Introduction to process mapping

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Introduction to process mapping

• Insert name of presenter

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Session objectives

• an introduction to an invaluable tool for service
  redesign
• when, where, how and why to use process mapping
• tools and tips for organising their own events
  and helping at others

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Every system is perfectly designed to get the
results it achieves

• Paul Batalden
• Dartmouth Medical School, New Hampshire, USA

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(No Transcript)
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Where do we get the bright ideas from?

• Encourage clinical and administrative teams to
  share their ideas and concerns
• Sharing ideas with other project or redesign
  teams etc
• Patient Discovery Interviews
• Process mapping sessions

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Process Mapping

• Powerful tool
• helps to identify
• areas of duplication
• repeated handoffs
• steps which do not add value for the patient
• steps missing from the process
• Gets people talking AND listening

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An elephant is like a brush
An elephant is like a rope
An elephant is like a snake
An elephant is soft and mushy
An elephant is like a tree trunk
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Patient processes cross many boundaries

• 30 - 70 of work
• doesnt add value for patient
• up to 50 of process steps involve a handoff,
  leading to error, duplication or delay
• no one is accountable for the patients end to
  end experience
• job roles tend to be narrow and fragmented

Organisational/Departmental boundaries
E
B
C
D
A
Acute M. I.
Diagnostic process
Treatment process
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Mapping the Process
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What did you discover?

• Different start and end points to the process
• Different degrees of detail

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Levels of process mapping
High level
Refer OPD Diagnose
Medium level
Detailed
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Processes can be mapped into more and more detail
woken by alarm
prepare for work
set alarm
break fast
leave house
wash
dress
travel
arrive
put on
think
prepare
select

• iron
• clean shoes

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Group Exercise

• Think of a simple process you all know well -
  making a cup of tea
• Spend 10 minutes in your groups writing down the
  individual steps

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Patient process and parallel processes
Parallel process administration process
Patient process
GP tells patient needs appt at hospital
Patient waits
Ambulance takes patient to hospital
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Hints

• High level process map - 10 -15 steps
• generate in set time e.g. 20 minutes
• use to establish scope and identify problems
• no rework loops and minimum complexity
• 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 effect show of
  redesign

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Compiling a patient process map
Name of person completing task verb

• who does what to the patient
• quick and dirty
• what do you do in 80 of cases
• test it with other people

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Planning your event

• Whats the purpose?
• Whose agenda? Who leads?
• Who should be there?
• Venue (facilities)
• Audience (knowledge)
• How long does it take?
• Follow up sessions
• Analysis and Action planning

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The Event...

• PLAN!
• Find helpers
• Clarify roles - Who will facilitate?
• Identify issues and ideas
• Set time aside to action plan
• Discuss potential changes
• PLAN!

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To change an organisation, the more people you
can involve, and the faster you can help them
understand how the system works and how to take
responsibility for making it work better, the
faster will be the change
Martin Weisboard Training and Development
Journal
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Brainstorming
Who are the key individuals you would invite to
your process mapping event?
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How to get people there

• Walking patient journey - inviting people on your
  way!
• Discuss with people before you send out letters -
  so they understand some of the process first
• Invitation letters - with reply slips (and
  envelopes)
• Duplicate Faxes / emails as appropriate
• Follow up phone calls as necessary
• Consider posters

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Suggested invitation...
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Suggested response
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Suggested agenda
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Booking the venue

• Check it out yourself in advance before booking-
  never rely on a phone conversation!
• Check out how you can attach the process map to
  wall.
• Sweets and water on tables
• Facilities
• Three flipcharts
• Projector screen
• LCD Projector
• OHP

• Preferably away from the work place - with
  parking!
• You need somewhere with SPACE
• wall space for the map
• space for tables and chairs
• space for moving around
• Consider offering food and drink

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Tools of the trade

• Mapping paper
• Marker pens
• Good quality post-its
• Flip charts (Idea and Issue parks)
• Sellotape
• Blue Tack
• Ground rules
• Patience
• Enthusiasm

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The group

• You have a mixed group of staff what could
  happen?

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Process Mapping Facilitation

• What are we doing?
• Challenge - keep asking why?
• BUT NEVER challenge the person only their view
• Reflect their comments back to them to check you
  understand what they mean
• Clarify scope at the beginning
• Keep focussed on what happens now not on what
  they would like
• Agree ground rules

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Process Mapping - in action
No, you say something
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Suggested ground rules.

• If you share something that you want to be
  confidential then please say so - and everyone
  else will respect it.
• Everyone has a valuable contribution to make
• We are not here to blame people
• Collective responsibility
• Thinking creatively
• It is important to listen to what other people
  say and feel.
• If an issues is being discussed for more than
  five minutes - it will be put on the issues
  chart.

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.and givens

• Recognise that we cant make staff work any
  harder
• We want to improve the patients lot
• We dont have to change a lot to have an impact
• We need to think how we can, not why we cant

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Process Mapping - in action
This stuff is great!
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Summary

• There is no right or wrong way to process map -
  adapt to your organisation and individuals
  availability
• Only record those steps which you carry out MOST
  of the time (80/20 rule)
• Keep the steps SMALL
• Make it fun but productive

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Now you have your map.?

• Looking at your tea process maps
• Identify the bottlenecks and potential efficiency
  improvements in your process
• Take 10 minutes to develop an action plan and
  feedback at least one PDSA you would test
• What impact would this have on the overall number
  of process steps?

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Change principles
A co-ordinate the patient journey
B Improve patient/carer experience
E match capacity and demand
D enable people to see themselves as part of
the same system
C optimise care delivery
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Analysing a process map

• Are we doing the right thing? (Clinical
  effectiveness)
• Are we doing them in the right order?
• Is the right/best person doing it?
• How co-ordinated is the patients journey?
• What information do we give to patients at what
  stage? Is the information useful?

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Delays amount to 58 hours 48 minutes in
Histopathology
Specimen arrives in department
Number allocated to specimen
Specimen entered onto laboratory database
Specimen cut up
Blocks checked
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491
105
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Fixation occurs while the steps take place and
varies between 10 min and 24 hours depending upon
the specimen type size and subsequent techniques
needed
Sections mounted under coverslips
Sections stained
Blocks cut sections placed on glass slides
Blocks embedded and checked
Blocks impregnated
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3
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Slides micro- scopically quality controlled
Slides labeled
Cases booked out on database
Cases placed in pathologist trays
Slides are viewed and a report dictated
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11
2
282
393
Reports taken to pathology post room
Reports are placed in envelopes
Reports are signed
Reports are printed
Reports are typed
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974
528
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Analysing a process map

• How many steps in your process?
• How many hand-offs?
• What is the approx. time of or between each step?
  
• Where are possible delays and why?
• How many steps do not add value for patient?
• Where are the problems for patients and staff?

Mark the steps in appropriate colour
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(No Transcript)
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Ideas being tested and changes implemented
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Visio - Example
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Word - Example
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Excel - Example
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Now action plan your process!

• Based around the concepts of re-design
• Identify priorities within your team
• reducing steps/ hand-offs
• expert tasks
• identifying bottlenecks
• non-value added activity
• If its obvious, just do it!
• Start planning to test new ideas

What Who When Review Date
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Change Ideas and Action Planning
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Plan Do Study Act cycles

• Process map helps to show parts of patient
  journey needing refinement
• Small changes tested on small groups of patients
• Some of the change ideas are obvious - just do
  them!

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It doesnt stop here...

• Share the map with the team
• Tool for further use
• Identify complex processes for low level mapping
• Use for comparison if mapping at a later date
• Identify improvements in access
• Follow up with individuals/ teams missing

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The follow-up event

• A suggested event
• Handling the motivation and expectations
• Plans for communicating the changes and
  improvements
• Action planning
• Measuring the improvements, PDSAs