Process Mapping

Heidi Johns, Quality Leader, BCPSQCJuly, 2013

Objectives

To better understand:

•Understand why mapping is useful in healthcare improvement

• Understand the steps to building a process map

•Feel confident leading a process mapping session

• Understand how to analyse and extract learning from a process map

“The problems in organizations often occur between changeovers, when one process step flows to another process step in a different department or to a different specialist…..processes are like a relay race, with the baton passing from one person to another within the organisation. The Olympic relay teams don’t practice running together, they only practice the baton changes.”

Bsi Effective Process Mapping @ the High Performance Organisations Ltd.

What is Mapping – review

Mapping Types

• Maps are pictorial representations of a process• Various forms of maps some are:

• Patient Journey Mapping• Value Stream – current state and future state• Swim lane• Relationship• Functional

Health Matters

http://www.youtube.com/embed/9ll01UNrbR4

Why is mapping chosen for Improvement work?

•Relationships•Illustrate gaps or confusion •Illuminate bottlenecks•Aha moments•Perspective•Common language – interdisciplinary•Clinical and patient perspective

Where to start?

•Know the scope and boundaries of the process.

•How would you break the 5 year cancer patient journey down?

•What are you wanting to improve?

Process

Best Practice

Money

Knowledge

People

Equipment

Buildings

Counselling Session

Admissions

Referral

A wait

X-ray

Prescription

Source: Intermountain Health

High Level Map Example

Building a Process Map

Building a Process Map

• Agreement on scope

• Multiple maps will connect

Development of Process Map

What is the process for the Community Home workers to receive their daily work assignments and client information?

Map symbols

Decision Point

Process Flow

Decision or Question

No

Answer to question and flow

Yes

Start and Finish of the Process

Mapping Techniques

•Time and flow movement left right

•Pareto principle

•Be consistent in the level of detail

•Active language

Source: NHS Institute for Innovation and Improvement: Improvement Leaders’ Guide, Process mapping, analysis and redesign

Activity

• At your table you have the steps of a process.• Using the map symbols map the process as outlined.

Map symbols

Decision Point

Process Flow

Decision or Question

No

Answer to question and flow

Yes

Start and Finish of the Process

High Level Process Map: Cardiac Cath LabPt arrives

and register form on

chart

Moved to wait area

Nurse brings to

exam

Cardiology assessment

Consent form and discussion consent added

to chart

Anaesthesia Exam

IV started RN

Pt changes

Oral pre med

given RN

Oral pre med

given RN

Needs Anaesthetic

Needs Anaesthetic

Nursing Assessment

IV started by RN

Pt changes

No

Yes

Source:isixsigma.com

AnaesthetistDelivers

drug

AnaesthetistDelivers

drug

AnaesthetistDelivers drugAnaesthetistDelivers drug

Porter moves patient

Porter moves patient

Pt called day before examPt called day before exam

Procedure room

Procedure room

Planning a Session

•Maps purpose is clear.

•Scope is clear.

•Who should be invited?

Planning a session cont’d

Where do you hold the session?

What is the time commitment?

Planning a session cont’d

Points to consider:

• Clarity of function

• Pre-work

• Facilitation

• Awareness of unit culture

Planning a session cont’d

Participant Information – before mapping

• Invitation

• Expectations

• Location

• Who owns the process - introductions

Supplies list

• Post-it notes• Painters tape/masking tape• Roll of brown butchers’ paper• Sign in sheet with all contact information fields (including position)• Felt pens, markers• Kleenex• Pipe cleaners • Beverages and/or food

How to run a session - 5 steps

•Agreement of scope

•Solicit input

•Work with group to agreement

•Create ‘parking lot’ for unanswered questions

•Preliminary analysis of map

Activity

In your group map one of the following health care activities.

1. Blood work to be completed at the hospital lab

2. X-Ray to be completed at diagnostic and imaging department at hospital

3. 2 month baby immunization and well baby check

4. Community Mental Health Rehab appointment

Activity debrief

•What worked well?•What was a challenge?•What were some of the questions?•Facilitation, any suggestions?•Where there any assumptions made?

Debrief in your group:

Activity Part 2

• Take 2 minutes and look at the other groups map.

• What was each groups experience?

Map Analysis

Analysis Techniques

• Post-it notes

• Colour markers

• Dots

• Group Process

• Individual with debrief

Analysis – Activity

• Choose new facilitator

• Using the Analysis questions - analyze the map

Map Analysis potential questions

• What are the number of steps to get through the process?

• Is there ability to remove or simplify the number of steps?

• What are the stops and starts?

• Patient handoffs?

• Who is doing what function in the process?

• How many people are doing the same function?

• Could you combine functions? Does that person need to be doing that step who else could do it is there a better fit?

At the end of the session

a) have opportunities for improvement in the maps through preliminary analysis by the group, or

b) use follow-up session to indicate the opportunities

Set a date for a review session with the group.

End of session tips

• Check- in

• Patient debrief separately

• Contact information

Post session

• Complete maps - share all the maps in draft form

• Gather consensus that the map clearly depicts the discussion of the day

Follow - up session

• Review the maps

• Look for opportunity

• Establish work teams for PDSA cycles

• Start date

The Human Factor

Do any of you have “Tips” to share with the group?

•How do you work with the ‘nay-sayer and yes- but’ person in the room?

•What is the best way to re-direct a conversation?

•How would you encourage participation from all disciplines?

•What do you do if a potential ethical or practice issue is surfaced?

• Questions?