Looking at Processes

Process MappingPrepared by: Bernie McCulloch

Session Objectives

• To understand how mapping processes can help identify improvement opportunities

• To learn how process mapping can be used by anyone on processes small & large

• To identify and prioritise processes within your department where greater scrutiny is required

• Hands on process mapping

What is process mapping

Process has inputs and outputs

Input OutputProcess

Definition - a process is a series of connected steps or actions to achieve an outcome

Every system is perfectly designed

to achieve the results it gets

We design in the system capability

“80% of the problem is in

the system not the people”

William Edward Deming

A

Diagnostic process

B

Looking at Patient Processes

C D E

• 30 - 70% of work doesn’t add value for patient

• up to 50% of process steps involve a “hand-off”, leading to error, duplication or delay

• no one is accountable for the patient’s “end to end” experience

• job roles tend to be narrow and fragmented

Organisational /departmental boundaries

Emergency care process

Treatment process

There are different ways of looking at the same thing

Process mapping….

• Views the system from the patient perspective following their journey across organisational boundaries

• Helps staff understand how complex and confusing processes appear to the patient

• Organisation / service specific• Diagnostic and used as a basis for redesign,

actively involving frontline staff in the process. (Shows how things actually are)

What is process

mapping

Why Process Map?

Why process map

Process Flow

Decision Point

Document / Report

Multiple documents / Reports

Resource Tracker04/05/2015 06/05/2015

05/05/2015

Process Mapping Key

Waste Is a Sensitive Issue

• Its critical to eliminate “waste”

• Its also critical to recognise that the non value adding activities may have been a core part of someone job for many years

• It’s the activities that are non value adding not the person

Waste Walking – Hints & TipsApproach to follow:• Watch the process (think about waste type)• Map the process• Identify and tag the waste activities in the process• What does the waste equate to (time and resource)• Prioritise which waste to eliminate first

Categories of Waste

Transport Moving “stuff”

Injuries Damage to people

Motion Unnecessary human movement

Inventory “Stuff” waiting to be done

Waiting People waiting for “stuff” to arrive

Over processing “Stuff” we have to do but doesn’t add value

Over production Producing too much “stuff”

Defects “Stuff” that’s not right and needs fixing

Staff Untapped potential

High level process map 6 – 12 steps

Generate in set time e.g. 20 minutesUse to identify scope and identify problemNo rework loops and minimum complexity

Jim goes

to see the GP

Secretary

posts letter

& referral form

Margaret

reads through the referrals

Places referral letter

into appropriate box

Jim receiv

es new

appointmen

t

Jim atten

ds appointment

Community Physiotherapy Scenario High level process map

_________________________ 12 weeks___________________________

High Level Map

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 show effect of

redesign

Community Physiotherapy scenario – detailed process map

Jim phones for GP

appointment

Jim goes to see GP

Jim goes home

GP dictates letter to physio

Surgery secretary types up

dictated letter

Secretary prints out

physio referral form

Secretary completes

physio referral form

Secretary posts letter and referral

form

Mail picked up at end of

day

Letter and referral form

arrive at Centre B

Jill reads through the

referrals

Jill gives referrals to

Phyllis

Phyllis types Jim’s details

into computer

Enters details into an electronic diary

Enters details into a paper diary

Places referral letter into

appropriate box

Letter goes into post

Phyllis adds appointment time

to letter

Phyllis prints off appointment letter

Jim receives appointment letter

Jim calls up to change

appointment date

Phyllis sends out new appointment

Jim receives new appointment

Jim attends appointment

Keys to mapTotal process steps - 24

Orange high level steps -6 Yellow steps added value steps for patient- 2

1 working day See next arrow

1-2 working days 2 working days 1 working day

17 days 59 days

Jim attends GP on May 2nd

Jim attends physio on July 22nd

12 weeks for whole process

??

Keys to Map: Total process steps – 24

Orange= High level steps - 6 Yellow =Added value steps for patient – 2

When undertaking a process map activity

• SCOPE – where does the process start and end? • What demand is placed on it• Who should be involved in the mapping process?• Decide the level of detail• Map what actually happens

Step 1

Step 2

Step 3

Step 4

Define what process is to be mapped, be clear on this and mindful of any interdependencies

Create a Current state process map using “Post It’s”

Review process map and identify waste and opportunities so you can create an Ideal State and Future State

Create an Action Plan to achieve ideal and Future State

Process Mapping – 4 key steps

Key elements to

Process mapping

• Map what actually happens – most of time• Time Lines• Identify the types of waste?• What value/waste is in the process?• Include parallel processes• Display the maps so all can see

– Allow comments• Don’t redesign for redesign sake

Practice with

activities !

Don't worry

Lets have a go.....

‘Ground rules’ for the process Mapping Activity

• Everything is confidential• Everyone has a valuable contribution to make• Value the diversity of the group• ‘Park’ issues• Keep to time

Compiling a Process Map

Name of the person completing task

+verb

Who does what and when?

Remember the following...

• Define where the process starts and ends• Consider who you would involve in the mapping

exercise?• Use post-its to record the activities including time• Assemble the post-its to create the journey

(remembering that some activities happen in parallel)

• Keep a note of issues and opportunities

On your table –

Flip chart sheetsPost it Notes

Activity 1Define what process is to be mapped

In groups try some process mapping…

- Take 20 minutes to map the process for Medicine Reconciliation

Medicine Reconciliation Process- Get the notes (if yes) if no ? - Pt demographics documented- Allergy status documented- 2 or more sources to confirm meds

-Parents-Notes, electronic system

- Complete kardex

Stage 2: Analysis

Understanding the Patient Journey

Process Mapping

and

Flow Analysis

Analysing the process map• How many steps in your process?• How many duplications?• How many hand-offs?• What is the approximate time of or between each

step?• Where are possible delays?• Where are major bottlenecks?• How many steps do not add value for patients?• Where are the problems for patients and staff?

▲The process STOPS▲Inhibits FLOW▲Does not add value for the PATIENT▲As a Clinician do you see the wait?

Waiting

WaitingReferrals are posted on to the centreNo cover while Phyllis on ALMay 1st-May 4th- 3 days to process referral. 1st appt

received on May 6th – new appt sent out May 23rd.

DuplicationElectronic and paper systemsRebooking of patient appointment.

Examples

Bottlenecks All forms are returned to nearest centreEvery patient appt is 30 mins1 physio to triage referralsPhyllis multi-tasking / no cover for AL.

EXAMPLES

BATCHING

GP dictating at end of dayMail picked up dailyPhyllis had 10 appts to makePhysio reading all referral letters at once

EXAMPLES

Value adding• The activity transforms the patient and moves them towards

the next defined outcome• The activity is something that the patient cares about

Non-value adding• Do not serve any purpose (aim to remove these)

Necessary non-value adding• Do not directly benefit patient but are necessary e.g. completion of forms, logging patient details onto systems,

numerous checks of details

Value / non-value adding steps

Jim goes

to see the GP

Secretary

posts letter

& referral form

Margaret

reads through the referrals

Places referral letter

into appropriate box

Jim receiv

es new

appointmen

t

Jim atten

ds appointment

Community Physiotherapy Scenario High level process map

Jim attends GP on May 2nd

Jim attends physio on July 22

12 weeks for the whole process

Keys to Map: Orange= High level steps

Yellow =Added value steps for patient

Total process time: 83 days, 119520 mins Value added time for patient= 40 mins

Appt time with GP & Physio

_________________________ 12 weeks___________________________

Community Physiotherapy scenario – detailed process map

Jim phones for GP

appointment

Jim goes to see GP

Jim goes home

GP dictates letter to physio

Surgery secretary types up

dictated letter

Secretary prints out

physio referral form

Secretary completes

physio referral form

Secretary posts letter and referral

form

Mail picked up at end of

day

Letter and referral form

arrive at Centre B

Jill reads through the

referrals

Jill gives referrals to

Phyllis

Phyllis types Jim’s details

into computer

Enters details into an electronic diary

Enters details into a paper diary

Places referral letter into

appropriate box

Letter goes into post

Phyllis adds appointment time

to letter

Phyllis prints off appointment letter

Jim receives appointment letter

Jim calls up to change

appointment date

Phyllis sends out new appointment

Jim receives new appointment

Jim attends appointment

Keys to mapTotal process steps - 24

Orange high level steps -6 Yellow steps added value steps for patient- 2

1 working day See next arrow

1-2 working days 2 working days 1 working day

17 days 59 days

Jim attends GP on May 2nd

Jim attends physio on July 22nd

12 weeks for whole process

??

Keys to Map: Total process steps – 24

Orange= High level steps - 6 Yellow =Added value steps for patient – 2

...............occurs when a step is the limiting rate of the process

The step takes a significant time, and slows the whole process down.

e.g. accuracy of information

given (5mls calpol)

Process Bottlenecks.....

Functional Bottlenecks

occur when a resource is used by more than one process

Junior Drs

Look for Batching

Dr sees patients individually

Requests sent in batches

Results return in batches

Does this apply to Med

management(Discharge

prescriptions)

Identify examples of:1- batching2- bottlenecks3- waiting4- duplication

Activity 2:

How much time 10 mins?

Walk the Patient Journey for yourself

Jim goes

to see the GP

Secretary

posts letter

& referral form

Margaret

reads through the referrals

Places referral letter

into appropriate box

Jim receiv

es new

appointmen

t

Jim atten

ds appointment

Community Physiotherapy Scenario High level process map

Jim attends GP on May 2nd

Jim attends physio on July 22

12 weeks for the whole process

Keys to Map: Orange= High level steps

Yellow =Added value steps for patient

Total process time: 83 days, 119520 mins Value added time for patient= 40 mins

Appt time with GP & Physio

_________________________ 12 weeks___________________________

Physio self

referral

Analysis Summary

StepsTotal number of stepsNumber of value stepsValue steps as % of total steps

e.g. 2/24 = 8%

TimeTotal time Hrs:MinsTime of value stepsValue Time as % of total timee.g. 40/119520=0.03%

Waste• Transport• Injuries• Motion• Inventory• Waiting• Over processing• Over production• Defects• Staff

Stage 3:

Redesigning Processes

Focus on the future process

• Think creatively/generate ideas

• Focus on ideas and opportunities

• Are the right people involved? – whole system approach where needed

Defining patient groups

Runners

Specials

Strangers

Group of patients

No.

in e

ach

cate

gory

with

in t

he g

roup

Runners SpecialsShare common characteristics CustomisedHigh volume Lower volumeFast throughput PredictableHighly predictable Share some steps but requireStandard –patient routes extra stepsUp to 90% pre-scheduled Can be pre-scheduled

StrangersLow volume, unique requirementsUnpredictable demand patternRoute unpredictable and complexThroughput time tends to be longer

Tools for defining patient groups

Opportunities for Redesign

• Current processes often operate in isolation from each other, particularly departments and directorates

• Each area needs to be linked to the one before, to ensure that they always have capacity to deal with what they are receiving

Linked processes

Add value

Remove waste

Remember always aim to

• How you will go about doing this?• Who will you ask to attend? • When will you hold it? • Where will you hold it? • What obstacles might you face? How will you address them?

• What will your role be during the session?• What will the outcome of the session be if it is successful?

Questions?

• Process mapping is a method of creating a “one page picture” of all the process steps that occur

• The goal in completing an effective process map is to create an “end to end” review of the process that depicts the “flow” of materials and information (reports, invoices etc) that drive the activity

• By completing this we can identify the flow of the customer value adding activity, see wastes in the process and identify opportunities to improve it

• A good process map helps the team understand the reality of what is happening

• In the process by using a “go see approach” builds consensus on the current state. They can also help to share a vision of where we want to get to

• Once a Current State process map has been developed, a Future State can be created as an implementation roadmap towards achieving excellence

Introduction to Process Mapping

A handoff occurs in a process when responsibility for the next activity passes from one person to another.

Key elements to

Process mapping

• Map what actually happens – most of time• Time Lines• Identify the types of waste?• What value/waste is in the process?• Include parallel processes• Display the maps so all can see

– Allow comments• Don’t redesign for redesign sake