Social services and mental health providers have limited resources, budgets, and staff, while facing a need to provide more services. This leads to the need to find opportunities to improve the total number of individuals who can receive services and reduce spending.
Lean, sometimes referred to as the Toyota Production System or Lean Six Sigma, is a philosophy and series of tools that enable individuals to remove inefficiencies (waste) from a process. It offers the possibility to maximize the impact of available resources without causing staff burnout or sacrificing quality.
It is important to note that Lean is not a treatment modality or service, nor a replacement for same. Instead, Lean focuses on improving the parts that come before and after the treatment modality or service.
Based on the voice of the customer, Lean categorizes all steps within a process into one of three groups: value add, business non-value add, and non-value add. The voice of the customer is not what an organization believes is valuable, but what the client who is receiving the service believes is valuable. If a step in a process is not a value add, it should at least be minimized, if not removed. Lean creates a continuous flow by removing non-value adds often created by eight wastes of Lean.
A common question is, if there are so many opportunities to improve a process, why have those items have not already been identified and changed? One answer is that staff who work in the process do not look at the full process from start to finish. Instead, they often understand and look only at their individual part in the process and this can obscure opportunities for improvement. Additionally, the person who created the process often has a “blind spot,” and is unable to see what he or she created as a negative rather than a positive. Finally, there is also the issue of when an employee starts a job the assumption is made that the process must be working in the best possible way.
Value stream or value stream mapping is a Lean tool that visually presents all the steps of a process from the beginning to the end. By looking at the full process rather than a part, it is possible to see what is not easily observable. Looking at the full process highlights wastes and opportunities for improvement. Small wastes that may not seem important on their own add up and create larger problems.
A value stream map is easy to create. One way to create a value stream map is using Post-It notes. The steps of the process are written on the Post-It notes, which are then placed on a wall. Alternatively, the steps could be drawn out on a whiteboard. With either method, the first step is always to begin at the start of the process. After this, each step in the process is added until the overall process is mapped out.
An example is, if a value stream map were to be created for an outpatient treatment center, the first step is the scheduling process; the map starts with the steps a client must take to receive an appointment. Next, all the steps involved in how the client arrives at the treatment center, all the steps of the check-in process and then delivery of the treatment modality are included. The last step is all the steps of the check-out process.
Once all the steps have been mapped, each step is categorized in one of three ways: as a value add, a business non-value add, or a non-value add process.
- Value-add are all items a person is willing to pay for if known about or anything that changes the service.
- Business non-value-adds are all items that the customer is unwilling to pay for but that must be done for the organization to operate.
- And non-value-add are all items the customer is unwilling to pay for or anything that does not change the service.
The steps identified as non-value add are removed from the process. This allows the time employees spent performing those steps to become saved time, and the resources used for those steps to become saved money. For the steps identified as value add and business non-value add, any of the eight wastes of Lean present are either removed or reduced from those steps. Observing the new streamline process to ensure that all the wastes including waiting between steps have been reduced is the final step. A key benefit of removing waste from a process is reducing the amount of staff time required to complete the process. The time saved from removing inefficiencies can be allocated to other tasks, thus reducing the need for staff overtime. In the end, a new streamlined process is created that optimizes the resources of time and money while creating increased capacity to provide more services.
The goal of Lean to remove non-value add steps and waste can be applied to any process, even those as simple as completing a form or any piece of documentation. If the document is in a paper format, by reducing the number of pages it would reduce the cost of paper and ink. It also would reduce the time taken by an employee to fill it out, review it, store it, and the cost of destroying it. If the document is electronic, removing fields would reduce the time taken for someone to complete the form, review it, and the cost of the data storage. The time saved can then be applied to other tasks, which can reduce overtime or increase the capacity of the existing staff members. The money that would have been spent can be applied to some other items or tasks.
Applying Lean to the documentation process is done in the same way as any other value stream. It begins with reviewing the document and learning if each field is a value add, a business non-value add, or a non-value add. For example, is the field is a regulatory or licensing requirement? If yes, then it is a business non-value add and the field remains. Does the field need to change or complete another process? If yes, the field remains. However, if the answer is no, then the field should be removed. Often when a paper form is revised, more fields are added without removing any of the older fields. In time, these paper forms are made into electronic forms without reviewing if the fields are still needed. A field that was once needed may no longer be required as needs evolve over time.
Another setting that could benefit from applying Lean is waiting rooms. Large waiting rooms are a sign that there is waste; the goal should be to have patients in a waiting room for the shortest time possible. By mapping out the full process and removing waste, the amount of time people are in a waiting room is reduced. By streamlining the process people can receive services more quickly and at a fixed pace. This creates the capacity to serve more people using the same number of staff members without overloading the staff. The footprint of the waiting room can be reduced and repurposed. This reduction in waiting room space would allow for increased service or staff space with minimal costs, since remodeling would cost less than renting or building a new space.
Overall, whenever Lean tools are applied to a process, there are the benefits of removing waste and streamlining the process. These benefits always create cost savings and the possibility of providing more services without increased burden on the current staff. The bottom line is that reducing and removing waste enables staff members to focus on what truly matters: providing timely, compassionate, and highly effective services while saving time and money.
Eight Wastes of Lean
- Waiting means any unnecessary waiting by a person before he or she can complete the next task.
- Overproduction means creating more than is needed.
- Rework means any work that needs to be done over for any reason.
- Motion means any unneeded movement in a process.
- Inventory is viewed as a waste if there is more than what is needed.
- Overprocessing means doing more work than the customer wanted.
- Transportation means the unnecessary movement of a part or person.
- Non-utilized talent means people are performing tasks that would be more efficiently done by someone else, or people’s skill sets are not utilized.
