advanced process mapping · 2019-12-11 · advanced process mapping jennifer wortham, dr.ph 1 ......
TRANSCRIPT
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©
20
10
Hea
lth
care
Per
form
ance
Par
tner
s, In
c.
Advanced Process Mapping
Jennifer Wortham, Dr.PH
1 © 2010 Healthcare Performance Partners, Inc.
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Objectives for Today’s Workshop
At the end of this session you will be able to:
– Describe how process mapping supports Lean
– Describe three types of process mapping and how they are used: • Functional process flow using swim lanes
• Value Stream Mapping
• SIPOC’s
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1. Create Strategy, Budgets & Report Cards
2. Then a Miracle Happens
3. Improved Patient Care Better Organizational Results
“I Think You Should Be More
Explicit Here In Step Two.”
Agenda: Talk about Step 2.
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The 4 “P’s” of Lean
Lean aligns the entire organization, in the continuous pursuit of excellence, through the development of people to solve problems, improve processes and create value for the customer.
Purpose
Process
People
Problem Solving
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Goal of Lean: Eliminating Waste from Processes
Everything the organization does needs to be treated as a
process that serves the patient/customer.
Steps that don’t directly provide better care to the patient/customer
must be considered Non-Value added or WASTE!
Defects
Over-Production
Waiting
Not Clear (Confusion)
Transporting
Inventory
Motion
Excess Processing
Direct Patient Care
Indirect Patient Carfe
Waste
Administrative
Waste
Direct 21%
Indirect 18%
Admin 12%
RN Time Distribution
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How Process Maps are Used in Lean Projects
They provide a fact-based process description for understanding current problems and opportunities.
–They communicate the specific elements of a process to internal and external stakeholders.
–They are used to perform value analysis.
–They enable teams to quickly see improvement opportunities within the process, and to begin defining critical Xs (underlying causes of problems).
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Versions of a Process
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At least 3 (Usually)
What You Think It Is... What You Would Like It To Be... Future State
What It Actually Is...
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Construct for Developing a Care Process The 4 Rules in Use
Activities – Content, Sequence, Timing,
Location and Outcome
Connections: – Direct, Paced, Binary
Pathways (Clear) – Direct, No forking or looping
Improvement: – Closest to the Work, using
Scientific Method, evidence based
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Traditional Process Map
Swim Lane/Functional Process Map – Best Practice U
nit
Sp
ec
iali
st
Un
it
Ma
na
ge
r
Dir
ec
tor
VP
Checks
supply
stock
2 hours 5 days 1 day 7 days 1 day
Complete
request
form
Review &
approve
request
Review &
approve
request
Review &
approve
request
Procure
Supplies
Reviews
packing
list
against
order
Stocks
supplies
on unit
Pu
rch
asin
g
CER
> $5,000
Yes
No
Creates delays
Review
request Supplies
Delivered
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CT – Current StateE
DT
RN
Un
it S
ecre
tary
CT
- T
ech
M
D
Place
order in
CPOE
5 Mins
Review
pre-exam
checklist
15 mins
Answers
call from
CT Tech &
Contacts
RN to notify
of order
5 Mins
Contact EDT
via Vocera
for Transport
5 mins
Prep
Patient for
Transport
10 mins
70% of orders are
incomplete –
requires call to
MD to clarify.
Patient not ready for CT – avg.
delay 10 min. Common cause:
- Need to call RN to clarify risks
- Undress patient
- Remove jewelry
- Start IV
Transport
Patient
10 mins
Lack of CT-
Tech
available for
transport –
avg. delay 40
mins
Call MD
to Clarify
order
25 mins
Complete
CT
10 mins
Transport
patient back
to ED
40 mins
5 5540 115 120 155 180 220
Administer
contrast
5 mins
Call ED to
inform OK
to Send
Patient
5 mins
Start
Reviews
order and
determines
next steps
15 mins
165 170
Only 20% of
orders are placed
via order sets.
Most orders are
placed using
generic orders.
Collect
specimen, and
send to lab,
wait for results
60 mins
50% of patients did not
have Kidney Function
test ordered
RN busy – average
delay in collecting
specimen
230
CT busy,
average wait
10 mins
Prep
patient
10 mins
Radiologist
reads film and
documents in
EHR
10 mins
ED Doc
reviews
report and
completes f/u
30 mins
End
130 140 260
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Understanding How Processes Perform
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Value Stream Mapping
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Swim lane/Functional Flowcharts
Lean best practice process flow chart/map
– Forces the question of who is responsible for a given activity
– Illustrates the sequence of events
– Provides a timeline
– Indicates the number hand-offs
– Shows opportunities to eliminate/reduce steps
Use process map to communicate what is going wrong (pain points) and identify opportunities for improvement
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Process Step
Decision
Beginning / End
Connector
Document
Data-base
Basic Process Flowchart Symbols
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Direction
In-process
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Value Stream Mapping
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Fundamental Concept
• Diagnosis and Treatment • Med Rec
• Surgery
Information
Coordinating Care
• Unnecessary work (click, click, click…)
• Waiting,… for anything
• Searching for information
• Redundant Approval Processes
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Patient and
Customer Focused
Non-Value Added Value-Added
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Typical Improvement Projects
Many organizations focus their efforts on improving the value added work in a process, but after years of optimization of the VA steps: How much improvement can you really expect?
The real opportunity is to reduce the non value-add time in a
process (waiting, work in queue, transportation, rework, etc.).
85 - 95% NVA 5 - 15%
VA
Total Lead Time
Lean focuses on eliminating non value-added time in a process.
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Processing (VA) 5% - 15% of lead time
Work Queue/Waiting (NVA) 70% - 80% of lead time
Transportation (NVA) 5% - 10% of lead time
Inspection (RA/NVA) 5% - 10% of lead time
Typical Process Activities
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Lead Time, Cycle Time and Down Time
Lead Time (LT): Time from the defined beginning of a process to delivery to the customer. This includes all travel, waiting, staging, and storage times between processes and operations (includes cycle time and down time). – Cycle Time: Period of time required to complete one
cycle/major step of an operation. – Down Time: the time between cycles, or non-productive
work within a cycle
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Identifying Waste in the Process
Used to reveal the flow of material and information as a product/service makes its way through a process.
Path from the beginning to end from the customers perspective.
Visual representation of each sub-process in the stream creates an end-to-end “current state” vision for everyone to follow.
The value add and non value add (waste) activities are measured and documented.
Then, by asking a set of questions about how the work should flow, a future state map or proposed plan can be created.
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Lead Time, Cycle Time, Down Time
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= LT + + + MSE Diagnostics + Treatment +
Discharge Triage Register Check-in +
5 5 5 15 5 5 5 5 5 5 5 10 30 30
Down-time Cycle-time
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Down-time
The only time the patient really cares
about
High Level Value Stream Map ED Visit
LT = 180 minutes
23 Value Added 36% Non-Value Added 64%
1. Patient completes intake form
2. Receptionist reviews forms, verifies ID, & verifies benefits
3. Types info into EMR
Check-In Prep Exam Check-Out
1. MA: Take vitals & document in EMR;
2. Review patient intake info in EHR;
3. Asks & documents chief complaint.
1. MD reviews hx and chief complaint;
2. Completes physical exam;
3. Fills out lab req form, and RX
4. MA documents orders in CPOE
1. Schedule follow-up appointment
2. Collect co-pay
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6.5
2
3.5 10.2 5
12 22 3 5 2
2 1
VA
NVA
VA = 25.2
NVA = 44.0 LT= 69.2
Detailed Value Stream Map
Clinic Visit
24 Value Added ____% Non-Value Added ____%
VA
NVA
VA = ____
NVA = ____ LT=
Value Stream Map
-Process Name Here-
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Determining Requirements
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What’s a SIPOC?
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S I P O C
Requirements Requirements
Suppliers Inputs Outputs Clients
Input Boundary Output Boundary
Process
Defines the required inputs and outputs of each step in the process, and how the process should be performing:
• Outlines the boundary of the process or scope • Helps identify stakeholders
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Suppliers Inputs Process Outputs Customers
SIPOC
List process outputs
List key output
requirements
List process inputs
List key input requirements
List 5 to 7 high level process steps.
List customers who receive the outputs
List suppliers of the inputs
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Supplier Input Process Step Output Customer Requirement
Physician Patient info Med Rec
Labs
Enter orders into EHR
Admit Order Notification
Bed Coordinator
5 minutes from time of disposition
decision
Bed Coordinator
Bed Board with bed availability
Review Bed Board and Enter Unit
Assignment into EHR
Unit Assignment Notification
Unit Charge RN
Within 10 minutes
Unit Charge RN
Unit Assignment Log
Review Unit Assignment Log
and Assign Bed/Nurse
Notification of patient
assignment
Unit Specialist
Within 5 minutes
Unit Specialist
Bed / Nurse Assignment
Complete transfer request in Tele-
tracking
Notification of Bed Ready
ED RN Within 5 minutes
ED RN Notice – bed ready & Patient
ready
Patient Transported to Unit
Patient arrival in unit
Assigned Nurse
Within 10 minutes
SIPOC-R - Example Patient Bed Assignment for ED Admit
Total Lead Time = 35 minutes
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Completing the SIPOC Suggested Approach
Process name
Process owner
Determine outputs
Process start/cue/trigger
Process end/cue
Complete supplier, customer, process steps
Determine Critical-to-Quality requirements:
– Cycle-time
– Quality, etc.
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Group Exercise
A patient on one of your medical surgical units has tested positive for C-Diff. Let’s create a hypothetical SIPOC.
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SIPOC
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Supplier Input Process
Step
Output Customer Requirements
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Success with SIPOC
Clearly identify the start and end
Lean Principle: Gemba: “Go to the Source” and find out what both internal and external customers truly need.
Ensure that assumptions are recorded, discussed, and validated
Document definitions of key terms, symbols, acronyms, equipment, standards, etc.
Don’t forget feedback loops and communication mechanisms
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Questions and Discussion
© 2010 Healthcare Performance Partners, Inc.
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Overall Thoughts
The real value of SIPOC is the discussion it creates Begin with the end in mind – how will you
use it? Determine critical to quality requirements for each step in the
process Use only as much detail as needed to communicate well and
understand the process.
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The End
© 2010 Healthcare Performance Partners, Inc.
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