Download - © 2009 Public Health Informatics Institute Multi-State Learning Collaborative September 17, 2009
© 2009 Public Health Informatics Institute
Multi-State Learning Collaborative
September 17, 2009
© 2009 Public Health Informatics Institute
Today’s Presenters
• Claudia W. Brogan, MS Ed– Associate Director, Training
• Deb Bara, M A– Associate Director, Programs
© 2009 Public Health Informatics Institute
The Institute & Improvement
• Part of our Mission
• Embedded in previous work
• Others are applying the methodology to quality improvement in public health
© 2009 Public Health Informatics Institute
Fundamental Questions for Improvement
• What are we trying to accomplish?
• How will we know that a change is an improvement?
• What changes can we make that will result in an improvement?
• Who will participate in the improvement process?
© 2009 Public Health Informatics Institute
Collaborative Requirements Development Methodology
© 2009 Public Health Informatics Institute
Collaborative Requirements Development Methodology
Business Process Analysis
thinkthinkHow do we do How do we do our work now?our work now?
•Define goals and objectives
•Model context of work
•Identify business rules
•Describe tasks and workflow
•Identify common task sets
© 2009 Public Health Informatics Institute
Collaborative Requirements Development Methodology
Business Process
Redesign
rethinkrethinkHow should we How should we
do our work?do our work?
•Examine tasks and workflow
•Identify inefficiencies
•Identify efficiencies with repeatable processes
•Refine business processes and business rules
•Remodel context of work
•Restructure tasks and workflow
© 2009 Public Health Informatics Institute
Collaborative Requirements Development Methodology
Requirements Definition
Requirements Definition
describedescribeHow can an information How can an information
system support our work?system support our work?
•Define specific tasks to be performed for optimized business processes
•Describe the implementation of business rules
•Describe in words and graphics how an information system must be structured
•Determine scope of next phase activities
© 2009 Public Health Informatics Institute
What is a Business Process?
© 2009 Public Health Informatics Institute
Sally’s Sandwich Shop
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Business Process Matrix
• A table that helps keep track of all the business processes you are mapping
• Includes, for each business process:– Goal– Objective– Business Rules– Trigger(s)– Task Set– Inputs– Outputs– (Measurable) Outcomes
© 2009 Public Health Informatics Institute
Business Process MatrixDefinitions
GoalGoal
The major goal in terms of benefits to population health that is supported by the business process.
ObjectiveObjective
A concrete statement describing what the business process seeks to achieve, pointing to quantifiable measures of performance.
Business Business RulesRules
A set of criteria that defines or constrains some aspect of the business process.
TriggerTrigger
Event, action, or state that initiates the first course of action in a business process.
Task SetTask Set
The set of required activities or steps that are carried out in a business process.
InputsInputs
Information received by the business process from sources outside of the process.
OutputsOutputs
Information transferred out of a business process.
OutcomeOutcomess
The result of performing a business process, which indicates the objective has or has not been met.
© 2009 Public Health Informatics Institute
Example: Order Fulfillment
Goals Objective Business Rules
Trigger Task Set Inputs Outputs Outcomes
Timely provision of food and service to the customer at the best value
Accurately process food order for and receive payment from customers in a minimal amount of time
FDA standards for food handling; cashier does not handle food; cashier provides greeting and acts as point of contact for all food stations
Customer arrives at drive-through station or counter
Greet customer; take order; process order; bill customer and receive payment; receive and deliver food to customer
Food and beverage inventory; inventory of paper goods (bags, straws, napkins)
Inventory orders; sales activity reports; deposits; incident reports
Payments received, timeliness of order fulfillment; number of customer complaints; incident reports
© 2009 Public Health Informatics Institute
Sally’s Sandwich Shop
© 2009 Public Health Informatics Institute
Context Diagrams
Entity Entity
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Sally’s: Order Fulfillment
Paym
entB
illO
rder detailG
reeting
Change
Sandwic
h
Drink
Side salad
Customer
Sandwic
h ord
er
Sandwichstation
Drink order
Side order
Sidestation
Drinkstation
Order taker
© 2009 Public Health Informatics Institute
Task Flow Diagrams
Task A
Task D Task E Task F
Task Series 2
Task
Decision
Choice B
Choice A
Information Flow
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Sally’s Task FlowOrder Fulfillment Sally’s
Lunch Stop
Provide Payment
Provide Bill
Amount
Complete Transaction
Receive Food End
Give FoodYes
No
Food Ready?
Start Arrive
Greeting
Provide Order Detail
Record Order
Receive Order
Prepare Food
Deliver Food to Cashier
© 2009 Public Health Informatics Institute
Questions so far?
Q A&
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Stakeholder Analysis:Influence / Interest Matrix
LowLowLowLow HighHighHighHigh
Lo
wL
ow
Hig
hH
igh
HIGH InterestHIGH InterestLOW InfluenceLOW Influence
LOW InterestLOW InterestLOW InfluenceLOW Influence
STRATEGY: Passive relationship management
STRATEGY: Provide information, status updates
LOW Interest LOW Interest HIGH InfluenceHIGH Influence
HIGH InterestHIGH InterestHIGH InfluenceHIGH Influence
STRATEGY: High levels of communication and
attention, goal alignment
STRATEGY: Active engagement, targeted communication, goal alignment, leverage influence
© 2009 Public Health Informatics Institute
Choose
Measure
Examine
Redesign
Test
Business Process Redesign Steps
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Choosing a Process to Redesign
• Is it inconsistent?
• Antiquated?
• Inefficient or redundant?
• High volume?
• High risk?
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2 x 2 Table
LowLowLowLow
Lo
wL
ow
HighHighHighHigh
Hig
hH
igh
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Building a Home in Mahoning County
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Why Measures Are Critical
• Provides objective, quantifiable way to see if new, redesigned process is really better than the old one
© 2009 Public Health Informatics Institute
Public Health Application
© 2009 Public Health Informatics Institute
ExamineSymptoms of Inefficiency
• Duplication of effort
• Unnecessary tasks
• Long cycle times
• Processes unclear to staff
• Lots of activity for an unimportant task
• Quality checks too distant from the process
© 2009 Public Health Informatics Institute
Principles of Redesign
• • Eliminate unnecessary tasks Eliminate unnecessary tasks • • Streamline tasksStreamline tasks
• • Group administrative tasks Group administrative tasks • • Perform steps in parallel Perform steps in parallel
• • Use multiple versions of the process Use multiple versions of the process •• Minimize handoffs Minimize handoffs
• • Find and remove bottlenecks Find and remove bottlenecks •• Smooth work flow Smooth work flow
•• Avoid cumbersome translations and interfaces Avoid cumbersome translations and interfaces
• • Use automation Use automation •• Help all process participants feel ownershipHelp all process participants feel ownership
•• Measure outcomes, not tasks or handoffs Measure outcomes, not tasks or handoffs
© 2009 Public Health Informatics Institute
Pilot Testing
• Test before invest
• Start on small scale
• Gather feedback
© 2009 Public Health Informatics Institute
The PDSA Cycle
SOURCE: Institute for Healthcare Improvement, Improvement Guide, P 10
© 2009 Public Health Informatics Institute
The PDSA Cycle
SOURCE: Institute for Healthcare Improvement, Improvement Guide, P 10
© 2009 Public Health Informatics Institute
Questions and Discussion
Q A&
© 2009 Public Health Informatics Institute
Thanks for attending!
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