Mapping Success: Workflow Design for

Improvement

Claire Fountaine, MSN, FNP-BC, RN

Clinical Workflow Consultant

OCHIN, Inc.

This course will:

• Introduce you to the concept of workflows

• Illustrate ways in which you can map workflows

• Share tips and tricks for successfully mapping workflows

Learning Objectives

This course will not:

• Cover specific workflows associated with a electronic medical record

• Review workflow mapping software

Why Map Workflows

How do we know that a change is an

improvement?

Why Map WorkflowsMeasures/Metrics

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• Consider current performance• In a detailed, process manner• This will “feed” into workflow

analysis• Workflow analysis will then move into

the next stage “What changes can we make that will result in improvement?”

• Before you can improve a process, the problem(s) need to be understood

• Map the current process to discover where the gaps and issues are located

• This is referred to as the “Current State”

Why Map Workflows

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• Map the new workflow once issues have been identified and a new course of action has been developed for the process

• This is referred to as the “Future State” and can inform your improvement plan

Why Map Workflows

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What Are Workflows?

• A workflow is the progression of steps or tasks that make up a work process: – Physical and/or mental tasks – Performed by various people – Over time– Across roles, teams, or locations

• A workflow map shows a picture of who does what, and in which order – Tasks can be sequential or simultaneous

What Are Workflows?

https://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/workflow

• Flowchart

• Activity Diagram

• Cross-Functional Diagram

• Process Map

• Swimlane

• Decision Tree

You Might Also Hear Them Called…

Example

Example

Example

Example

• What scenarios can you think of where workflow mapping would be helpful?

• What are some of the benefits of mapping workflows?

Think About …

• Defines the tasks inherent in a process and the order in which they occur

• Establishes who does what within a process, thereby reducing ambiguity and confusion

• Provides a clear, concise visual document to use as a means of communicating about a process

• Helps to identify gaps or problem areas within a process, enabling teams to direct improvement efforts

Benefits of Mapping Workflows

• When making any major changes to a process or group of processes – When opening up a new position – When preparing to implement a new system – When planning a new program

• When kicking off an improvement effort– What’s happening now? – What would we like our future state to look like?

• When seeking to spread a change or improvement– What does the change look like?

• When looking for new ways to communicate about a workflow

• When you’re stuck and need to think about your work in a new way

When to Map Workflows

Best Practices for Mapping Workflows

1. Identify and name the process

2. Clarify the purpose or outcome of the process

3. Identify a clear start and end point for the process

4. List or draw out the tasks and decision points within the process and put them in order

5. Define and note which role completes each step

Basic Steps

Tips: Use roles, not names - Use verbs

Workflow Symbols

• Gather your subject matter experts (SMEs)

• Start with pencil and Post-it® notes

• Ask questions! – “Walk me through your typical …“ – “What do you do now?” – “And then what?” – “Who does that step?” – “Who makes that decision?” – “How do you know to do that?” – “Tell me more about …”

• Watch for assumptions

Facilitating Workflow Conversations

Tools for Understanding Workflows

• Interviews

• Videos

• Screen shots

• Walking the process

• Procedure documentation

• What else?

• Start low tech: use a paper and a pencil or Post-it® notes, then move into an electronic format like Visio

• Map current state first, then move to future state

• Follow the 80/20 rule

• Use a parking lot

• Note opportunities for improvement on workflow map

• Validate the workflow map with SMEs and customers, if possible

• Shorter is better

Best Practices

Scoping Is Important …

• How do you decide when a workflow starts and ends?

• How do you avoid making massive, hard-to-understand workflow maps?

• How do you define what is one workflow and what is many?

• Tips:– Know your audience – Workflows are not role-dependent – Look for handoffs – Look for different outcomes

How to Scope Workflows

• “Sometimes…”

• “Maybe…”

• “It depends…”

• “If…”

• “Possibly…”

• “Perhaps…”

Opportunities for Improving a Workflow

• Designate a champion for team or clinic workflow development and tracking

• Designate an owner for each workflow

• Set a schedule to review and update workflows regularly

• Make sure that workflows are available in a central location that everyone can access: wiki, team binder, etc.

• Define a communication strategy for updating staff when a workflow changes

Long-Term Success Strategies

• Riverside - San Bernardino County Health Center– Dr. Karen Davis

• Chapa De– Wendy Barnhart

Mapping Telehealth

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• Workflow Assessment for Health IT Toolkit: https://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit

• Overview of Workflow Mapping: http://cepc.ucsf.edu/sites/cepc.ucsf.edu/files/Overview_workflow_mapping_14-0602.pdf

• Practice Facilitation Handbook, Module 5: http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod5.html

• Lynda.com Visio 2013 Essential Training: http://www.lynda.com/Visio-tutorials/Visio-2013-Essential-Training/374757-2.html

Resources