HA540 Unit 4 Endoscopy Lean Value Stream Case Example

One Patient Every Five Minutes, One Assessment Every Eight: A Lean Process Improvement Case Mapping the Value Stream From Arrival to Discharge at a Composite Hospital Endoscopy Unit and Setting Morning Takt Against the Bay Nurses' Pace

[Student Name]

Purdue University Global

HA540: Health Care Operations and Quality Assessment

Unit 4 Lean Process Improvement Case

[Instructor Name]

[Date]

The unit, the map and every time are composite and bracketed for the writer's own data.

Value From the Patient's Side

A patient having a routine colonoscopy values a safe, accurate procedure, a clear result and getting home. Time in the lobby or a bay waiting for a physician adds nothing the patient values, even when staff are busy elsewhere. Lean thinking defines value and waste from that point of view, then follows the flow of a single patient rather than the work of each department (Womack & Jones, 2003). The map below draws that flow in the manner of a classic value stream map, with process boxes and waiting triangles (Rother & Shook, 1999).

Current-State Value Stream

Check-in: [4] minutes; then wait in lobby [26]. Nursing assessment and intravenous line: [16]; then wait for physician [19]. Consent with endoscopist: [6]; then wait for room [24]. Procedure, room in to room out: [24]. Recovery observation: [35]; then wait for escort and discharge [21]. Discharge teaching: [7]. Process time: [92] minutes. Waiting: [90]. Lead time: [182]. Process cycle efficiency, process time divided by lead time: [50.5] percent.

How the Times Were Gathered

Times on the map are medians from [30] routine outpatients followed on [five] mornings, using time stamps from the scheduling and nursing systems and checked by direct observation for [ten] of them. Waits were measured as the gap between one recorded step ending and the next beginning. Advanced cases were left out because their flow differs and would be mapped separately. Before the map was finished, bay and recovery nurses reviewed it at a huddle and corrected two times, the consent wait and the escort wait, which the system stamps had placed too early.

Takt Time and the Morning Rush

Across the day, [46] patients over [600] minutes gives a takt of [13.0] minutes, which looks comfortable. But [18] patients arrive in the [90] minutes before [08:15] for the first cases, a peak takt of [5.0] minutes. Two bay nurses at [16] minutes per patient complete one every [8.0]. By [08:15], about [seven] patients are waiting for assessment, which is where the lobby wait and the late room starts begin. The daily average hides the rush that actually sets the pace of the whole morning.

Waste Found on the Map

Waiting: lobby, physician and room waits, [69] minutes per patient. Rework: the history, anticoagulant and escort loops mapped in Unit 2, which send nurses back to the phone. Motion: bay nurses walking to the printer and the supply room [nine] times per patient on average. Overprocessing: vital signs repeated after delays and allergy questions asked by three different staff.

Six Sigma: Counting Defective Records

A defect was any of six items missing or out of date in the pre-procedure record: current history and physical, anticoagulant instruction, escort documented, allergies, signed consent, and fasting time. Across [1,150] records, [96] defects in [6,900] opportunities gives [13,913] defects per million opportunities, about [3.70] sigma. Lean finds the waits; Six Sigma shows how often the record arrives incomplete, which is a cause of the rework loops. Reviews of health care studies find the two methods most useful when combined in this way, though rigorous evidence remains limited (DelliFraine et al., 2010).

Future-State Value Stream

Change 1: a nurse pre-call two business days before each procedure confirms escort, anticoagulant instructions and the date of the history. Records arrive complete, and the three loops move out of the morning. Change 2: level the morning by matching arrival times to the staggered room starts tested in Unit 3 and moving one recovery nurse's start to [06:45], when recovery is empty, so three nurses assess during the rush. Three nurses at [16] minutes complete one patient every [5.3] minutes, close to takt. Future-state estimate: waiting [36] minutes, lead time [128], process cycle efficiency [72] percent.

Kaizen Plan

A five-day event in [month] bringing together the unit's manager, a pair of bay nurses, one recovery nurse, a scheduler, an endoscopist and a patient adviser. Day one: walk the current state. Day two: build the pre-call script. Day three: set new arrival times. Day four: test with one day's patients. Day five: agree on standard work and measures. Owners: nurse manager for the pre-call; scheduling lead for arrival times; recovery charge nurse for the shifted start.

Measures

Lead time from arrival to discharge, median weekly. Defects per million in pre-procedure records. Share of patients entering any loop. Balancing measure: recovery staffing after [09:00], to confirm the moved nurse is not missed later.

Risks

Patients may not answer the pre-call; the script includes a text fallback and a second call. Staff may see the earlier start as a burden; it will rotate.

Conclusion

The morning rush, not the daily volume, sets the unit's pace. Matching nurses to takt and moving checks upstream should cut waiting by more than half.

References

DelliFraine, J. L., Langabeer, J. R., & Nembhard, I. M. (2010). Assessing the evidence of Six Sigma and Lean in the health care industry. Quality Management in Health Care, 19(3), 211-225. https://doi.org/10.1097/QMH.0b013e3181eb140e

Rother, M., & Shook, J. (1999). Learning to see: Value stream mapping to add value and eliminate muda. Lean Enterprise Institute.

Womack, J. P., & Jones, D. T. (2003). Lean thinking: Banish waste and create wealth in your corporation (Rev. ed.). Free Press.