The value stream mapping in hospital: The case of emergency department

Value-stream mapping, a tool of lean thinking, is integral to any application of lean in the healthcare setting. Practical guides exist on how to map process flow, collect data for value-stream mapping, and how to draw and use a value-stream map of many applications for making improvements in healthcare. However, a specific methodology for how hospitals organize collected data towards creating an accurate, and relevant value-stream map of overall patient flow, was not clear from any of the works we encountered during our literature review, requiring us to design our own method. Value-stream mapping overall patient flow is possible, even in a department experiencing wide variation in terms of process flow, such as the Emergency Department, although major challenges exist. Accuracy in the attribution of time required for value-quotient calculations within the process boxes, and retention of the relevance of data in the design of process boxes due wide variation of process flow. This paper describes how to present Emergency Department patient flow as a value-stream map and shares our methodology for defining process boxes for relevant illustration of information, and the attribution of time within the process boxes required for accurate value-quotient calculations.