Table 4. Opportunities identified for future state improvements .

Waste type	Overall opportunity
	Traditional VSM	Modified VSM
Transportation	Moving product between processes does not add value to the product. Excessive movements and handlings can cause damages and can lead to reduction in quality.	Individuals on wait list for ICCS are moving to other care providers and treatment which could lead to poor quality of care as they may not be appropriate or redundant.
Opportunity
Excess inventory	Excess inventory uses valuable floor space and hides problems related to process incapability. Patients are not being discharged due to various reasons such as not receiving proper support at discharge, long wait times to re-enter ICCS. They hold up space by using time of clinicians and less spots for new patients.
Excess motion	Any motion that employee has to perform which does not add value to the product and is considered unnecessary or excess motion. Offering treatment to patients when they are not engaged in care such as dietary or psychological interventions.
Waiting	Whenever goods are not being processed, they are waiting. Wait list patients, patients waiting to receive dietary and psychology interventions. They are being held by processes such as intake appointment with physician, offering psychology or dietary interventions to patients who are not ready to receive care.
Over production	Producing more than the customer demand requires. Holding patients with processes more than required by the patients.
Over processing	Taking unneeded steps to process the parts. Offering care to patients who are not ready or may not require recommended care, holding patients at discharge by offering care not relevant versus taking steps to improve readiness and confidence for discharge.

VSM= Value Stream Mapping; ICCS= Integrated Chronic Care Service.