Applying value stream mapping techniques to eliminate non-value-added waste for the procurement of endovascular stents

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Abstract

Ojectives

To eliminate non-value-adding (NVA) waste for the procurement of endovascular stents in interventional radiology services by applying value stream mapping (VSM).

Materials and methods

The Lean manufacturing technique was used to analyze the process of material and information flow currently required to direct endovascular stents from external suppliers to patients. Based on a decision point analysis for the procurement of stents in the hospital, a present state VSM was drawn. After assessment of the current status VSM and progressive elimination of unnecessary NVA waste, a future state VSM was drawn.

Results

The current state VSM demonstrated that out of 13 processes for the procurement of stents only 2 processes were value-adding. Out of the NVA processes 5 processes were unnecessary NVA activities, which could be eliminated. The decision point analysis demonstrated that the procurement of stents was mainly a forecast driven push system. The future state VSM applies a pull inventory control system to trigger the movement of a unit after withdrawal by using a consignment stock.

Conclusion

VSM is a visualization tool for the supply chain and value stream, based on the Toyota Production System and greatly assists in successfully implementing a Lean system.

Introduction

Early initiatives carried out in industry to establish supply chain developing programs have shown that it is necessary to map value-adding processes. By eliminating non-value-adding (NVA) factors and creating an overall smoother process, products and services become more valuable to the consumer as well as more competitive to rivals on a market. These economic approaches are increasingly applied in numerous medical settings [1], [2], [3], [4], [5].

The car manufacturer Toyota was the first company to use value stream mapping (VSM) techniques to implement Lean concepts and tools. The purpose of VSM is to minimize waste that prevents a smooth, continuous flow of products and information throughout a value stream [6]. A value stream displays the set of activities (and their respective value) involved to create a product or provide a service. Value stream mapping can be defined as a lean manufacturing technique used to analyze the flow of materials and information currently required to forward a product or service to a consumer [7]. Using pencil and paper or computer assistance, visualization serves as a tool to convey information about processes and interactions, to understand complex relationships and to identify hidden waste. Table 1 depicts key facts on VSM.

Section snippets

Area of application and outline of an implementation plan of the value stream mapping technique

The VSM technique was applied at a university interventional radiology department to eliminate non-value-adding waste in the process of endovascular stent procurement.

The focus was set to endovascular stents. They account only for a small amount of overall items used (ca. 15%) while accounting for the majority of value (ca. 80%) processed during the medical intervention. There are various stent differences e.g. in size, length, material and functionality, thus rendering a voluminous and very

Creation of the current state value stream map

The current state VSM was created and graphically organized (Fig. 1), considering thirteen procedural steps (Table 5).

Assessment of the current state value stream map

An assessment of the current state VSM (Fig. 1) demonstrated that out of thirteen processes for the procurement of stents only two processes were genuine value-adding processes:

  • The supplier of stents (process no. 1).

  • The procedure of stent implantation (process no. 9).

Out of the remaining processes, five were identified as unnecessary, six as necessary NVA activities:

Unnecessary

Discussion

One important factor in gaining control over an organization is to know and profoundly understand its basic processes. Faulty systems and processes, which may also induce medical errors, are certainly one of the reasons for rising health care costs [8], [9], [10]. Industrial engineering practices and economic work organization improvement techniques are increasingly applied in medical settings in general [11] as well as in Radiology [12]. Especially the Toyota Production System is frequently

Conflict of interest

There are no conflicts of interest to declare for this study. It was not financed by third-party funds.

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