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Month 2

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Now its time for:

  • LEAN

  • Value Stream Mapping

  • Non-Value Added Processes

Blue Skies

Lean is all about rethinking how you think. Looking at things another way. Organizing and separating the urgent from the important.


LEAN is Process Analysis

Plinko Probability Board from the video


Plinko is an engaging game that involves dropping a small disc down a peg-filled board, allowing it to bounce randomly before settling into a slot at the bottom. Although seemingly unrelated, there are intriguing parallels between the game of Plinko and the application of Lean processes within various industries.

In Lean methodology, the continuous improvement and optimization of processes are central objectives. Plinko represents a metaphorical depiction of these processes, where the pegs in the game board correspond to the elements and steps within a given process.

Much like the pegs in Plinko, the process elements in Lean operations can be categorized into two groups – those that facilitate and guide the process, and those that hinder its efficiency.

By observing the trajectory of the disc in Plinko, we can draw insights into the optimization of Lean processes.

The pegs that guide the disc's movement in Plinko analogously represent process elements that are indispensable for the overall operation. These elements may include critical steps, key personnel, or essential resources. Their presence ensures the smooth flow, accuracy, and desired outcome of the process. Aligning them strategically and maintaining their presence allows for a streamlined and efficient operation.

Conversely, the pegs that disrupt the disc's trajectory in Plinko mirror process elements that hinder the smooth flow and optimization. These elements may include excessive bureaucracy, redundant activities, bottlenecks, or wasteful practices. Identifying and eliminating these pegs becomes crucial in Lean processes to enhance operational efficiency and reduce waste or unnecessary efforts.

Shrewdly removing selected pegs in Plinko allows the disc to optimize its path and ultimately increase the chances of landing in a desired slot. Similarly, within Lean processes, eliminating non-value-added steps or unnecessary resources enhances operational flow, reduces lead times, and improves overall process efficiency.

Just as the game of Plinko aims to maximize the disc's chances of landing in the most beneficial slot, Lean processes seek to enhance productivity, quality, and customer satisfaction. By recognizing the relevance of Plinko's mechanics, organizations can develop an intuitive understanding of the significance of selectively retaining or removing process elements to improve their overall operations.

In conclusion, the game of Plinko provides an insightful analogy to understand the optimization of Lean processes. By recognizing the impact of various process elements (pegs), both those that need to stay to guide the process and those that need to be removed to optimize efficiency, organizations can foster continuous improvement and achieve operational excellence.


Lean Value Stream Mapping (VSM) is a powerful tool used within the Lean methodology to identify and visualize the flow of materials, information, and activities required to deliver a product or service to customers. It serves as a foundation for process improvement by providing a holistic view of the value and revealing opportunities for eliminating waste, improving efficiency, and enhancing customer value.


At its core, VSM is about understanding the current state of a value stream and designing an improved future state that aligns with Lean principles. The process begins by mapping out the entire value stream, from the initial customer request or order to the final delivery. Each step, process, and department involved in delivering the product or service is carefully analyzed and represented within the map.

The value stream map not only visualizes the flow of materials and information but also highlights the time taken at each stage, inventory levels, process bottlenecks, and potential sources of waste. This comprehensive view enables stakeholders to gain a deep understanding of the value stream's intricacies, helping them identify areas of improvement and focus their efforts on eliminating non-value-added activities.

By implementing Lean principles such as just-in-time production, pull systems, and continuous flow, organizations can create a future state value stream map that embodies the desired state of operations. This envisioned future state identifies opportunities for reducing lead times, improving quality, enhancing customer satisfaction, and maximizing operational efficiency.

Moreover, VSM fosters collaboration and engagement among team members across different functions, as it encourages individuals to collectively analyze and improve the entire value stream rather than focusing solely on their individual tasks or departments. This cross-functional approach facilitates better communication, problem-solving, and a shared understanding of the overall organizational objectives.

Lean Value Stream Mapping is not a one-time exercise; it is an ongoing process that encourages continuous improvement. Through regular review and iterations, organizations can refine and optimize their value streams, steadily reducing waste, increasing productivity, and enhancing value creation.

In summary, Lean Value Stream Mapping is a powerful technique that provides organizations with a visual representation of their value streams. By analyzing the current state and designing a future state, it empowers organizations to streamline processes, eliminate waste, and enhance overall operational efficiency. By leveraging the insights gained from Value Stream Mapping, organizations can create a more customer-focused and value-driven approach to their operations.


Value Stream Mapping (VSM) has proven to be of great value in the healthcare industry. It offers significant benefits by helping healthcare organizations identify and streamline processes, reduce waste, improve patient outcomes, enhance patient experiences, and achieve cost savings. While I cannot provide you with specific quantifiable data or show real-world examples directly, I can provide you with information on how VSM has been utilized and the potential improvements it can bring.

1. Process Optimization: VSM allows healthcare providers to visualize and analyze the entire patient journey, from initial contact to discharge. By mapping out the current state, organizations can identify bottlenecks, delays, redundancies, and other sources of waste. By removing non-value-added steps and optimizing the flow, organizations can streamline processes and improve overall efficiency.

2. Reduced Lead Times: VSM helps healthcare organizations identify opportunities to reduce lead times, such as waiting time for appointments, test results, or consultations. By streamlining these processes, healthcare providers can enhance patient experiences, increase satisfaction, and improve overall quality of care.

3. Better Resource Allocation: VSM enables healthcare organizations to identify resource utilization patterns and inefficiencies. It helps in identifying overburdened departments, underutilized resources, and imbalanced workloads. With this insight, organizations can optimize resource allocation, improve capacity planning, and reduce costs.

4. Waste Reduction: VSM facilitates the identification and elimination of various forms of waste within healthcare processes, such as excessive inventory, unnecessary paperwork, redundant activities, and inefficient handoffs. By reducing waste, organizations can improve resource utilization, enhance patient safety, and maximize value for both patients and providers.

5. Improved Patient Flow: VSM helps healthcare organizations analyze patient flow throughout the facility and identify opportunities for improvement. By optimizing patient flow, organizations can reduce wait times, enhance patient access, and increase throughput, ultimately improving patient experiences and outcomes.

6. Support for Continuous Improvement: VSM is a tool that supports the principles of continuous improvement and fosters a culture of problem-solving and collaboration within healthcare organizations. It encourages cross-functional teams to work together, share insights, and implement changes to achieve incremental improvements over time.

While specific quantitative data and case studies showcasing the direct impact of VSM in healthcare may vary depending on the context and organization, numerous healthcare providers have reported notable improvements in patient flow, reduced wait times, enhanced resource utilization, and increased overall operational efficiency through the strategic application of VSM.


Best article for VSM in Healthecare -


The System Development Life Cycle (SDLC) is a structured approach used in software development projects to ensure the effective planning, development, implementation, and maintenance of information systems. Although SDLC is primarily associated with software development, it can also be valuable when applied in the context of Lean methodologies.

SDLC provides several key benefits that align well with Lean principles and practices:

1. Standardized Processes: SDLC offers a standardized set of phases and activities, ensuring consistency and uniformity throughout the development process. This aligns with Lean's focus on eliminating variations and standardizing work processes, enabling organizations to streamline their development efforts and reduce waste.

2. Clear Requirements Definition: SDLC emphasizes upfront requirements gathering and analysis, ensuring that the development team understands the needs and expectations of stakeholders. This aligns with Lean's principle of customer focus and value identification. By explicitly defining requirements, waste arising from rework, misalignment, and miscommunication can be minimized.

3. Continuous Improvement: SDLC incorporates continuous feedback loops through testing, quality assurance, and user validation. This iterative approach aligns with Lean's continuous improvement principles, allowing for early identification and resolution of issues or inefficiencies. By embracing feedback and acting upon it promptly, organizations can optimize their systems, enhance quality, and drive continuous improvement.

4. Lean Decision-Making: SDLC emphasizes evidence-based decision-making by gathering and analyzing data throughout each phase. By leveraging this data-driven approach, organizations can make more informed decisions regarding system design, development processes, resource allocation, and risk management. This aligns with Lean's principle of making decisions based on data and facts, reducing reliance on assumptions and improving overall efficiencies.

5. Risk Mitigation: SDLC incorporates risk management activities at different stages of the development cycle. This allows organizations to identify and assess potential risks early, propose mitigation strategies, and proactively address them. By addressing risks in a systematic manner, Lean organizations can reduce the chances of project setbacks, delays, and disruptions, promoting efficiency and value generation.

In summary, incorporating SDLC within Lean initiatives can provide valuable structure and guidance for software development projects. It helps organizations standardize processes, gather clear requirements, promote continuous improvement, facilitate data-driven decision-making, and mitigate risks. By leveraging SDLC practices alongside Lean principles, organizations can achieve streamlined, efficient, and high-quality software development processes.


The System Development Life Cycle (SDLC) is a structured framework used to guide the development and implementation of information systems. It encompasses a series of phases, activities, and deliverables that ensure the successful creation of software or technology solutions. The SDLC provides a systematic and organized approach to software development projects, serving as a roadmap for the entire development lifecycle. Here is a breakdown of the typical phases involved in the SDLC:

1. Requirements Gathering: This initial phase involves gathering and documenting the functional and non-functional requirements of the system. It includes activities such as conducting interviews, workshops, and surveys to understand user needs, business processes, and technical constraints.

2. System Analysis: In this phase, the gathered requirements are analyzed in detail to identify system functionalities, dependencies, and potential design solutions. It involves creating system models, process flows, and data models to visualize the proposed solution.

3. System Design: The design phase focuses on translating the requirements and analysis into a detailed system design. It includes designing the architecture, user interface, database structure, and any other necessary components. The design phase lays the foundation for the development process.

4. Development: During this phase, the actual coding and programming of the system take place. Development teams use the chosen programming language, frameworks, and tools to build the software based on the system design. This stage involves writing code, conducting unit tests, and ensuring code quality.

5. Testing and Quality Assurance: The developed system goes through rigorous testing to identify defects, bugs, and issues before its deployment. Testing includes various levels, such as unit testing, integration testing, system testing, and user acceptance testing. Quality assurance activities are performed to ensure compliance with defined standards, requirements, and expected quality levels.

6. Deployment and Implementation: Once the system passes the testing phase, it is deployed to the live environment. This involves installing the software, configuring the necessary infrastructure, and migrating data if required. User training and change management processes also take place to ensure a smooth transition to the new system.

7. Operation and Maintenance: The system enters the operational phase, where it is actively used by end-users. Ongoing maintenance and support activities like bug fixes, enhancements, and updates are performed to ensure system reliability, performance, and security. This phase may include regular system monitoring, troubleshooting, and user support.

The SDLC is not a linear process but can be iterative or incremental. Iterative approaches involve cycling back to previous stages for further refinement, while incremental approaches deliver the system in stages, building upon each release.

By following the SDLC, organizations can ensure that software development projects are well-structured, traceable, and capable of meeting the defined requirements and objectives. It promotes effective project management, risk mitigation, stakeholder involvement, and the delivery of high-quality software solutions.


Bonus Material:

Hoshin Kanri, also known as Policy Deployment, is a strategic planning and management process originally developed in Japan. It has been widely adopted in various industries, including healthcare. Hoshin Kanri provides a systematic approach for aligning organizational goals with specific actions and targets, fostering continuous improvement and overall performance enhancement.

When applied to the healthcare context, Hoshin Kanri helps healthcare organizations establish clear objectives, define strategic initiatives, allocate resources effectively, and monitor progress towards achieving desired outcomes. The process involves the following key steps:

1. Establishing Vision and Goals: Healthcare organizations define their overarching vision, long-term goals, and strategic priorities. This typically involves a detailed analysis of current performance, identification of crucial improvement areas, and consideration of patient needs and expectations.

2. Deployment of Objectives: The identified goals are cascaded down the organizational hierarchy, ensuring alignment and understanding at all levels. Each level of the organization collaboratively develops specific objectives and improvement targets that contribute to the broader strategic goals.

3. Strategy Deployment: Leadership engages in the process of developing a well-defined roadmap for achieving the established objectives. This includes identifying the key initiatives, projects, or changes needed, as well as assigning responsibilities and allocating necessary resources.

4. Action Planning: Each department or team translates the strategic initiatives into actionable plans and defines the tasks, timelines, and performance measures required to implement them successfully. These plans focus on improving workflow processes, enhancing quality and safety, optimizing resource utilization, and enhancing patient experiences.

5. Review and Performance Management: Regular reviews and monitoring mechanisms are put in place to track the progress of the identified tactics and their impact on achieving the objectives. These reviews allow for performance assessment, identifying areas where course correction or adaptation is necessary.

6. Continuous Improvement: Hoshin Kanri emphasizes a culture of continuous improvement in healthcare organizations. It encourages ongoing learning, problem-solving, and the utilization of feedback loops to refine strategies, adjust plans, and continuously enhance the quality and value of care delivery.

By adopting the Hoshin Kanri Lean process, healthcare institutions can create a disciplined, data-driven approach to strategy execution, foster cross-functional collaboration, and promote organizational learning and improvement. This method enables healthcare organizations to navigate the complex and dynamic healthcare environment more effectively while achieving their strategic goals and delivering better outcomes for patients.



Top 7 highest risk, time and cost areas in healthcare:

In healthcare, there are various and process errors that can have significant financial implications and consume valuable time. While it's important to note that specific risks and errors can vary depending on the healthcare setting and the nature of the processes involved, the following are some common examples:

1. Medication Errors: Medication-related errors, such as prescribing mistakes, administration errors, or dispensing errors, pose substantial risks in healthcare. These errors can result in patient harm, increased hospital stays, legal liabilities, and costly medical interventions to rectify the errors.

2. Healthcare-Associated Infections (HAIs): Infections acquired during the course of healthcare delivery are a significant concern. HAIs can result from inadequate hand hygiene, improper sterilization practices, or other breaches in infection control protocols. They often lead to increased length of hospital stays, additional treatments, and increased costs for both the healthcare provider and the patient.

3. Diagnostic Errors: Diagnostic errors can occur when healthcare providers misinterpret test results, incorrectly diagnose a patient's condition, or fail to identify a critical illness. These errors can lead to delays in appropriate treatment, unnecessary procedures or treatments, increased morbidity, and even patient mortality. The costs associated with extended hospital stays, repeat tests, and legal implications can be substantial.

4. Surgical Errors: Surgical errors encompass a range of mistakes, such as wrong-site surgeries, retained foreign objects, or intraoperative complications due to medical equipment failure. These errors can result in devastating consequences for patients, requiring additional surgeries, prolonged hospital stays, and costly litigation.

5. Patient Falls: Patient falls are frequent in healthcare facilities, particularly among elderly or vulnerable individuals. Falls can cause injuries, fractures, and other complications, leading to extended hospital stays, specialized care, and increased healthcare costs.

6. Inefficient Admission/Discharge Processes: Inefficient admission and discharge processes can lead to prolonged wait times, delays in care delivery, and decreased patient satisfaction. These issues can directly impact patient flow, resource utilization, and overall operational efficiency, resulting in increased costs and reduced capacity for effective care.

7. Inadequate Communication and Care Coordination: Poor communication and coordination among healthcare providers can lead to errors, duplicated tests, medication discrepancies, and fragmented care. These inefficiencies can impede timely and appropriate treatment, prolong hospital stays, and increase the risk of adverse events.

Addressing these risks and errors requires a multi-faceted approach, including the implementation of robust quality improvement initiatives, standardized protocols and procedures, effective training and education, strong leadership and teamwork, and the use of technology to improve patient safety and process efficiency. By systematically identifying and mitigating these risks and errors, healthcare organizations can enhance patient outcomes, reduce avoidable costs, and optimize resource utilization.



  1. Pick a simple process that you know really well

  2. Get a small team together and VSM every aspect of the process - use the TripleFecta as a guide

  3. I guarantee you will find ways to improve it

  4. Use LEAN to remove pegs - Non-value added processes - optimize the process

  5. using PDCA - Plan Do Check Act - Deploy the changes

  6. Update the process changes in the proper documentation and training materials

    1. If you need help with this - use the A3 from Month 1 Bonus Material

  7. Then pick another process and start again

Next month:

Six Sigma

Standard Deviation 


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