Chapter 3 - Process Analysis PDF

## MODULE 4 | UNDERSTANDING AND ANALYSING PROCESSES ### CHAPTER 3: PROCESS ANALYSIS ### 3.1 UNDERSTANDING THE CONCEPT VALUE-ADDING, SUPPORTIVE AND WASTEFUL ACTIVITIES When one evaluates a process, several factors influence outputs significantly. Among others are wasteful activities within suc...

## MODULE 4 | UNDERSTANDING AND ANALYSING PROCESSES ### CHAPTER 3: PROCESS ANALYSIS ### 3.1 UNDERSTANDING THE CONCEPT VALUE-ADDING, SUPPORTIVE AND WASTEFUL ACTIVITIES When one evaluates a process, several factors influence outputs significantly. Among others are wasteful activities within such a process. These wasteful activities sometimes gradually creep into the process and before long a lot of time is spent on these activities that do not add value. Consider the following analogy: A blood sample is examined under an electron microscope. If a virus particle (virion) is observed, it is a very small entity, less than one millionth the volume of a single cell. One virus particle can do nothing if it circulates in the blood. However, if that virus particle gets into a single cell and replicates, it will spread throughout the entire body. If successful, a single flu virus particle can become a fully-fledged virus and takes a person away from work for a significant number of days. In a company, wasteful activities are like a virus - once it has infected the processes and teams, it impacts on productivity as a lot of effort goes into these wasteful activities. Process analysis is like fighting the virus with medicine until the virus has no effect on the system anymore. "When wasteful activities start to look like work, a company is in trouble." - Taiichi Ohno In companies, several activities take place to perform and complete a task or activity and eventually a full process. These tasks and activities, however important, are often ‘not necessary', but are required to complete the task. A process consists of several tasks and activities performed in sequence. Once completed, the output is delivered in the form of a transaction, product or service, and is sent to the next operation, team or customer. Some of these activities and tasks are defined as value-adding, others as supportive (non-value-adding, yet necessary) and others as wasteful activities, as depicted below: | INPUT | PROCESS | OUTPUT | | ------------------------------------- | ---------------------------- | ----------------------------------- | | **VALUE ADDING** | | **VALUE ADDING** | | **SUPPORTIVE** | | **SUPPORTIVE** | | **WASTE** | | **WASTE** | By viewing value-adding, supportive and wasteful activities in the process, it often leads to improvement opportunities being spotted and as such, unit cost can then be reduced. Consider the following as the definition of the three terms: ### VALUE-ADDING ACTIVITIES These are activities that the patient is willing to pay for. To define what value means to patients, one needs to ask what it is that they are willing to pay Mediclinic for, that they cannot do for themselves. It is very important to understand this because, sometimes, what we consider to be work, is not really value-adding. Patients are not willing to pay us for triple-checking work, reworking, escalated cases to be handled by senior people, being in meetings, having breaks, doing the budget, drawing up action plans, reading our emails, printing information, moving work to the next team or operation, talking excessively to each other, having a team-building session with clients' money, etc. This might sound harsh, but the fact of the matter is that many of these example activities are things that we need to do to complete our process, but many of these activities do not directly add value for the patient. ### SUPPORTIVE ACTIVITIES Necessary support activities are those activities that we need to perform to do the value-adding activities that the patient is willing to pay for. For example, it would be impossible or very difficult to treat patients without having some planning, daily team meetings, training and root cause analyses. Drawing up a budget and doing capacity planning are also two activities that we perform so that we are able to do our value-adding activities. They are, therefore, called necessary support activities or essential non-value-adding activities. ### WASTEFUL ACTIVITIES Wasteful activities are those that do not result in any value whatsoever being added. These activities include duplication of work, unnecessary walking, searching, waiting, watching, delays, incomplete information, unnecessarily long meetings or phone calls, unneeded process steps, etc. Necessary support activities can easily become wasteful without us realising it. ### IMPORTANT INFORMATION The aim is to spend most activities, time and resources on value-adding activities and to reduce or eliminate wasteful activities. Lean, as one of the predominant continuous improvement methodologies, has been described as the 'antidote' to ‘muda’, the Japanese term for waste. Its goal is to incorporate less human effort, less inventory, less time and less space to develop products or services in order to become highly responsive to customer demand while producing top-quality products or delivering top-quality services in the most efficient and economical manner possible. As mentioned, waste is defined as anything for which the customer is not willing to pay. Initially, seven types of waste were defined by a Japanese industrial engineer and Toyota executive, Taiichi Ohno. The figure on the next page depicts these seven wastes: - **Overproduction:** - **Waiting:** - **Transport:** - **Motion:** - **Inventory:** - **Defects:** - **Extra Processing:** **SEVEN TYPES OF WASTE** [Image of a diagram of 7 types of waste is here] Originally muda was one of three concepts together with 'muri' and 'mura'. Mura relates to 'unevenness' and argues for a stable demand that enables smooth process flows. The more uneven the demand, the more variation in the process, and the less efficient the process will be. Muri is a term for ‘excessive strain', which argues for good working conditions that prevent injuries and strain on the worker. This is a clear factor in reducing absenteeism. Mura and muri are viewed as contributors to waste. The picture below differentiates between muda, muri and mura. It is important to remember there are two ways in which to increase customer value: one, by reducing waste and, thus, the cost of a product or service, or two, by increasing the value to the customer without increasing the cost of the service or product. [Image of a diagram that differentiates between muda, muri and mura.] ### IMPORTANT INFORMATION **EXAMPLES OF THE SEVEN WASTES IN A HOSPITAL:** - **Motion:** Searching for patients, charts, doctor orders, medication, wheelchairs, etc. - **Waiting:** Delays for bed assignments; waiting for admissions to Emergency Centre, excessive signatures or approvals; delays while waiting for laboratory test results - **Defect:** Medication errors; wrong patient information - **Transport:** Placing a patient trolley in the hall and constantly having to move it; moving samples, specimens, or equipment too early or late, and/or to the wrong location - **Extra processing:** Retesting (i.e. performing a second 24-hour urine test because a staff member obtained the first specimen incorrectly); requesting and processing information that will never be used - **Overproduction:** Making extra copies of charts, reports, laboratory results, etc.; treatment (medication, dressing changes, etc.) given early to suit staff schedule; printing, emailing, sending or faxing the same document multiple times - **Inventory:** Duplicate medications and supplies in excess of normal usage; extra or outdated manuals, newsletters or magazines; excessive office supplies; obsolete charts, files, and equipment The figure below shows a graphical depiction of value-adding vs non-value adding activities in a hospital process. [Image of a diagram of value-adding vs. non-value adding activities in a hospital process.] ### ACTIVITY 3 1. In groups, discuss and list which processes or activities of your team or department are in the three categories of value-adding, supportive and wasteful activities. 2. Estimate what percentage of all the processes or activities your team or department performs, is in the category of direct value adding, supportive and wasteful. 3. Identify the top three wasteful processes or activities that you can immediately address in your team, and generate possible solutions. | VALUE-ADDING | SUPPORTIVE | WASTEFUL | | ------------------------------------------------------------------------------ | ------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------- | | | | | | | | | | | | | ### 3.2 METHODOLOGY FOR PROCESS ANALYSIS Process analysis is about understanding and acknowledging that there are entire wasteful processes and wasteful activities (in different forms) in all processes. It is about creating a culture where these wasteful processes and activities are continuously challenged and eliminated by all employees. The approach is usually applied on two levels: * **Continuous improvement (the Japanese call it ‘Kaizen'** ): - Continuous Improvement Teams improve the activities in processes and optimise what is currently being done in processes. This entails the never-ending questioning of the status quo in order to improve all the time * **Business process re-engineering (the Japanese call it 'Kaikaku')** : - Taking a giant leap in process design whereby technology and zero-based thinking allow for new and fresh approaches to optimise how work flows through a process. It is usually more of a step-change and often requires high capital expenditure as some of these designs require new platforms or systems to run on. ### IMPORTANT INFORMATION In Module 3: Developing Problem-solving and Innovation Capability, the principle of Continuous Improvement Teams and problem-solving approaches (like the A3 method) are discussed. The tools dealt with in Module 3, therefore, become the vehicle for implementing process improvement. In this section, a nine-step methodology for doing process analysis and improvement is described. It can be summarised as follows: 1. **Decide which process to improve.** 2. **Assemble a Continuous Improvement Team** 3. **Gather information on the current process** 4. **Map the 'as is' process** 5. **Visually display the process for evaluation** 6. **Analyse the process and identify improvement opportunities** 7. **Map the ‘to be' process** 8. **Celebrate success and continuously improve** ### 3.2.1 Step 1: Decide which process to improve The Performance-Driven Team should identify a process for improvement that is not too simple, but also not too complex. If it is too simple no significant improvement can be obtained. If the process is too complex, implementation of improvement could be lengthy and time-consuming. ### IMPORTANT INFORMATION Every business is a collection of processes. A process is a sequence of activities or steps that must be carried out to create value for patients. A process could also be called a 'value stream' of activities. When selecting a process for improvement, consider the following: - **The bottleneck process** (that process where capacity is less than the demand placed on it or where the production schedule can often not be met) - **Quality problems that are regularly experienced** i.e. clinical quality or patient experience issues - **Throughput and volume that is not what it should be** - **Team members that struggle to achieve throughput targets** - **High operating cost** - higher than standard or budget - **Excessive long lead times** - **High backlog** - **Too much paperwork or cumbersome computerised procedures** - **Difficult and complex work** ### IMPORTANT INFORMATION Remember that a process should ideally be a series of value-adding activities. It is, therefore, also important to decide which parts of value creation will be mapped. The following flows can be mapped in any combination, or each as a separate flow, depending on the focus area identified from the points above. **Different flows in a hospital:** - **Patients:** * Patients * Families * Information * Medication - **Supplies:** * Supplies * Instruments or equipment * Staff - **Supportive services:** * Providers, e.g. specialists, physiotherapists, radiology and pathology It is important to study a whole process, end to end, for it to make sense. If these studies are only focused on a small functional team, then improvement opportunities between teams could be missed. ### 3.2.2 Step 2: Assemble a Continuous Improvement Team To use different perspectives from different people with unique experiences, a Continuous Improvement Team (refer to Module 3) should be selected for the process analysis and improvement. Ideally, such a team should include team members from the process to be analysed and should be between three to six people. Keep the following in mind when choosing team members: - Involve team members working within the process. - Involve people from upstream and downstream teams. - Invite somebody that deals with quality and/or patient complaints. - Involve the process owner - the person accountable for performance. - If possible, involve a specialist or doctor (where appropriate). - If possible, involve an IT, technical, process or systems designer. This Continuous Improvement Team should get together for between 30 to 60 minutes once every week, for about four to eight weeks. ### IMPORTANT INFORMATION For leaders it is very important to involve team members from the beginning because they know the job and the work process better than anybody else. Being involved in a process analysis activity gives them more control over their workplace. ### 3.2.3 Step 3: Gather information on the current process Discuss and explain the scope of the process analysis to the Continuous Improvement Team. In a meeting room with enough wall space, put up big sheets of paper. As a team, talk through the process as it is and draw up rough sketches of the process. If the process being studied is complex, divide the team into smaller teams, according to the part of the process that they are involved in, or have the best knowledge of. An A3 method (the technique discussed in Module 3) could also be used in this step to analyse the current 'as is' situation and to gather data and information. Mapping an improved ‘to be' process could then serve as the countermeasure. ### IMPORTANT INFORMATION As far as possible, always go to the workplace. This activity is called 'going to the Gemba' (as discussed in Module 1). This means, 'go and see' at the workplace what is happening; use real facts and information gathered at the place where work is performed in the process. The team is about to go to the workplace to collect process data. However, first agree on which data is necessary. The following list can guide you in planning the data collection, but it is not necessarily the only data you need. Discuss this as a team. Remember, the focus is on analysing flow, so speed and capacity are often very important, so is a backlog and any kind of delay. The table below lists some aspects of processes, grouped into the clusters time, capacity and process capability that could be observed when a team goes to the 'Gemba'. | TIME | CAPACITY | PROCESS CAPABILITY | | :----------------------------------------- | :-------------------------------------------------- | :-------------------------------------------------------------------------------------- | | Total time worked in the area | Number of people | Quality specifications | | Work schedules, if applicable | Time standards for work types | Rework rates, error rates, non-conformance rates | | Regular planned non-available work time, e.g. | Service-level | Availability problems | | lunch, tea breaks, morning meetings and | Agreements (SLAs) | Backlog volumes | | unplanned time, i.e. special requests | Turnaround times | Productivity, efficiency and utilisation information | | Planned work time (total time minus planned | Work volumes and work demand | Other disruptions in flow | | non-available time) | | | Now the team is ready to go to the ‘Gemba’. Go to the work area, assemble information and observe how work is performed. If possible, walk the workflow path. Begin with the most upstream (first) process step. Start assembling information about the process. Make notes on the process and things that you notice as you spend time at the workplace. ### IMPORTANT INFORMATION When going to workplaces to do observation, some people might feel intimidated by the presence of managers or strangers. For this reason, always keep the following guidelines in mind: - Explain to the team under observation why you are there, why you are doing it and a little of how you are going to do it. - Invite them to share information with you or to help you with ideas for improvement. If people know what is happening, they are more likely to provide the correct information. - Introduce your team members by name and find out the names of the people in the team that you observe, if you see that they are open and do not feel threatened. - Ask whether they have any questions from their side. - Ask your team to respect the various workspaces. Ask the team being observed whether there are any rules, policies or procedures that your team needs to be aware of. - Thank the team for the opportunity to study their process flow. ### IMPORTANT INFORMATION Refer to Chapter 4 in this workbook. The tools might assist with your observations in the workplace. After sufficient information is available, meet in the meeting room or in a quiet area close to the workplace. Discuss the findings and results. If any gaps in understanding the process flow were observed, go back to find the necessary information, otherwise, go to the following step. ### IMPORTANT INFORMATION Always ensure that information is collected on the actual current state, and not the ideal state or what is desired. Always describe the inefficiencies and do not make excuses or defend the process. ### 3.2.4 Step 4: Map the 'as is' Process Now that you have all the necessary information, start to map the process. If a standard operating procedure is available, it will be the starting point of the analysis. If it is not available, it will be one of the outcomes. It is best to document the process visually for all to see. A flip chart or brown paper will assist with visual management and more effective team member participation. As part of the process mapping, the following maps should be constructed: - **Physical flow map** - **Value stream map** - **Process flow map** ### PHYSICAL FLOW MAP Continuous operational flow with streamlined processes is the ideal for any hospital environment. This can be achieved by organising the work space to reduce time waste by motion and transport. Creating a physical flow map (sometimes referred to as a motion map or spaghetti diagram) can help understand the physical process flow and identify areas of 'traffic', unnecessary journeys, obstacles and bottlenecks. **Definition:** A visual representation using a continuous flow line tracing the path of an item or activity through a process. It enables Continuous Improvement Teams to identify redundancies in motion, travel distance and the actual path taken along with the number of repetitions. **When to use:** When the actual movement of an item needs to be analysed along with the travel distance and the number of times it moves on that path (back and forth). **Visual example:** [Image of a diagram of patient flow in a hospital] **How to use:** 1. Obtain (or draw) a basic floor plan of the facility. - Map every motion involved in a process - record the amount of time spent in motion and measure (or estimate) distances. 2. Review the map and data and see how process motion can be improved. Critically look at the following aspects: - Can the work space be reorganised to minimise the amount of travel? - Can instruments or equipment be relocated? - Can consumables be stored in a more accessible area? - In shared equipment rooms - can the number of visitations be reduced? - Consider batch sizes - is it better to process smaller amounts or take several journeys to transport a larger batch? - Review transportation methods (i.e. using a trolley). **Time, money and energy are lost in motion.** **Result:** An optimised process flow with reduced transport and movements can help minimise errors and reduces fatigue for employees. Continuous flow creates a more streamlined workload and increases productivity. [Image of a diagram showing before and after improvements in process flow] ### VALUE STREAM MAP AND PROCESS FLOW MAP It is essential for any business to understand their value stream of activities with a proper identification of what adds value, what are wasteful activities and the relevant components that cause the system to slow down or grind to a halt. This can be achieved by creating a Value Stream or Process Flow Map. "Whenever there is a product or a service for a customer, there is a value stream. The challenge lies in seeing it." – Mike Rother and John Shook ('Learning to See') Both value stream maps and process flow maps are ways to perform process analysis. | VALUE STREAM MAP | PROCESS FLOW MAP | | :------------------------------------------------------------------------------- | :---------------------------------------------------------------------------------------------- | | The aim is to identify wasteful activities, delays and work-in-process between | The aim is to identify the activities in a specific process or department as it flows from the one | | departments of a hospital level. | to the next. | | It maps overall hospital level information typically, operations and transactions, | It maps the basic elements of the process; | | flow, delays and their effects on the overall inspections and delays. | typically, operations and transactions, flow, inspections and delays. | **Definition:** A technique used to document, analyse and improve the flow of people, information, equipment, or materials required to deliver a service to a patient. It is a tool that helps to visualise and understand the flow of people, information, equipment or materials through the value stream. **When to use:** It is used when any type of flow needs to be analysed - this could include patients, families, information, medication, supplies, instruments, equipment, staff, support services and providers. This enables you to see at a glance where the delays are in your process, any restraints and excessive inventory, work-in- process or delays. The value stream map is used for interdepartmental flows, whereas the process flow map is better suited for activity flows within a department or specific process. | PROCESS MAPPING | VALUE STREAM MAPPING | | :------------------------------------------------------------- | :------------------------------------------------------------------------------------- | | Only shows the sequence of activities in a process | Shows the flow of materials and information in a process | | No indication of time or delay between processes | Indicates lead time and cycle time for each process | | No identification of value-added or non- value-added | Identifies each step as value-adding or non-value-adding | | | Requires thorough first-hand study of process | **Visual examples:** **PROCESS MAP EXAMPLE OF PATIENT FLOW IN AN EMERGENCY UNIT** [Image of a patient flow diagram for a hospital's Emergency Unit.] **VALUE STREAM MAP EXAMPLE FOR A MANUFACTURING PLANT** [Image of a typical value stream diagram for a factory] **VALUE STREAM MAP EXAMPLE FOR THE FLOW OF AN ORTHOPAEDIC PATIENT THROUGH AN EMERGENCY UNIT** [Image of a value stream diagram focusing on patient flow in an orthopaedic hospital.] **How to use** 1. **Determine the boundaries.** - Where does the process begin and end? 2. **List the steps.** - Use a verb to start the task description. 3. **Sequence the steps.** - Tip: On a flip chart page or brown paper, use Post-it notes to move tasks easily. Do not draw arrows until later. 4. **Use appropriate symbols.** - Ovals show input to start the process or output at the end of the process. - Rectangles show a task or activity performed in the process. - Arrows show the process direction flow. - Diamonds show decision points in the process where a yes/no question is asked. Usually, there is only one arrow out of an activity box. If there is more than one arrow, you may need a decision diamond. If there are feedback arrows, make sure the feedback loop is closed; i.e. it should take you back to the input box. 5. **Check for completeness and finalise.** - Evaluate all steps, flows and directions of arrows and ensure it represents the most accurate current version of the process. - Does the flow represent what employees actually do? ### FINAL CODING, FINAL BILLING AND CLAIMS ('AS IS') [Image of a process flow diagram showing the current “as is” process of coding, billing, and claims processing] ### FINAL BILLING, FINAL CODING AND CLAIMS SUBMISSION ('TO BE') [Image of a process flow diagram showing the ideal “to be” process of coding, billing, and claims processing] ### 3.2.5 Step 5: Visually display the process for evaluation All the activities up to this step have made the information available; techniques were used to map the current process and already some ideas for improvement would have been made. Everything that was done in the previous steps needs to be visually displayed in an area where a broader audience can comment on it. The importance of this activity is that everyone has a chance to comment on existing bottlenecks, delays, inefficient processes and activities. This step is all about identifying problems and generating solutions to improve the process. This can be done in organised sessions where the Continuous Improvement Team presents the mapped process to key stakeholders to get their input and advice. [Image of a team brainstorming around a white board with post-it notes.] ### 3.2.6 Step 6: Analyse the process and identify improvement opportunities Process analysis is about identifying all activities that are wasteful and aim to significantly reduce or eliminate them. A secondary focus would be on the value-adding activities, to find even further improvement opportunities. All activities making up the entire process are analysed in a similar style as introduced in Module 3 through the Improvement Kata. [Image of a diagram showing the steps involved in problem-solving/continuous improvement.] A process improvement sheet is used to summarise the analysis. It logs the problems associated with particular activities, the improvement actions and due dates (similar to an action plan) as well as the results or savings. [Image of a table showing a sample process improvement log]. ### MEDICLINIC **TEAM** Insert the team name here **NO.** | **ACTIVITY** | **PROBLEM AREA** | **IMPROVEMENT ACTION** | **RESPONSIBLE PERSON** | **DUE DATE** | **RESULT/SAVING** | | :------ | :------------------------------------- | :------------------------------------- | :--------------------------------------- | :-------------------------- | :----------- | :----------------------------------------------------------------------------- | | 1 | | | | | | | | 2 | | | | | | | | 3 | | | | | | | | 4 | | | | | | | | 5 | | | | | | | ### Guidelines for doing process analysis - Separate activities into those that add immediate value for the patient and those that do not. - Eliminate, simplify, and reduce non-value-adding steps. - Simplify or reschedule any activity that delays a value-adding activity. - Identify activities, particularly non-value-adding activities that can be done in parallel with the sequence of value-adding activities. - Reorganise activities that have to be passed from department to department (and back) into a team activity. Identify whether one person can perform them. - Identify what preparations can be made before the main sequence of value-adding steps is initiated so as to avoid delays (e.g. preparing paperwork, requesting additional information beforehand). - Improve staff flexibility so as to allow several tasks to be done by one person. - Devolve decision-making power to the point of use. Deal with routine decisions on the spot. - Identify what to do to provide a 'one-stop' service to patients. - Identify possible delays due to problems and identify how to minimise those delays. - Make information available to make the value-adding sequence more continuous (use a common database). - Try to do as much processing as possible at the point where the data originates. - Try to make every value-adding step continuous with the last value-adding step without interruptions for waiting, queuing, or for procedures that assist the company but not the patient. - Reduce the time taken for value-adding activities. ### IMPORTANT INFORMATION Other appropriate tools and techniques can also be used by a Continuous Improvement Team during the process improvement. The following are typical: - Activity sampling - Line balancing - Workload balancing - Capacity utilisation - Standard operating procedures - Mistake-proofing systems (poka-yoke) As activities are discussed, the process improvement sheet is updated with actions and responsible people. When all wasteful activities have been analysed, the value-adding activities are also analysed for improvement. ### 3.2.7 Step 7: Map the 'to be' process Now that the wasteful activities have been identified, ask the team to map the future state of the process. This can be done in phases. There might be some immediate improvements that can be made - this would be phase 1 of the improvement. Draw the phase 1 future state map. Improvements that will take a few months to implement would form part of the phase 2 future state map, and so on. The team should also map the ideal future state. To do this, they will need to challenge their existing paradigms and ways of working, to something that is remarkable. During each future state mapping process, there are three areas of improvement that you need to focus on. These are as follows: ### Patient needs Start the improvement by understanding what the patient’s requirements are, i.e.: - What does the patient need? - When does the patient need it? - What are the important traits or characteristics of the patient? - How does the patient need it ### Flow Find bottlenecks that obstruct flow. These could be areas where work does not flow and where it gets stuck, i.e. at a team, a team member or process. ### Workload balancing Ensure that work is evened out. Workload balancing ensures that work is distributed to where capacity is available. ### Tips - Use a pencil so that you can change the future state map as you go along. - Do not go into too much detail at this stage – talk about flow, not operations. Remember that this process is part of the CAPDo cycle – make decisions, see the result and improve again. ### 3.2.8 Step 8: Celebrate success, standardise and continuously improve During this step, the results of the process analysis (as discussed above) are used to develop concrete improvement plans. Information from the analysis is captured on the process improvement sheet. Responsibilities are agreed upon with follow-up presentations about action plans. This is the start of the Check, Analyse, Plan, Do (CAPDo) cycle for continuous improvement. The CAPDo cycle is followed for implementing the plan. Follow-up Continuous Improvement Teams work sessions are scheduled and facilitated by a facilitator. During this implementation phase, new actions might be required, as well as the use of tools and techniques from other modules. To formalise the new process, a standard operating procedure needs to be drawn up, or an existing one updated. This needs to be shared by all team members. During this step, improvements are implemented and actions are put in place to sustain the improvements. The new process is now the standard. ### ACTIVITY 4 In this activity, apply the methodology for process analysis. **Step 1: Decide which process to improve and why:** **Step 2: Assemble a Continuous Improvement Team.** List your team members below: **Step 3: Gather information on the current process.** Visit the workplace and gather information. You can also use the 'stand in the circle' observation technique described in Chapter 4. **Step 4: Map the 'as is' process.** Come back and map the 'as is' process on a flip chart or whiteboard. **Step 5: Visually display the process for evaluation.** Ensure that it is correctly mapped and everyone agrees. **Step 6: Analyse the process and identify improvement opportunities.** Follow the steps and analyse your mapped process. Use the improvement log sheet to capture all your work. **Step 7: Map the 'to be' process.** Design and map the future state 'to be' process. **Step 8: Celebrate success, standardise and continuously improve.** <br/> *** Hopefully, this structured markdown format helps you understand the document better! If you have any specific questions or need further assistance, feel free to ask.