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Session Objectives
• To understand how mapping processes can help identify improvement opportunities
• To learn how process mapping can be used by anyone on processes small & large
• To identify and prioritise processes within your department where greater scrutiny is required
• Hands on process mapping
Process has inputs and outputs
Input OutputProcess
Definition - a process is a series of connected steps or actions to achieve an outcome
We design in the system capability
“80% of the problem is in
the system not the people”
William Edward Deming
A
Diagnostic process
B
Looking at Patient Processes
C D E
• 30 - 70% of work doesn’t add value for patient
• up to 50% of process steps involve a “hand-off”, leading to error, duplication or delay
• no one is accountable for the patient’s “end to end” experience
• job roles tend to be narrow and fragmented
Organisational /departmental boundaries
Emergency care process
Treatment process
There are different ways of looking at the same thing
Process mapping….
• Views the system from the patient perspective following their journey across organisational boundaries
• Helps staff understand how complex and confusing processes appear to the patient
• Organisation / service specific• Diagnostic and used as a basis for redesign,
actively involving frontline staff in the process. (Shows how things actually are)
Process Flow
Decision Point
Document / Report
Multiple documents / Reports
Resource Tracker04/05/2015 06/05/2015
05/05/2015
Process Mapping Key
Waste Is a Sensitive Issue
• Its critical to eliminate “waste”
• Its also critical to recognise that the non value adding activities may have been a core part of someone job for many years
• It’s the activities that are non value adding not the person
Waste Walking – Hints & TipsApproach to follow:• Watch the process (think about waste type)• Map the process• Identify and tag the waste activities in the process• What does the waste equate to (time and resource)• Prioritise which waste to eliminate first
Categories of Waste
Transport Moving “stuff”
Injuries Damage to people
Motion Unnecessary human movement
Inventory “Stuff” waiting to be done
Waiting People waiting for “stuff” to arrive
Over processing “Stuff” we have to do but doesn’t add value
Over production Producing too much “stuff”
Defects “Stuff” that’s not right and needs fixing
Staff Untapped potential
High level process map 6 – 12 steps
Generate in set time e.g. 20 minutesUse to identify scope and identify problemNo rework loops and minimum complexity
Jim goes
to see the GP
Secretary
posts letter
& referral form
Margaret
reads through the referrals
Places referral letter
into appropriate box
Jim receiv
es new
appointmen
t
Jim atten
ds appointment
Community Physiotherapy Scenario High level process map
_________________________ 12 weeks___________________________
High Level Map
Low Level or Detailed process map – Dozens of steps– To establish loops and complexity– Good to establish roles and relationships within
process– Use again in later phase to show effect of
redesign
Community Physiotherapy scenario – detailed process map
Jim phones for GP
appointment
Jim goes to see GP
Jim goes home
GP dictates letter to physio
Surgery secretary types up
dictated letter
Secretary prints out
physio referral form
Secretary completes
physio referral form
Secretary posts letter and referral
form
Mail picked up at end of
day
Letter and referral form
arrive at Centre B
Jill reads through the
referrals
Jill gives referrals to
Phyllis
Phyllis types Jim’s details
into computer
Enters details into an electronic diary
Enters details into a paper diary
Places referral letter into
appropriate box
Letter goes into post
Phyllis adds appointment time
to letter
Phyllis prints off appointment letter
Jim receives appointment letter
Jim calls up to change
appointment date
Phyllis sends out new appointment
Jim receives new appointment
Jim attends appointment
Keys to mapTotal process steps - 24
Orange high level steps -6 Yellow steps added value steps for patient- 2
1 working day See next arrow
1-2 working days 2 working days 1 working day
17 days 59 days
Jim attends GP on May 2nd
Jim attends physio on July 22nd
12 weeks for whole process
??
Keys to Map: Total process steps – 24
Orange= High level steps - 6 Yellow =Added value steps for patient – 2
When undertaking a process map activity
• SCOPE – where does the process start and end? • What demand is placed on it• Who should be involved in the mapping process?• Decide the level of detail• Map what actually happens
Step 1
Step 2
Step 3
Step 4
Define what process is to be mapped, be clear on this and mindful of any interdependencies
Create a Current state process map using “Post It’s”
Review process map and identify waste and opportunities so you can create an Ideal State and Future State
Create an Action Plan to achieve ideal and Future State
Process Mapping – 4 key steps
Key elements to
Process mapping
• Map what actually happens – most of time• Time Lines• Identify the types of waste?• What value/waste is in the process?• Include parallel processes• Display the maps so all can see
– Allow comments• Don’t redesign for redesign sake
‘Ground rules’ for the process Mapping Activity
• Everything is confidential• Everyone has a valuable contribution to make• Value the diversity of the group• ‘Park’ issues• Keep to time
Remember the following...
• Define where the process starts and ends• Consider who you would involve in the mapping
exercise?• Use post-its to record the activities including time• Assemble the post-its to create the journey
(remembering that some activities happen in parallel)
• Keep a note of issues and opportunities
Activity 1Define what process is to be mapped
In groups try some process mapping…
- Take 20 minutes to map the process for Medicine Reconciliation
Medicine Reconciliation Process- Get the notes (if yes) if no ? - Pt demographics documented- Allergy status documented- 2 or more sources to confirm meds
-Parents-Notes, electronic system
- Complete kardex
Analysing the process map• How many steps in your process?• How many duplications?• How many hand-offs?• What is the approximate time of or between each
step?• Where are possible delays?• Where are major bottlenecks?• How many steps do not add value for patients?• Where are the problems for patients and staff?
▲The process STOPS▲Inhibits FLOW▲Does not add value for the PATIENT▲As a Clinician do you see the wait?
Waiting
WaitingReferrals are posted on to the centreNo cover while Phyllis on ALMay 1st-May 4th- 3 days to process referral. 1st appt
received on May 6th – new appt sent out May 23rd.
DuplicationElectronic and paper systemsRebooking of patient appointment.
Examples
Bottlenecks All forms are returned to nearest centreEvery patient appt is 30 mins1 physio to triage referralsPhyllis multi-tasking / no cover for AL.
EXAMPLES
BATCHING
GP dictating at end of dayMail picked up dailyPhyllis had 10 appts to makePhysio reading all referral letters at once
EXAMPLES
Value adding• The activity transforms the patient and moves them towards
the next defined outcome• The activity is something that the patient cares about
Non-value adding• Do not serve any purpose (aim to remove these)
Necessary non-value adding• Do not directly benefit patient but are necessary e.g. completion of forms, logging patient details onto systems,
numerous checks of details
Value / non-value adding steps
Jim goes
to see the GP
Secretary
posts letter
& referral form
Margaret
reads through the referrals
Places referral letter
into appropriate box
Jim receiv
es new
appointmen
t
Jim atten
ds appointment
Community Physiotherapy Scenario High level process map
Jim attends GP on May 2nd
Jim attends physio on July 22
12 weeks for the whole process
Keys to Map: Orange= High level steps
Yellow =Added value steps for patient
Total process time: 83 days, 119520 mins Value added time for patient= 40 mins
Appt time with GP & Physio
_________________________ 12 weeks___________________________
Community Physiotherapy scenario – detailed process map
Jim phones for GP
appointment
Jim goes to see GP
Jim goes home
GP dictates letter to physio
Surgery secretary types up
dictated letter
Secretary prints out
physio referral form
Secretary completes
physio referral form
Secretary posts letter and referral
form
Mail picked up at end of
day
Letter and referral form
arrive at Centre B
Jill reads through the
referrals
Jill gives referrals to
Phyllis
Phyllis types Jim’s details
into computer
Enters details into an electronic diary
Enters details into a paper diary
Places referral letter into
appropriate box
Letter goes into post
Phyllis adds appointment time
to letter
Phyllis prints off appointment letter
Jim receives appointment letter
Jim calls up to change
appointment date
Phyllis sends out new appointment
Jim receives new appointment
Jim attends appointment
Keys to mapTotal process steps - 24
Orange high level steps -6 Yellow steps added value steps for patient- 2
1 working day See next arrow
1-2 working days 2 working days 1 working day
17 days 59 days
Jim attends GP on May 2nd
Jim attends physio on July 22nd
12 weeks for whole process
??
Keys to Map: Total process steps – 24
Orange= High level steps - 6 Yellow =Added value steps for patient – 2
...............occurs when a step is the limiting rate of the process
The step takes a significant time, and slows the whole process down.
e.g. accuracy of information
given (5mls calpol)
Process Bottlenecks.....
Look for Batching
Dr sees patients individually
Requests sent in batches
Results return in batches
Does this apply to Med
management(Discharge
prescriptions)
Identify examples of:1- batching2- bottlenecks3- waiting4- duplication
Activity 2:
How much time 10 mins?
Jim goes
to see the GP
Secretary
posts letter
& referral form
Margaret
reads through the referrals
Places referral letter
into appropriate box
Jim receiv
es new
appointmen
t
Jim atten
ds appointment
Community Physiotherapy Scenario High level process map
Jim attends GP on May 2nd
Jim attends physio on July 22
12 weeks for the whole process
Keys to Map: Orange= High level steps
Yellow =Added value steps for patient
Total process time: 83 days, 119520 mins Value added time for patient= 40 mins
Appt time with GP & Physio
_________________________ 12 weeks___________________________
Physio self
referral
Analysis Summary
StepsTotal number of stepsNumber of value stepsValue steps as % of total steps
e.g. 2/24 = 8%
TimeTotal time Hrs:MinsTime of value stepsValue Time as % of total timee.g. 40/119520=0.03%
Waste• Transport• Injuries• Motion• Inventory• Waiting• Over processing• Over production• Defects• Staff
Focus on the future process
• Think creatively/generate ideas
• Focus on ideas and opportunities
• Are the right people involved? – whole system approach where needed
Defining patient groups
Runners
Specials
Strangers
Group of patients
No.
in e
ach
cate
gory
with
in t
he g
roup
Runners SpecialsShare common characteristics CustomisedHigh volume Lower volumeFast throughput PredictableHighly predictable Share some steps but requireStandard –patient routes extra stepsUp to 90% pre-scheduled Can be pre-scheduled
StrangersLow volume, unique requirementsUnpredictable demand patternRoute unpredictable and complexThroughput time tends to be longer
Tools for defining patient groups
• Current processes often operate in isolation from each other, particularly departments and directorates
• Each area needs to be linked to the one before, to ensure that they always have capacity to deal with what they are receiving
Linked processes
• How you will go about doing this?• Who will you ask to attend? • When will you hold it? • Where will you hold it? • What obstacles might you face? How will you address them?
• What will your role be during the session?• What will the outcome of the session be if it is successful?
• Process mapping is a method of creating a “one page picture” of all the process steps that occur
• The goal in completing an effective process map is to create an “end to end” review of the process that depicts the “flow” of materials and information (reports, invoices etc) that drive the activity
• By completing this we can identify the flow of the customer value adding activity, see wastes in the process and identify opportunities to improve it
• A good process map helps the team understand the reality of what is happening
• In the process by using a “go see approach” builds consensus on the current state. They can also help to share a vision of where we want to get to
• Once a Current State process map has been developed, a Future State can be created as an implementation roadmap towards achieving excellence
Introduction to Process Mapping
A handoff occurs in a process when responsibility for the next activity passes from one person to another.