Getting Lean at MIT, Part 2

I just learned about an idea so phenomenally, immediately useful that I felt the need to share it. The idea is called value stream mapping and analysis, and typically it reduces production time (for anything – a paper for Literature 1A, a Rolls-Royce, a successfully administered medication) by 75 percent.

Essentially, what you do is write down every single step in a given process, using a flowchart-style diagram. Then you identify the steps that add value to the customer. Here’s how you know if a step adds value:

1. The customer cares about it.
2. The item being produced changes in some way.
2. The step is done right the first time.

When you do this, the time-wasters pop out at you in Technicolor. Bells sound, lights flash, etc. And you now have a better picture of what’s taking so darn long.

Here’s an example. I recently set up internet service for my home (I’m not going to name the company, but it rhymes with Berizon). What’s the company’s process? In my case, it was something like this:

Step 1: I place the order by phone on a Friday. (10 min)
Step 2: Customer service rep (Jackie) receives and files order. (3 days)
Step 3: Jackie calls and schedules a time when Ray, the technician, can come to my house. (10 days)
Step 4: Does Ray go to the right house at the right time? If no, back to step three.
Step 5: Ray examines the wiring at my house. (30 min)
Step 6: Is Ray properly skilled and equipped with the right tools for the job? If no, back to step 3.
Step 7: Ray notifies Jackie, in the home office, of the need for a new work order. (15 min)
Step 8: Is Jackie in today? If no, back to step 3.
Step 9: Jackie approves work order. (2 hours)
Step 10: Ray sets up internet. (15 min)

In this process, which steps actually added value for me? I’d say Step 1 and Step 10 – a total of 25 minutes’ worth of work. In between, there were examples of pure waste (for instance, Ray went to the wrong house) and steps that didn’t add value but were necessary (Step 3).

I’ve charitably made this process only ten steps long. It actually took me about a month and a skillion, jillion phone calls before I could watch “Star Wars: Retold” in the comfort of my own home. If Berizon made a process map of all the steps required to install internet at my house, do you think they’d quickly find ways to reduce their cycle time (the time that elapsed between the order and the delivery of the product)? I think yes.

The applications of process mapping for health care are obvious. Instead of a customer requesting internet service, think of a man who shows up at a crowded emergency department with chest pains. Or a woman with poorly-controlled diabetes who doesn’t have a car to get to her appointments. Or a patient whose insurance company promises to pay out a claim but takes months to do it – giving the patient a choice between paying the enormous bill or watching his credit rating drop into the toilet.

To learn more about process mapping and related ideas for system improvement, check out the Lean Enterprise Institute's website – full of good ideas and resources.

(Many thanks to Dick Lewis, Earll Murman, and Annalisa Weigel, who allowed the IHI Open School team to observe their class on Lean at MIT today.)