagship, right?
We'll see you next time.
Thank you for listening to this episode of Be the Flagship with Jeff Parsons.
We hope you enjoyed it.
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Until next time, take the step to become the flagship in your marketplace.