In aged care, value is created through more than a completed form, a medication round or a documented handoff. Value is created when a resident experiences safe, timely, coordinated and respectful care.
Yet the resident journey often crosses many functions: admissions, nursing, care workers, pharmacy, allied health, administration, family members and external healthcare providers. Each handoff creates an opportunity for delay, duplication or missing information.
Value Stream Mapping (VSM) makes this complete journey visible. It shows how residents, information, decisions and care activities move from admission to ongoing care: and where waiting, rework and variation interrupt flow.
Healthcare improvement guidance describes VSM as a method for mapping both the current state and the future state, with particular attention to activities that add value for the patient or service user.[^1] A healthcare scoping review also identified VSM as a practical starting point for improving flow, reducing waiting and clarifying improvement opportunities.[^2]
This guide explains how to apply VSM in an aged-care setting using a worked example with realistic, illustrative data.
What Value Stream Mapping Means in Aged Care
A value stream includes every step required to deliver a service from beginning to end. In aged care, the stream may include:
- Referral and pre-admission assessment
- Eligibility, consent and funding documentation
- Room preparation and arrival
- Medication reconciliation
- Initial assessment and care planning
- Shift-to-shift handoffs
- Daily care and medication rounds
- Falls or incident response
- Review and adjustment of the resident’s care plan
The fundamental purpose is not to make care feel industrial or impersonal. It is to remove avoidable process friction so caregivers can spend more time delivering meaningful resident care.
Start by defining value through the Voice of the Customer. For residents and families, value may include:
- A smooth and welcoming admission
- Accurate medication information
- Clear communication
- Minimal repetition
- Reliable follow-through
- Prompt response to incidents
- Dignity, choice and continuity of care
1. Select a Manageable Scope
Aged-care operations contain many interconnected streams. Attempting to map the entire facility in one workshop usually produces a diagram that is too broad to guide action.
Select one resident journey and establish precise start and end points.
| Potential stream | Start point | End point |
|---|---|---|
| Admission | Referral accepted | Initial care plan communicated and active |
| Medication round | Medication list verified | Administration documented |
| Shift handoff | Outgoing shift begins handoff | Receiving team confirms priorities |
| Falls response | Fall occurs or is discovered | Care plan updated and actions assigned |
For this example, the selected scope is:
From admission arrival to completion of the resident’s first 72-hour care plan.
The mapping team should include a registered nurse, care workers from multiple shifts, an admissions coordinator, medication or pharmacy support, an allied-health representative, a quality lead and, where possible, a resident or family perspective.
The Lean Six Sigma Practitioner Guide can support the project charter, process data collection and DMAIC governance.
2. Build the Current-State Map
The current-state map records what actually happens: not what the procedure says should happen. Walk the process at the gemba, meaning the place where the work occurs.
Capture:
- Process steps
- Waiting time between steps
- Cycle time for active work
- Handoffs and information sources
- Rework and incomplete documentation
- Number of staff involved
- Defects, incidents and exceptions
- Resident and family experience
Use consistent definitions. For example:
- Cycle time: active time spent completing a task
- Lead time: elapsed time from start to finish, including waiting
- Value-added time: time that directly contributes to safe, meaningful resident care
- First-pass completeness: percentage of records completed accurately without rework
Worked Current-State Example
A 48-bed residential aged-care facility reviewed 20 recent admissions. The team found the following typical journey:
- Resident arrives at 10:00 am.
- Administration verifies identity and admission documents.
- A nurse completes the initial assessment.
- Medication information is reconciled with hospital or primary-care records.
- The care plan is drafted.
- The resident is introduced to the care team.
- The evening shift receives a handoff.
- The 72-hour review is completed.
The baseline data was:
| Process measure | Current-state result |
|---|---|
| Admission lead time: arrival to active initial care plan | 31.5 hours |
| Direct admission processing time | 142 minutes |
| Resident waiting or inactive time | 1,748 minutes |
| Care documentation time | 96 minutes |
| Caregiver value-add time during first 24 hours | 68 minutes |
| Admission records complete on first pass | 62% |
| Medication discrepancies identified after arrival | 6 of 20 admissions |
| Average morning medication round | 94 minutes |
| Average shift handoff per resident | 11 minutes |
| Handoffs missing at least one critical item | 28% |
| Falls or near-falls during the first 72 hours | 4 events across 20 admissions |
The figures are illustrative, but they demonstrate an important principle: the active work is much shorter than the overall resident journey.
The facility’s process cycle efficiency was calculated as:
Value-added time ÷ total lead time × 100
Using 68 minutes of caregiver value-add time and 1,816 total minutes from arrival to the first 24-hour care milestone:
68 ÷ 1,816 × 100 = 3.7%
This does not mean the remaining time is clinically unnecessary. Some observation, rest and waiting may be necessary. It does show that the team should examine where information, decisions and resources are delayed. The Process Cycle Efficiency Calculator provides a practical way to structure this analysis.
3. Identify the Eight Wastes in the Resident Journey
The eight Lean wastes, often remembered through DOWNTIME, can be translated directly into aged-care operations.
- Defects: Incorrect medication lists, incomplete assessments or missing incident details.
- Overproduction: Completing duplicate reports or preparing information before it is needed.
- Waiting: Residents waiting for assessments, medications, rooms, approvals or responses.
- Non-utilised talent: Frontline caregivers spending time searching for information instead of applying their expertise.
- Transportation: Moving paper records, medication charts or equipment unnecessarily.
- Inventory: Excess work in process, such as unreviewed referrals, unsigned charts or unresolved incident actions.
- Motion: Repeated walking to locate equipment, records, supplies or available staff.
- Extra-processing: Re-entering the same information in multiple systems or repeating questions to residents and families.
Findings From the Example
The current-state review identified four major leverage points:
- Admission documentation was entered into three separate records, creating an average of 24 minutes of duplicate work per resident.
- Medication reconciliation waited for an external confirmation, contributing an average of 7.5 hours of delay.
- Shift handoffs were inconsistent, with high-risk information often buried in free-text notes.
- Falls and near-falls were reviewed after the immediate response, but learning actions were not always connected to the next shift’s care plan.
A bottleneck is a constrained step that limits overall flow. In this case, medication reconciliation was the primary information bottleneck, while the 72-hour care-plan review was a governance bottleneck because it depended on several prior records being complete.
4. Design the Future-State Map
The future-state map should show how the resident journey will operate after improvement. It should not simply remove steps; it must preserve safety, dignity, clinical judgement and regulatory requirements.
The design team proposed the following changes:
- Send a standard pre-admission information pack 24 hours before arrival.
- Use one admission checklist with clear ownership for each field.
- Introduce a medication-reconciliation trigger at the point of referral acceptance.
- Use a structured handoff template containing allergies, falls risk, medication changes, mobility needs and immediate preferences.
- Create a visual daily readiness board for incomplete care-plan items.
- Introduce a standard post-fall response and review sequence.
- Use a small Andon-style visual signal: for example, a teal alert on the team board: to show when a critical item requires immediate escalation.
- Establish a daily 10-minute flow huddle rather than relying on informal updates.
The future state should also consider demand and capacity. If 10 new residents may arrive across a five-day period and the admissions team has 1,200 available minutes per week:
Takt time = available working time ÷ customer demand
1,200 ÷ 10 = 120 minutes per admission
This provides a useful planning reference. It does not replace clinical judgement, but it helps reveal when the process design cannot reliably meet expected demand.
5. Current-State Versus Future-State Measures
The following targets show how the redesigned stream could perform after piloting and stabilisation.
| Metric | Current state | Future-state target | Improvement |
|---|---|---|---|
| Admission lead time | 31.5 hours | 12 hours | 62% reduction |
| Care documentation time | 96 minutes | 58 minutes | 40% reduction |
| Resident waiting or inactive time | 1,748 minutes | 640 minutes | 63% reduction |
| Caregiver value-add time in first 24 hours | 68 minutes | 104 minutes | 53% increase |
| First-pass admission completeness | 62% | 95% | +33 percentage points |
| Medication discrepancies | 6 of 20 admissions | 1 of 20 admissions | 83% reduction |
| Morning medication round | 94 minutes | 72 minutes | 23% reduction |
| Average shift handoff | 11 minutes | 7 minutes | 36% reduction |
| Handoffs missing critical information | 28% | 5% | 82% reduction |
| Falls or near-falls in first 72 hours | 4 events | 2 or fewer events | 50% reduction target |
These are improvement targets, not guaranteed outcomes. Each target should be validated through a pilot, with resident safety and care quality monitored alongside efficiency measures.
6. Sequence Kaizen Actions
A future-state map becomes useful only when it is converted into owned, sequenced action. Avoid launching every improvement simultaneously. Sequence the work so that foundational changes support later improvements.
Recommended Kaizen Sequence
-
Stabilise information
- Define operational terms.
- Create one admission checklist.
- Assign process ownership.
- Confirm the data-collection method.
-
Improve admission flow
- Trigger pre-admission information collection earlier.
- Remove duplicate data entry.
- Create a standard room-readiness signal.
-
Strengthen medication reliability
- Standardise medication reconciliation.
- Establish an escalation route for missing information.
- Track discrepancies and late administrations.
-
Standardise handoffs
- Pilot a concise structured handoff.
- Include resident priorities and high-risk information.
- Audit completeness for two weeks.
-
Improve falls learning
- Use a standard immediate-response sequence.
- Complete a timely review of contributing factors.
- Communicate preventive actions at the next handoff.
-
Control and sustain
- Monitor admission lead time, documentation completeness, resident wait time and incidents.
- Review performance at 30, 60 and 90 days.
- Refresh the VSM when the process, technology or staffing model changes.
The Kaizen Events guide explains how to organise focused improvement events, involve frontline staff and convert findings into standard work.
Build Capability Through Lean Six Sigma Certification
Value Stream Mapping is most effective when the team can connect visual process analysis with structured problem-solving. A Yellow Belt can support mapping, data collection and small improvements. A Green Belt can lead a cross-functional DMAIC project using deeper analysis, prioritisation and control methods. A Black Belt can lead complex, multi-department improvement work and mentor other practitioners.
Lean 6 Sigma Hub provides CSSC-accredited, self-paced online training from White Belt to Master Black Belt, supported by practical examples, templates, simulations and end-to-end DMAIC case studies.
Start with Lean Six Sigma certification training and build the capability to improve resident journeys with greater clarity, safety and measurable control.
[^1]: NHS England/AQUA Value Stream Mapping resource
[^2]: The Role of Value Stream Mapping in Healthcare Services: A Scoping Review
Kaizen. Kai-Care. Kai-Done. ( Lean Six Sigma)
