Friday, September 16, 2005

Value Stream Management, Identify the Value Stream

Apologies for my neglect of this site, now, where were we?

Once value is specified in terms of what the client wants, the next step in developing a lean system or organization is to identify the value stream. This refers to the sequence of actions that bring resources forward toward the end client. It includes everything the agency does, but also everything their suppliers do. In California's system, for example, the process of becoming lean would start with what the client needs and look at how the direct support staff provide for that. The next step would be to look at the both the program design and the supervisor and how each provide the needed resources for the direct support person to serve the customer.

Value Streams when looked at honestly are extraordinarily complex and long, and rarely confined within a single agency in manufacturing. Certainly not in this system. This does not mean by itself that they are wasteful or inefficient. The economist, Milton Friedman once used a cover photo on one of his books depicting himself holding a pencil. The point of the photo was the pencil which contained rubber from Indonesia, metal mined in Central America, wood from canada and graphite from somewhere else (it's been awhile since I read Friedman) and were assembled and sold in the United States for a dime apiece.

A rough example of a value stream might be as follows: A male Supported Living client is hungry so a staffperson cooks for him using food purchased by another staffperson with money delivered by a Supervisor. Those funds may have been given to the Supervisor by an agency comptroller who cashed a check with funds for several clients received from the regional center as the fiduciary for Social Security. On another branch of the Value Stream, the employee cooking was following a person-centered Individualized Service Plan (ISP) which authorized cooking and described any parameters to the meal. That ISP may have been reviewed by a supervisor and must have been also reviewed by a regional center employee, signed off on by a Program Manager and funded. Both the funds and the terms of approving the ISP were delivered to the regional center from DDS based on allocations and controlling statutes set forth by the California legislature. If the client was eligible for the Medicaid waiver, a second branch of the allocation and regulation process travels through the federal government.

There are three things that I believe can safely be said about the process above:
1) That it is an oversimplification of the value stream leading to a single client eating a single meal,
2) That it probably repeats tens of thousands of times per day in California, maybe a half-million times per year.
3) That it probably doesn't go smoothly every time at every step. Even 99% success reflects a lot of defects in a tiny portion of the overall community-based system.

Taken together, if the assertions above are true, there exists extraordinary potential for both improving the satisfaction of clients and reducing the cost of the system. Just in the preparation of meals. Just in Supported Living clients.

Note: Because demons have prevented me from updating this site regularly, I am adding a feed to the links. People interested in this site who have browsers with RSS capability can bookmark the link marked "Pay attention!" to be notified of updates.


Anonymous said...

Money flows in.
Money flows out.
Question is, does either entity (DDS/RC) know how/if it is watering soil or concrete(serving people vs. serving itself as an organization)?
Self determination as California delievered is one hand least parents and service providers who understand if a clap(or noise were needed) would turn to another person and find the action in the effort of joining two separate hands or slap the solitary hand against a solid object to create sound/momentum action.
I guess the intent of this post is, STILL, children like my 10 year old son suffer from not being helped by Regional Center's active indifference and in the area of SD I could easily collaborate on a study of SD entitled
Self Determination-California Style: One Hand Clapping.
Still expect better but see systemwide complacency towards special needs children and their parents.....IMSO

Doug said...

Anonymous, I like the metaphor and may steal it. We'll have to see about Self-Determination. I'm hopeful enough of the water will fall on seeded soil. My biggest fear about it is this: Authentic self-determination has to shrink not only the vendor community but the role and importance of the Regional Centers. People working at Regional Centers seem certain that this won't happen. I think they're wrong, but if they're right, you're right. One. Hand. Clapping.

Anonymous said...

Self determination, California Style, as proposed in Sacramento, is generic when it should be as specific and necessary as a pair of shoes.
RCs and DDS, and SDs(school districts) for that matter would look at a child who needs a size 7 shoe and argue that a one size fits all or a size 3 or 12 should suffice because that is "all we can offer", but then suggest that parents can file due process if they disagree.
In true self determination the size 7 shoe for the child with a size 7 foot would be provided post haste....and later when the child needed an 8, or perhaps a size 8.5, there would be timely and appropriate response to need.
Because those who know the needs, know the needs. And are trusted.

Currently, if the state were in charge of providing footwear to developmentally disabled, we would find a lot of barefoot clients(probably further diagnosed as showing signs of maladaptive behavior in their practice of shoelessness) or those improperly served would then be in need of foot orthotics when none should have been necessary.
Regional Centers and School Districts under self determination have to realize that their jobs rely on the clients/students being served through allocations generated by those same childrens' needs.....The budget IS NOT the RCs' or the SDs' it is an allocation meant to provide community benefit to a specific target population within an underserved geographic or demographic population.
I believe the biggest fear of those who work for their budgets, rather than those they are supposed to serve, is the fear of loss of jobs.
Jobs, like job titles and duties, would just shift within and outside the organizations with true Developmental Disability Reform....however both the group homes for kids as well as a State Developmental Center 12 miles away from our home exist in attempts to make accessing the system so difficult that parents would consider giving up their children when no community based supports are evident.
The system is in need of reform and in turn is in denial of its true role.
How about someone funding a statewide initiative for Self Determination while we wait forever for true corrections and reform?
$3,000,000,000 is a lot of money to not use cost effectively for those it was intended to serve.

Long live true Self Determinatiom.