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,

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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