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Improving Office Practice:
Process Flows
Mark Murray, MD, MPA
Mark Murray and Associates
Objectives
Identify key office processes. Flow map a key process at your site.Begin to think about how you might redesign that key process.Review the High Leverage Changes for improved office flow and efficiency.
© Murray
Why ?
Office Efficiency is the next level of delay Streamline the work processesDecrease workloadSmooth flowsDecrease the likelihood of errorCreate a rational environment for patients, staff and providersSave money
The Link Between Access and Efficiency
Efficiency requires reducing delays across the office as well as streamlining work processesThis increases throughputMore efficient processes and throughput increase capacity
Components of Work Flow
SystemProcessTask
Components of Work Flow
System – Group of processes working
together to achieve aim Tools: System process flow map
Components of Work Flow
Process – Group of tasks or activities
working in an orderly fashion to achieve an aim
Tools: Workflow or process flow analysis
Components of Work Flow
Tasks – A specific job or piece of work Tools: Activity analysis
Office Efficiency Tools
Flow map and analyze a processSynchronicityTask Analysis: What is work? Who does it?
The Metrics
Lead Time = start to end The sum of the cycle times + delays For the whole process
The visit The referral Medical record retrieval
Each segment of the process = cycle time
Appointment booking, reminder, registration, greeting, waiting room, rooming, vital signs, value added vs non-value added time,
© Murray
Lead Time MeasurementCheck in MA to Room Check outMD LeavesMD Enters
Process•Greet
•Check in/registration
•Get chart
•Prepare information
•Vital signs
•Interview
•Prepare information
•Greet interview
•Exam
•Closure
•Prepare information
•Closure
Over-arching•Information transfer
•Communication, pre, during, post visit
•Synchronize patient, provider, information, equipment
•Standardize rooms - means to an end….universal room usage
•Choreography - co-location, multi-processing staff
•Batch vs. continuous flow processing
Measurement- cycle time/leadtime
Audit - sampling
Lead Time Measurement
Check in
MA to Room
MD Enters
MD Leaves
Check out
Identifying Flow problems…
• Walk through• Patient complaints• Provider and staff complaints• Processes with high variation• Brainstorm examples…….
• What makes you frustrated?• What makes your patients frustrated?• Where are the piles?• Where’s the re-work?
©Murray
Redesigning a critical process….
Identify the bottleneckIdentify the associated processUnderstand current process, in detailDesign the ideal process…Flow MapTest changes to processMeasure process cycle times throughoutMeasure lead time – avoid sub-optimizingBatching vs. continuous process flow
©Murray
What’s a Work Process?
“A work process is made up of steps, tasks or activities and has a beginning and an end.”
Key concepts… Input…the materials, equipment,
information, people, money or environmental conditions needed to carry out the process.
Output…the product or service that is created by the process; that which is handed off to the customer.
Understanding the current process
Flow mapping Record each step in sequence Put the steps in order Record who is responsible for
each step Add forgotten steps Agree to all of the above
©Murray
Flow Mapping Example…Brushing your teeth
OpenOpen toothpastetoothpaste
Wet Wet toothbrushtoothbrush
Apply Apply pastepaste
to brushto brush
Brush Brush teethteeth
Turn Turn off off lightlight
Put awayPut awaypaste paste and and
brushbrush
Rinse Rinse mouthmouth
Rinse Rinse brushbrush
Flow Mapping ExamplePre-appointment registration process9 a.m. appointment
Client enters Reception line
8:45
Client Greeted
8:50
Client Registered
8:53
Demo’s andFinancialsconfirmed
8:55
Providergreets clientand escorts
to office.9:09
AnnounceClient to Provider
9:08
Client fills outforms,
Clerk finds MRClient returns
forms9:00
Forms andInstructions
given8:58
5 min. 3 min. 2 min.
3 min.
2 min.8 min.1 min.
When did client arrive?What was appointment time?When did appointment start?Why?What could be done differently?
Team Exercise
Pick a work process Flow map the current process in detailRecord your current processWhere are the bottle-necks?Where are the opportunities?What improvements could be tested?Prepare to share what you learned
©Murray
Medical Office Efficiency High Leverage Changes
Balance Capacity and DemandSynchronize Patient, Provider, and InformationPredict and Anticipate Patients NeedsOptimize Rooms and EquipmentManage Constraints
References…
Managing the Unexpected, Karl E. Weick and Kathleen M. Sutcliffe,
University of Michigan Business School, 2001
Mapping Work Processes, Dianne Galloway, ASQC Quality Press, Milwaukee, Wisconsin
Mastering Patient Flow, Elizabeth Woodcock, MGMA Englewood, Colorado, 2000