Case Study WV
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“The Westerville Physician Practice: Value Stream Mapping” Case Study
MIS 651: Creating value through operation analysis.
Introduction:
Drs. Pat and Pam Schmidt started the Westerville Physician Practice in Westerville, Ohio, in
2000 to provide primary care services to the community. There was not much development in
Westerville at that time; however, the couple started the clinic anticipating future growth.
Competition “was weak and they ran the clinic by themselves with a nurse and receptionist.
Eventually, Westerville had a burst of growth and development with more and more people
moving to this suburb of Columbus, Ohio. There were more patients to see, and more clinics
popped up. Patients had more choices to get primary care. Patients chose the clinics where
they were seen quickly. The Schmidts hired some more doctors, and Medical Assistants
(MAs) to meet the increasing demand. It helped for a while but eventually, they started losing
their customers to their main competition a few blocks away—The Westerville Fast-track
Physician Practice. By 2015 the revenues were down by 40 percent. Informally collected
patient satisfaction scores related to wait times were down from 86 per cent to an abysmal
low of 54 per cent. (5)
Abstract:
Having delays in the healthcare sector is a common occurrence as all of us had to experience
long wait times for treatments and to get appointments. Even after arriving at the facility,
there is always an additional wait time for filling up personal information and examinations
which is common. All these delays contribute to various inconsistencies, inefficient
processes, and defects and add up to a poor customer experience. They do not add any value
to the customer experience, as we can categorise them as Non-Value-Added Activities. And
other activities which contribute to the provision of services are categorised as Value Added
Activities. Reduction of Non-Value-Added activities is essential as it may lead to long wait
times, hurt customer satisfaction scores and that may have an impact on the healthcare.
Additionally having long wait times and non-value-added activities may force customers to
find care somewhere else ultimately affecting healthcare’s profits. It is important to manage
all the NVA (non-value added) activities and improve within the healthcare facilities. This case study highlights common issues in patient services leading to wait time, delays and
errors. With that, there is a detailed analysis by implementing value stream mapping, which
has the involvement of measures such as total takt time, value-added and non-value-added
times, lead time and the difference in percentage between value-added and non-value-added
activities. After the analysis of the present situation in healthcare, there are some
recommendations that can help improve the systems and overall processing time.
With all the waiting and processing issues there is one issue that can be identified with a
single observation, there are no direction signs for patients to the registration desk which can
be confusing. In addition, it was challenging to differentiate between patients who are done
with registration and those who are awaiting registration. There was a delay in being seen by
medical assistants after the registration for the vital assignment. On top of that, they do not
have electronic medical records (EMR’S) as the medical assistants were using Post-it notes to
record results instead of inputting them into the computers. Besides, the doctor failed to
check the patient’s information beforehand resulting in extra time spent. Subsequently, the
patients experienced delays and wait time in lab work and reports as the assistant had to look
for lab samples, lengthening the process. The doctor failed to record the follow-up
appointment details in the EMRs after the appointment, prescribed medication and ordered
follow-up tests, which added up to a longer checkout time. The doctor took time to complete
the patient’s paperwork till their departure by not completing it immediately which took an
additional 10 minutes. Takt Time?
Takt time is a key concept in Lean manufacturing, which is a systematic approach to reducing
waste and improving efficiency in production processes. (1)
In its simplest form, takt time is a calculation: time available divided by demand. Without a
thoughtful takt time awareness, it is impossible to analyse patient demand and use that
information to redesign a process to meet or exceed patient and organizational expectations.
Because there are a discrete number of hours per day, staff have a certain amount of allotted
time to deliver a service or product to their patients. Therefore, if their cycles of work are
designed and paced to takt time, and the wastes inherent in their work are eliminated —
wastes like waiting, walking and managing defects — their work will flow smoothly without
patient or product backups or waits. (7)
The takt time formula: Takt Time = Available Production Time / Average Customer Demand
We got to know that the working hours mentioned are 8 am till 4 pm which is 8 hours in a
day and with 89 patients per day. 8 hours in a day is 480 minutes.
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When applied to the formula,
Takt Time = 480 minutes/89 customers = Takt Time = 5.3932 minutes per customer per day
Value Stream Map:
The lean manufacturing concept has been applied for years now in the healthcare services sector (primary care centres or specialist centres and hospitals). Lean healthcare can be considered a management philosophy for developing a hospital culture characterized by increasing the satisfaction of patients and other stakeholders through continuous improvements, in which all employees actively participate in identifying and reducing non-
value-adding activities. Different techniques can be used to help the continuous improvement process and to deploy lean manufacturing. One of these is Value Stream Mapping (VSM), which has been traditionally considered a basis or a basic pillar to deploy others. When the healthcare institutions apply VSM, their aim is to develop a culture that promotes the satisfaction of patients, healthcare staff and healthcare managers by means of continuous improvement, characterized by the personnel’s engagement (managers, doctors, female nurses, lab technicians, hospital porters, office staff and outsourced workers) to detect areas than can improve. (5)
This is where we analyse the total value-added time
and non-value-added time.
But first, Value Added Time
refers to the time spent on activities that directly contribute to the creation or enhancement of a product or service for which a customer is willing to pay. These activities are considered to add value to the end product or service from the customer’s
perspective.
(Healthcare: In a hospital, the time doctors, nurses, or technicians spend diagnosing, treating, and caring for patients would be considered value-added time.) (2)
NVAT
: They are activities in a process, which do not physically change the nature or shape of
the product or service you are providing. Things like searching for information, dealing with errors from previous steps in the process, processing mistakes, excessive walking and moving
around, meetings, setting up machines or processes and waiting for others to provide you with work or information, are all typical examples of non-value-added activities. (6)
The following is the current value stream map of the Westerville Physician Practice.
From the above value stream map, we found out that the total VAT is 40 and the total NVAT
is 157.
Lead Time:
Lead time measures the length of time — days, weeks, months — that elapses from the
beginning to the end of a business process. Each process includes a number of smaller,
distinct processes that must all be taken into account when calculating lead time. When
dealing with suppliers, these might include the time required for processing an order,
sourcing raw materials, and delivering completed goods. (3)
“Lead Time in health care facilities can be expressed as the time it takes for the patient to
receive the service within the facility. The services could be from the time of the
appointment, MA check-up, seeing the doctor, receiving treatment, scheduling follow-ups, or
getting a lab test till receiving results. Supervising Lead Time in the healthcare industry is beneficial to give patients timely care,
reduce wasted time, and fully use the resources”.
Lead time is calculated as, Total Lead Time= VA time+ NVA time
Total Lead Time = 40 + 157 = 197 Minutes
And the total VA/NVA Percentage is, VA/NVA * 100 = 40/157 *100 = 25.4%
From analysing the value stream map, we can see that the main work itself doesn't take up a lot of time as the non-value-added activities contribute a large amount to wait time, and delays. Nevertheless, using the analysis to our advantage and making necessary changes we can enhance the system within the practices efficiently and help reduce non-value-added time. Places and departments that need improvement are:
1. Firstly, installing a new sign/direction board would help customers navigate to the registration desk easily.
2. Resources like printers should be near the desk to avoid going back and forth and ultimately save patient’s time.
3. The doctor being familiar with the patient’s information which would then save additional time.
4. Checking on the inventory like lab samples, equipment, and other resources. 5. Usage of electronic equipment like EMR’S is advised by doctors and assistants instead of using Post-it notes.
6. Training on EMR’s is advised for faster processing of patient’s paperwork. 7. Real Time Documentation of patients instead of doing the paperwork after hours.
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8. Hiring additional medical assistants to assist patients immediately. With all these suggestions and taking them into action there is a high chance of reducing non-
value-added time which would help the practice be more profitable, as overseeing the lead
time in the healthcare industry is important and it would later on provide customers with high
satisfaction scores. In the following, the value stream map is an improvement compared to the current map with
all the necessary changes and modifications.
From the following map with all the modifications, we can analyse that: The total value-added time is 40 minutes, and the total non-value-added time is 41 minutes.
Total Lead Time= VA time+ NVA time
Total Lead Time = 40 + 41 = 81 Minutes
As we can observe the total lead time has decreased from 197 minutes to 81 minutes.
There is a difference and decrease of 116 Minutes in lead time.
We can also observe changes in the value-added and non-value-added percentages. The total VA/NVA Percentage is: VA/NVA * 100 = 40/41 *100 = 97.56%
Conclusion:
From analysing both the value stream maps, we can see that there is a huge difference in lead time for the activities that are customer-satisfactory and beneficial to the workers too. Not having the right direction signs, and equipment in a different room, having less staff, not checking the inventory, not uploading the patient’s paperwork right away and not using the EMR’s can affect the workers and lead to errors and delays. Implementing new changes from the updated value stream map can help the healthcare facility bring back the customers and that can lead to growth in profit and satisfactory scores.
Citations: Takt Time: What Is It and How to Measure It? (1)
( https://businessmap.io/continuous-flow/takt-time )
What Is Value Added Time? (2)
( https://www.superfastcpa.com/what-is-value-added-time/ )
Lead Time Defined by Abby Jenkins (3)
( https://www.netsuite.com/portal/resource/articles/inventory-management/lead-time.shtml )
ISE EBook Online Access for Operations Management in the Supply Chain (4)
Schroeder, Roger; Rungtusanatham, M. Johnny; Goldstein, Susan
The Role of Value Stream Mapping in Healthcare Services: A Scoping Review Juan A. Marin-Garcia,* Pilar I. Vidal-Carreras, and Julio J. Garcia-Sabater ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908358/ ) (5)
What Are Non Value Added Activities & How to Find Them(6) (https://digitalenterprise.org/leadership/what-are-non-value-added-activities/) How Takt Time Can Help Health Care Organizations Improve the Quality, Pace and Cost of Care Virginia Mason Institute (7) (https://www.virginiamasoninstitute.org/how-takt-time-can-
help-health-care-organizations-improve-the-quality-pace-and-cost-of-care/#:~:text=To
%20achieve%20synchronized%20flow%20and,time%20available%20divided%20by
%20demand. )
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