Previous experiences of Value Stream Mapping (VSM) at the hospital units included in the Swedish part of the NOVO Multicenter Study

Paper in proceeding, 2012

Within the county councils of Sweden (hospitals, elderly care, etc.) two waves of introduction of Lean Production (Lean) have occurred. The first occurred during the 1990s and was unsuccessful mainly due to dramatic and negative impact on the employees (Härenstam et al, 1999). The 2nd wave started after the turn of the millennium. In 2011 about 80% of the county councils were running Lean projects (SKL, 2012). Now more emphasis was put on leadership and teamwork as well as knowledge on methodology. Successful projects creating e.g. more efficient patient flows are supposed to save time. A key issue is, however, that no general agreement seems to occur on how these saved resources should be reprioritized (cf. the “50/50-basis” in Denmark). Due to this, Lean projects are often perceived as “saving projects” where staff will eventually be phased out leading to further “work intensification”. VSM is a main Lean tool used to reduce waste in production flows. Our present case studies show differences between hospitals in Lean and VSM experiences. At one hospital Lean has been developed from "below" in the organization since 2004 through successive education (SkaS-guiden 2008). In our 2 cases from this hospital the initial steps of VSM were guided by internal Lean educated stakeholders. No resistance was met from any employee. However, the writing of action plans and the following actions were integrated in parallel rationalization processes. In contrast, our 2 other cases at another hospital had only been marginally influenced by Lean. The VSM processes were guided by an external Lean educated stakeholder (one of the authors). Especially one of the cases had significant difficulties in achieving consensus on an action plan including work environment issues. The required time for the VSM analyses became considerably prolonged, partly related to lack of Lean and VSM experience. Conclusions: The duration of the VSM process seems to depend on previous Lean experiences. Problems in the assessment of an action plan, an essential part in the VSM procedure, seems partly due to employee uncertainty regarding the consequences for the individual and parallel rationalization processes.