236 Leveraging Lean in Ancillary Hospital Services
business unit, where the value stream manager would have an entirely cross-functional organization
reporting to him/her, but were responsible “soup to nuts” for the entire operations—from sales and
marketing to delivering the product. In hospitals, the value stream is more difcult to determine.
Some would argue that the operating room and ED are value streams, but they don’t encompass the
entire ow of the patient. So should they really be value streams? In our view, a value stream would
be a service line or combination of similar service lines that own the patient from their arrival until
the bill is paid.
As we transition to Lean, old traditional jobs change. We no longer need ve or six ...