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Definition of a Process Map
A process map is a visual display of a process using symbols and formats.
Benefits of Process Mapping• Provides a visual representation of the process
• Requires verification and objectivity
– Hands-on exposure to local activities
• Identifies rework loops and redundancies
• Gives insight into bottlenecks, cycle times, and inventory
• Identifies non-value added steps
• Helps identify when and where to collect data
• Identifies where different work teams use different processes
• Serves as a training and orientation tool
Components of A High Level Process Map (SIPOC)
• Supplier: Whomever provides the inputs to the process
• Input: Materials, resources, and data required to execute the process
• Process: The activities and resources applied to the inputs to convert them to outputs
• Output: The tangible products or services that result from the process
• Customer: Whomever receives the outputs of the process – internally or externally
SIPOC Process Mapping
PPSS CCSuppliers Inputs Process Outputs Customers
CTQs CTQs
•_____•_____•_____•_____
•_____•_____•_____•_____
Input OutputCookingPasta
Raw PastaPanH2OCupStoveSpoonSaltOil
Cooked Pasta
Suppliers Customers
Restaurant OwnerGrocery Store
PatronsOwnerCook
Step 1 Example: “Pasta” High Level SIPOC Map
Pasta High Level Process Map
SIPOC - Relation to a Detailed Process Map
ProcessMap
Process
X
X
X
PPSS CC•_____•_____•_____•_____
•_____•_____•_____•_____
Inputs Outputs
– Process Step or Operation (White)
– Delay (Red)
– Quality Check, Inspection or Measurement(Yellow)
– Storage (Yellow)
– Decision (Blue)
– Transport or Movement of Material orTransmission of Information (Yellow)
Common Detailed Process Mapping Symbols
At Least Three Versions(Usually)
What It Is Thought to Be…
What It Should Be…What It Actually Is…
Versions of a Process
Process Mapping and the Hidden Factory
Hidden Factory
Step 2 Example: Identify All Process Steps
Pasta Process Map
Designate steps as value-added or non-value-added
Add cycle time, defect/yield data and ALL rework loops
Input
Raw PastaPanH2OStoveSpoonSaltOil
Output
CookedPasta
Cook Pasta
9 MINUTES
VA
Add water,salt & oil
VA
.5 MINUTE
AddPasta
VA
.25 MINUTE
Done?
Rework
No
Yes
.01 DPU
Boil Water
6 MINUTES
VA
Step 3 Example: Determine Outputs For Each Step
Pasta Process Map
Input
Raw PastaPanH2OStoveSpoonSaltOil
Output
CookedPasta
Cook Pasta
VA
Add water,salt & oil
VA
AddPasta
VA
Done?
Rework
No
.01 DPU
Boil Water
VA
What are the outputs for the other steps?
Yes
Boiling WaterWater RemainingSteam
Properly Cooked
9 MINUTES.5 MINUTE .25 MINUTE6 MINUTES
Step 4a Example: List Inputs For Each Step
Pasta Process Map
Amt. of SaltAmt. of OilLid or NotAltitudeAmbient TempTimeMinerals in H2OPan MaterialPan SizePan ConditionBoiling InstructionsBTUs
TimeLid or NotType of PastaAmount of PastaAltitudeAmbient TempCooking instructions
Input
Raw PastaPanH2OStoveSpoonSaltOil
Output
CookedPasta
Cook Pasta
VA
Add water,salt & oil
VA
AddPasta
VA
Done?
Rework
No
.01 DPU
Boil Water
VA
Yes
Boiling WaterWater RemainingSteam
Properly Cooked
9 MINUTES.5 MINUTE .25 MINUTE6 MINUTES
Process Map Exercise
Using one or two process tasks from your SIPOC, work with others at your table to create an “As-Is” detailed process map.
Step 1 :Identify the cross functions in the process
Step 2 :Identify the sub processes and list it down
Step 3 :All the relevant details of the process are mapped
Step 4 :Join all the successive steps of the process
Step 5 : Get the approval from all the stake holders
SPAGHETTI DIAGRAM
SPAGHETTI DIAGRAMBefore
DIE
T CL
INIC
ECH
O/
TMT
PFT
SPAGHETTI DIAGRAMCurrent process
Tracking Movements – Spaghetti Diagram
Medication
Call Bell &Bedpan
EducatingDischargeProcess
Rounds With
Doctor
Booking Investigation
1.1. Events recorded after 30 Events recorded after 30 minutes walk around with the minutes walk around with the Nurse at 5Nurse at 5thth Floor Floor
2.2. Ward Nurses travel 4 km per Ward Nurses travel 4 km per shift. shift.
Patient and information flow analysis (PIFA)
Patient and information flow analysis (PIFA)
What is the purpose ?What is the purpose ?
▪ Create a holistic view of the entire (end-to-end) current system on one piece of paper
▪ Provides framework for solution development and future operations
Key StepsKey Steps1. Select an existing flow e.g., patient movement from emergency room to
wards2. Discus in team to identify:
– Start and finish point, frequency of activity– Key steps in the flow– Time required at each steps– Participants, existing tools and materials, etc.
3. For each step in the flow, identify the information which made it possible to move to the next step, and complementary information (in particular, staff information)
4. Identify the source of information and trace its path5. Identify key issues in the flow
End ProductEnd Product▪ A visual map of how patients and information flow from end-to-end of the
chain and where is the flow interrupted by inefficiencies
Porter arrive
Notes photocopied
Patient arrives in Majors
Board Nurse• 'Hello” • Notes
Take files, put card on board
Allocation• Chair • Cubicle
Patient called TIS
Ambulance• Tests*• Specialist• Treatment
A&E Doctor
Reception
SpecialistDecision discharge/ admit
Home
Request bed Get bed allocation
Bed ready
• Tests*• Specialist• Treatment
18–26 min
8-12 min
43%
57%20–40 min
72%
28%
~45 min~75 min
• Tests*• Specialist• Treatment
60-80 min50-80 min
▪ Minors▪ Resus ▪ Walk In Centre▪ GP
▪ Minors▪ Resus▪ Walk In Centre
(from specialist called to arrival)
25–35 min
Patient information flow analysis with key issues
Majors▪ X-ray ~40%▪ Bloods ~60%▪ Referral ~25%
1 9 10
15 14
Complexity of board and notes management currently requires senior nurse, pulling scarce capacity out of the team
Waiting for Technician or doctor (e.g., to take blood)
Waiting for test results (don’t know when ready)
Delays when allocated beds are actually occupied
Delays from requesting bed to identification of
‘available’ bed Waiting for Specialist –
Time from TIS tospecialist arrival
120–200 min
12
Delay due to other teams / external issue
6 11
4
13
17
3
18
Very busy spot with ~130 interactions per hour and people queuing for information▪ 60% doctors & nurses▪ 15% patients▪ 10% phone▪ 15% other (tech,
ambulance, student, porter)
Variability in how staff ‘TIS’ and how tests are launched
Waiting for A&E doctor
Language barrier, waiting for health
advocate (10-10 service only)
Multiple checking by doctors and slow writing
of notes
Potential further cycle of tests –~5% of cases
No admin and photocopier
support at night
Waiting for senior staff to TIS patients
Delays in porter arriving to transport patient to
bed or in finding and copying notes
Slow PCs
Nurse often needed to accompany
patient to ward and handle transfer
to bed
Awaiting test resultsBloods: 70–110 min (chem), 60–80 min
(haem lab), 5–20 min (haem near-patient) from bleeding to results authorised
Changing equipment
(ECG, wheelchair, keys, etc.)
7 85
Delay due to local team / internal issue2
16
Golden rules for observing a PIFA
Do Don’t
Take the time to follow the whole process Neglect to explain objectives to the staff member you followed (observations do not focus on individual performance!)
Let the staff members act naturally Interact with the employees during observation
Write down all activities of the sequence observed
Try to justify inefficiencies observed
Analyze activities observed in teams (after observation!)
Try to confirm an assumption
Be fact-based and critical… to better improve the process
Find a culprit!
CT/MRI scan process flowDoctor advices CT scan
Appointment scheduled
Patient arrives at reception
Type of scan
Verification and registration at reception
Handover datasheet and consent form to Doctor/tech
Explain process and take consent form
ScanningCorrelate image with clinical history
Verify details and check blood report,
if contrast
Ask for:- Blood values- Special preparation
Doctor/tech informed
Send to respective consultant
Patient informed despatch time
Post processing of image (pacs/print) and documentation
File, datasheet enclosed in a cover and sent for reporting
Jr. doctor writes report
Image and report review by consultant
Sent for typing
If not ok
If ok
If contrast
If plain
If okReport signed
Report enclosed in respective cover
Sent to despatch counter
Check report
If not ok
6 hrs
Critical phase
Verify bill at
reception
If ok
PIFA process for X-ray
Patient departure
Patient given des-patch time
Image print/pacs
Handover film to patient – ask to return for report
Wet film request
Write report on presc.
Report typing
Stop
Or to check film clarity and
quality
Check for clinical
history
Doctorto check
report
Sign the report
Send to despatch counter
Stop
Wait for patient
Send for rectification/ modification
Patient under goes X-ray
Confirm patient - Patient is asked to change
Send for reporting
Wet film received
Token no. displayed
Patient available
Patient arrives at X-ray counter
Doctor advises X-ray Patient pays bill in op billingPatient reaches X-ray reception
Patient is given a token and asked to wait for his turn
Repeat X-ray
If image not proper
Image check
Image ok
Yes
No
Yes
No
Accept-able Appropriate
No error
Error/ modify
Yes
No
Later arrival
Poor quality
Not Appropriate
Issue – Inappropriate clinical history
Issues – Typing errors & IT interface
Issues – Only 1
change roomIssue – Return of the wet film
Issue – PACS
Patient to wait
Ultrasound process flow
Report enclos-ed in respec-tive cover
Sent to despatch counter
Doctor advises scan
Patient pays the bill
Reaches ultrasound reception
Appointment scheduled and patients instructed
Patient arrives at reception
Sent for system entry (pacs/print)
Patient informed about despatch time
Films and report enclosed in cover
Send for typing Report signedCheck report
Verification, registration, and token no. given
Fill data sheet and paste sticker
Handover sheet to ultra-sound room
Procedure done
Report written by doctor
Check patient pre-
paration
If ok
If not ok
If ok
If not ok
Issues – Typing errors & IT interface
Issues – Waiting time
Issue – PACS
1 hour
Thank You!