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Lessons Learned in a Lean Health Care Journey

Contributor: Wade Mitzel
Posted: 06/30/2010
Wade Mitzel
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Transforming health care using Lean principles is not an easy journey. There are many great technical articles about implementing Lean, but I want to share Sanford Health-Meritcare’s journey — the laughs, trials and adventure we found when the rubber met the road.

Over the years, people have come to me overwhelmed, confused and not sure how to begin using Lean principles to improve patient care. As we think of all the work, sometimes we can’t see the forest through all the trees.

Revelations from a Value Stream Map

So where do you start with your Lean journey? You can start by completing a value stream map, which is a Lean tool that can really reveal how efficient or challenging a process is for your patients. The value stream map helps draw a picture of the current state of work and how patients flow through your areas.

Each time I have helped departments look at their processes using this Lean tool, I am amazed at how much is revealed. To show you just how effective this tool is, I have compiled a short list of the top revelations over the years from completing a value stream map.

  1. It was possible in one department for patients to be asked to undress and dress up to four times in one visit. If patients needed an X-ray, tests or to visit another department, there could be even more times they would be asked to strip down. After looking at the value stream map, one provider stated, "No wonder my 80-year-old patients are so tired when they leave!"
  2. In one system, the facility sent patients six different reminder letters for the same appointment. They could get one letter for the appointment, labs, tests, care management, etc. Then, patients would still get a reminder phone call. The department didn’t even know they were sending all these letters because the system was automated.
  3. Another area realized it had four people unintentionally doing the same task within 7 minutes of each other.
  4. A sub-specialty department realized it would ask a patient a minimum of four times per visit if he or she smokes. One patient thought we wanted him to smoke!
  5. A form that was used in the hospital was touched by five people in one area. When we did our value stream map, one person revealed that the use of the form was supposed to be stopped two years ago. This area filled this form out an average of five times per day and took 5 minutes to fill it out each time. As a result, over 9,000 minutes of time per year were wasted doing unnecessary paperwork.



You Have a Value Stream Map. Now What??


You worked with your group and developed a value stream map that shows value added and non-value added times, cycle times, lead times, and operators used. You see areas of opportunity and have looked at the process through the eyes of your patients. Now what?

One thing to remember is that you can’t improve everything at once. Start tackling problems where there are bottlenecks for your patients. Gather your team and develop an action plan to make process improvements. After each improvement, reanalyze the value stream map to see how the changes affected patient flow. This assessment will give you vision to see the small and large changes in patient flow. If you can cut lead time for your patients or increase value-added time in your process, you can show your leaders solid metrics of improvement. These results will help energize your team to make changes and improve patient care more quickly.

Your Challenge

Do you think you are giving the best care you can to your patients? I would challenge you to put your processes in a value stream map and look at them from the patient’s perspective. Like us, you may be surprised to see the opportunities in your organization. Do you have a good example? I would love to hear your stories!


Thank you, for your interest in Lessons Learned in a Lean Health Care Journey.
Wade Mitzel
Contributor: Wade Mitzel