PRESENTATION : IMPROVEMENT SCIENCE

PROCESS MAPPING Prepared by: June ~Watters

AIMS OF THE SESSION• Increase knowledge of

the improvement methodology

• Learn how to use Process Map

• Learn how to design processes to reduce harm

• Learn to identify weaknesses in current process

• Hearing from others on its use

• Produce your own process map

• Questions / points of clarification

What is improvement?• Its about developing care that

delivers for patients.• Its about breaking the • "We've always done it like this!"• culture, encouraging both

patients and staff to challenge and change healthcare services for the better.

Subject Matter Knowledge

Subject Matter Knowledge: Knowledge basic to the things we do in life. Professional knowledge.

Profound Knowledge: The interaction of the theories of systems, variation, knowledge, and psychology.

Profound Knowledge

Improvement

(W Edwards Deming)

HEALTHCARE• Change in Healthcare = people

changing• Complexity• Patients / staff• Estimated 80% of change projects

failure = failure to manage the people issues

• Need to understand the ways people react to change– minimize the risks of failure – maximizes skills and talents of the team

Think of a time when you were successful in making an improvement at work

Think of a time when you were unsuccessful in making an improvement at work

Write down the differences between the two situations

TABLE EXERCISE – 10 MINS

• Change is difficult and can be threatening

• Change can be time-consuming

• Change involves understanding people, systems and processes

• Healthcare systems are often complex and fragmented

LEADING IMPROVEMENT – PEOPLE

• While there are many tools and methodologies underpinning continuous improvement in healthcare, we need to recognise that it is people, and not tools or methodologies, who cause change to happen.

We will need people who are capable of identifying problems, introducing change and monitoring the outcomes to create sustainable change in NHSScotland. In short, we will need people who can lead improvement.

LEADING IMPROVEMENT - MODELS

– Process mapping – today’s focus– PDSA– Lean–Demand and capacity– Six-sigma

WHAT IS A PROCESS MAP

• Visual representation of relevant procedures and administrative processes.

• Shows how things are and what happens rather

• Simple or complex processes can be mapped

• Processes have evolved

• MAKING A CUP OF TEA/COFFEE

• TRAVELLING TO WORK TODAY

15 minutes

LET’S HAVE A GO AT OUR OWN PROCESS MAP

PROCESS MAPPING SHAPES

• Represents and activity

• Represents a decision

• Represents a Delay

• Represents Transport/Movement

PROCESS MAPPING SYMBOLS

• Represents Storage/Filing

PROCESS MAPPING SYMBOLS

WHY PROCESS MAP?• Reduce delays• Highlight improvements for patient and staff– Unnecessary delays– Unnecessary steps– Unnecessary handovers– Duplication of effort – Duplication of waste– Things that don't make sense– Likely hotspots, bottlenecks

WHEN TO USE?

• Area where there is a gap in understanding

• Area which requires improvement

• Define start and end point of process to be mapped• Invite all members of the multi-disciplinary team

involved in that process to a mapping event (allow approximately 2 hours and give adequate notice).

• Do not be too concerned if you can't get all members of the multi-disciplinary team to attend. After the event you can take the map to them.

• Send out some preparatory information on process mapping for participants to read prior to the event.

WHAT WILL YOU NEED?

WHAT WILL YOU NEED?

• Brown paper or flipcharts• Post-it® notes• Marker pens• At the event, start by outlining the process to be

mapped and then encourage participants to start writing their part of the process on Post-it® notes.

• Process mapping events often require strong facilitation to keep people on track with the task and prevent distractions caused by discussing the issues in detail.

WHAT WILL YOU NEED?

• Encourage people to write issues and ideas for improvements on separate Post-it notes and park them on a flipchart.

• Reinforce the importance of mapping the process as it usually happens, not the ideal or how it should happen, but what happens for the majority of patients.

• Arrange the Post-it notes to ensure they capture the patient journey in the correct sequence.

• Where relevant capture times, delays, waits, hand-offs etc.• Thank all participants for their involvement, and reinforce

the need for a follow-up meeting to agree the map and actions to be progressed.

WHAT WILL YOU NEED

• Walk the patient journey and involve patients to gain an understanding of their experience and to capture their ideas for improvement.

• Show the process map to the relevant individuals from the multi-disciplinary team

• Display the process map in the relevant clinical area and encourage all staff to amend/update and put forward ideas for improvement.

• Type up the process map, issues and ideas and send out to all participants with a date for a follow-up meeting quite soon afterwards, to maintain momentum.

• How many times is the patient passed from one person another (hand off)?

• Where are delays, queues built into the process?• Where are the bottlenecks?• What are the longest delays?• What is the approximate time taken for each step (task

time)?• What is the approximate time between each step (wait

time)?• What is the approximate time between the first and

last step?

FOLLOW UP MEETING- IDENTIFY RISKS AND POTENTIAL HARM

• What are the longest delays?• Is work being batched?• Where are the problems for the patient?• At each step is the action being undertaken by the

most appropriate staff member?• Where are the problems for staff?• Where is the greatest amount of time currently

lost or wasted?• Can any processes be carried out simultaneously?• Consider what patients complain about.

IDENTIFYING POTENTIAL RISKS AND HARM

• What is the approximate time between each step (wait time)?

• What is the approximate time between the first and last step?

• How many steps are there for the patient?• How many steps add no value for the patient?• Are there things that are done more than once?• Look for rework loops

IDENTIFYING POTENTIAL RISKS AND HARM

CRAIGMILLAR MEDICAL CENTRE - INR PROCESS

MAP

Joan FletcherAshley Tait

15 minutes

NHS LOTHIAN

Process Map your current system for:

Prescribing and monitoring of patients on Warfarin or DMARDS (such as

methotrexate)

20 minutes

PRACTICAL EXAMPLE

What will it take to improve?• Winning the hearts and minds of the staff• Focusing on improvement not targets• Develop testing

– What to test ……how to test • Leadership • Integration - Making it daily work • Creating infrastructure• Creating capability and capacity• Measurement that has meaning • Just enough data… interesting versus useful

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But remember, tools are there to help you.

Use the right tool at the right time.

They are not the beginning or end of your Quality Journey!

Well done everyoneThank you for your participation and

enthusiasmGood Luck

Any questions?