Gemba

In Japanese, gemba means “the real place.” This is the place where work happens; where the facts can be found. In veterinary medicine, it would be the reception area, the exam room, the surgery room, etc. It is the place to go see where a problem exists, as it exists, when it exists. Contrary to Western management, Toyota understands that if a problem is to be fully understood, then all stakeholders, such as executives, supervisors, managers and workers, must be present at the problem site in order to consider all points of view and ideas, and build a consensus on how to fix it permanently. Lean leaders will “go to the gemba” when there is a problem to investigate and solve. It’s also a common practice to do planned “gemba walks” to get out of the office, to engage with staff, and to see problems and opportunities for improvement first hand.

Value Stream

 The value stream is the overall high-level sequence of steps necessary to take a product or service from start to finish (and the delays that occur between steps). A value stream is the “end to end” process, as opposed to just looking at one department or one function.  For example, it might be all the steps necessary to take an animal presented with an illness to a condition where it is healthy enough to go home. Ideally, each step should move the product along towards that which the customer values, and be devoid of any waste. Value stream thinking helps us break down silos that interfere with delivering value to the customer.

The current state map is created by going to gemba with all stakeholders present in order see and record all the steps (and delays). Then, all unnecessary waste is identified and removed. Finally, any steps that can be performed concurrently, combined or need to be rearranged are changed in order to  create the future state map.

Organizations create value stream maps to help people understand the big picture and how to improve things systemically. A current state map documents how things are today, while a future state map is used to create a vision and a plan for an improved system.

Value

 

According to Lean, value is defined by three concepts. First, it is something that the client wants or needs and is willing to pay for. If the client brings in a pet, but is not willing to pay for vaccinations, they are obviously not valuable to the client, at least at this time, and we certainly would not perform that service. Secondly, it must move the care process forward in some, in terms of comfort, diagnosis, treatment, or education -- working toward restoring or maintaining health and wellness. The pet presented for vaccinations must be moved towards a more healthy condition by actually vaccinating the animal. And, thirdly, it must be performed correctly the first time (quality). Giving the wrong vaccines or inappropriate vaccines is of no value. Especially, if we have to go back a second time and vaccinate with the appropriate vaccines.

If a step is not value, it is waste. Lean organizations are focused, ultimately, on adding value from the client's point of view.  Improved efficiency, improved safety, reduced costs, better resource utilization, increased staff engagement, a culture of continuous improvement, and quality are all important aspects of Lean, but they are by-products of the methodologies Lean uses in order to provide value to the customer from the customer's point of view.

It’s important to note that adding value and being busy are not the same thing. Just because you are running around doing something, does not mean you are adding value. There is a lot of motion and activity involved in chaos, but the vast majority of it is not adding value to the patient or client.