International Research Journal of Engineering and Technology (IRJET) e-ISSN: 2395-0056

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Value Stream Mapping (VSM) – A Case Study in Orthopedic Hospital

Prof. Harshal V. Ingole1, Prof. Yogesh.P.Wankhade2, Prof. Chetan S. Sethia3
1 Assistant Professor, Mechanical Engineering Department, Jagadambha College of Engineering & Technology,
Yavatmal, Maharashtra, India
2 Assistant Professor, Mechanical Engineering Department, Jagadambha College of Engineering & Technology,

Yavatmal, Maharashtra, India

3 Assistant Professor, Mechanical Engineering Department, Jagadambha College of Engineering & Technology,

Yavatmal, Maharashtra, India

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Abstract - The complete elimination waste is the
target of any qualified system. This concept is vitally 1.1 Over Production
important today since in today’s highly competitive
world there is nothing we can waste. This paper Entering repetitive information on multiple documents or
forms.
attempts to apply the principles of lean manufacturing
in the Healthcare sector with the purpose of eliminating 1.2 Waiting Time
wastes and increasing capacity. Value Stream Mapping
tool was used to expose the waste and identify a Primary team waiting for patient service.
proposed plan for improvement. The results achieved in Patient waiting for appointment.
the proposed plan showed significant improvements in
the overall performance of the system, which allowed to 1.3 Transportation
be more productive, flexible, smooth and with high
Waiting for transportation to arrive, take patient to
quality service
testing, surgery, discharge.

1.4 Excess processing

Key Words: Lean Methodology, VSM, Current State,
Future State etc.. Ordering more diagnostic tests than the diagnosis,
Retesting.

1. INTRODUCTION 1.5 Inventory

The Lean methodology implementation started with the Unnecessary instrument in operating room kits.
creation of a VSM of the existing situation. VSM is a
process analysis tool to identify the key process 1.6 Waste of Movement
characteristics such as the sequence of activities in the
process, their speed or cycle time. VSM helps establishing Nurses leaving room for common supplies.
a judgement as to whether or not the activities add value Searching for charts, patients, medication.
for the patients. “Current state” maps are used to capture
the existing process and these are adapted to “future
state” maps that suggest how the process may be
1.7 waste of producing defects
changed to become lean. The mapping phase is crucial to
understand the process and to study the delays, from the
decision of the treatment to the first treatment session. Iatrogenic illness.
By focusing efforts on reducing wasteful activities, Medication error.
healthcare organizations can more efficiently attain
organizational objectives. The general wastes occur
during the process are.

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 International Research Journal of Engineering and Technology (IRJET) e-ISSN: 2395-0056
Volume: 02 Issue: 07 | Oct-2015 www.irjet.net p-ISSN: 2395-0072

= = 32min
2. CASE STUDY
After collecting the information needed with the regard to
Case study performed in an Orthopedic Hospital at
the patient flow, it is easy now to draw the value stream
Nagpur.
map for the current state. A value stream is defined as all
General information about the hospital is an Orthopedic
the actions both value added and non- value added
Hospital having Radiology, pathology, physiotherapy
required to bring a specific product, service to a customer
departments and operation hall having 10 bed capacities.
or patient.
Working shifts are three, 6 hrs, 6hrs and 12 hrs. First shifts
The VSM of the ED is created by using a predefined set of
and second shifts have 4 staff members each and last shift
icons shown in Fig 1 These icons include the process icon,
have 2 nurses. Along with this there are one main doctor
the data box, the outside source, patient serve icon, and
and an assistant doctor.
information flow icon.
The weekly process and cycle time required for each
process is given in Table -1. C/T=

Table -1: Hospital Daily Statistics C/O=

Processes Cycle Time Process Data

Waste=
Box Outside Patient Information
Source Serve Flow
(min) Fig -1: Value Stream Mapping Icons.

On the basis of weekly data available we can draw VSM for

1. Registration. 5 the current state to analyze the current process which
shows in Fig 2 below.

2. Evaluation 15 After drawing the VSM for current state we can identified
the wastes which exists in the current process

3. X-Ray & Evaluation 15

4. Plaster 30

5. Physiotherapy. 20

2.1 Takt Time Analysis

Takt time is the important tool needed for the assessment

of current system. It is a tool used to eliminate over
servicing. The hospital as explained above works in three
shifts. The lunch breaks as well as other necessary breaks
for the working staff are covered by another staff. So the
total available time is 24 hrs a day which equals to 1440
min.

In average, the daily hospital visits is 45 and available Fig -2: VSM for Current State
time is 1440 min. so the Takt Time for the process of
service is calculated below. The Process start with arrival of the patient in the
hospital. Before check up, patient has to enter his name
and address in the register record. After registration
 Takt Time = patient wait for the evaluation by the doctor. After
evaluated by the doctor or if required or to confirm

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 International Research Journal of Engineering and Technology (IRJET) e-ISSN: 2395-0056
Volume: 02 Issue: 07 | Oct-2015 www.irjet.net p-ISSN: 2395-0072

whether bone is facture or patient send to radiology reduce inventory by 2 in X-ray section, waiting time of
department for X-Ray. patient can be reduced by 5 min and patient intake per
shift can be increased.

After X-ray process patient advice for further

treatment if facture occur, if not then patient get
discharge. The treatment include plastering of fractured These improvements are shown on the future map which
bone or last stage is will be surgery. As in this case, we shows the process changed and can be leaned.
specially focus up to the plaster process and avoid surgical
operation for fine result. As mentioned above the current
map focus on existing process and identified the muda’s
i.e. wastes which can be eliminated.

After study the current process and map we

identified some of the problems which occur during the
process. The problems are shown on the map by looping
which focuses the waste occur during the process. The
map shows two loops indicating problem identified during
the process.

2.2 Problem Identification

2.2.1. Loop 1 (Patient & X- ray Evaluation)

 Only one doctor is in operation for patient and X-

ray evaluation.
 Bottleneck occurs between the two processes i.e.
patient evaluation and X-ray evaluation which
increases waiting time.
 Combine patients creates waiting time for further Fig -3: VSM for Future State
process. The detailed result showing the difference between
current and future state given below the Table -2
2.2.2. Loop 2 (Physiotherapy)

 Space utilization is not proper in physiotherapy Table -2: Comparison of results between Current State
department which leads to less patients get & Future State
served weekly.
 Not standard location for equipments.
Item Current Future
State State
2.3 Proposed Plan
In the proposed plan, for loop 1 we can appoint a
Capacity 45 62
new doctor in radiology or X-ray department who can
read the X-ray report which before get read and
evaluated by the main doctor or utilized the doctor doing
plaster and look after the surgical patient in the X-ray Takt Time (min) 32 23.22
department for X-ray reading and evaluation. For loop 2
proper space utilization can be carry out and this can be
happen by using the “5S” tool for proper space utilization Value Added Ratio 3.857 3.9285
and placing of equipments which are used on regular
basis. (VAR)

These improvements mentioned above led to

increasing the patients served i.e. capacity from 45 to 62,

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 International Research Journal of Engineering and Technology (IRJET) e-ISSN: 2395-0056
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