Process Map and Value Stream

The second principle noted was that of a value stream. The key word here is value when you ask the question does what I am doing now add value to the customer or does it not. If so, that value add step should continue. If not, ask yourself do I need to do this or do I need to do this at this time? Thus we are identifying value add, VA, and non-value add, NVA, to our consideration of meeting the VOC!


One key tool in Lean is to use “process maps” or flow charts. These are pictures of what tasks are done to achieve an outcome, e.g., patient registration, the triage process, or even the five steps in a patient cycle mentioned in an earlier blog. You can use specific symbols found on many software applications under “Shapes” to help out. We would use a rectangle for a process step and a diamond for a decision point, etc. Do a web search on process maps and you will find a wealth of information on the specifics of the process map concept.

More importantly is to gain an understanding of what, why, how, when, etc. each of the rectangles (steps) accomplishes. Does that step add value to the customer or not. How does what you are doing at that step relate to other steps that you may do. The idea of the process map is the picture will tell you more easily the purpose and relationship of the step.

A simple way to develop the process map is to do so without the computer! Use 3 X 3 sticky notes as your rectangles for steps. Then angle them to look like diamonds for decision points. Have the team meet and note what they do and post on brown paper that has been attached to the wall. You will want to draw lines between the steps to help understanding the direction and relationship of each step.

The next piece is to gather the time each step takes and the time in between each step. This is where you will gain a better understanding of the value, non-value or muda that occurs in each cycle you are analyzing.

How much time does the “typical” patient spend in the office, how much of that time is VA and how much is NVA? What then can you do to eliminate the NVA time? This also becomes your baseline measurement. The basic idea here is to understand the time commitment to identify any gaps or bottlenecks in your cycle. When identified, other tools may be applied to help eliminate gaps or remove bottlenecks. Do another value stream map time study and you will be able to see from your baseline the degree of improvement?


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