Process Mapping Ricky Samson Date Agenda Introduction Why do Process Mapping ? Process Mapping Discussion What is a Process Map? •Visual description of the activities involved to deliver any process •Sequence they flow in Why do Process Mapping? • Understand current situation — big picture point of view • Identify QI opportunities tests of change • Develop & prioritize action plan for QI Forms the Blueprint for improvement Transformation Process time Work – value add time Wait/waste – non value add time Attacks waste To improve: quality, capacity, productivity Value is determined from the patient and or customer’s perspective 3 types of value • Value add – customer wants, ` direct care` `touch time`, in a commercial environment customer would pay for • Value enabling – steps essential to enable value add to be provided – indirect care? • Non- Value add – Waste • Why use these? A way of looking at a process and what each step contributes without making a judgement of the people or the process. Getting started Three versions of any process What you think it is What it actually is What you would like it to be Start with the bare essentials… The scope … – Start point – End point Getting Ready for Work Alarm Leaving House Alarm Snooze 5 mins Alarm Snooze 5 mins Dressing Gown Downstairs 2 mins Fill Kettle Turn On Wait Boil 3 mins Get Milk Cups Tea Bags Make Tea 2 Cups 3 mins Upstairs Give Mandy Tea Go to the Shower 3 mins Lucy in the Bathroom Waiting List 1 Bathroom 25 mins Shower Bedroom Shave Get Clean Dressed Teeth 5 mins 10 mins Downstairs Dry Hair 4 mins Upstairs Change for Bus Downstairs Get Bag Out the Door 2 mins 1min Open Door Look for ID Badge 5 mins Leave Decision making points •Who makes the decision? •How is it recorded? •How is it communicated? Data / Information • Time for each stage • Total process time • Waiting times • Number of waiting •Reasons for delays • Times of delays Over to you •Austria Skiing •South Africa Safari •Devon Caravan •Mediterranean Cruise • Disney Land Paris Decision to Go Table 1 Table 2 Table 3 Table 4 Table 5 Arrival External No Cost Centre WGH Walk In GP Lauriston Tray OPD 6 RIE Triaged Internal WGH Mountcastle Bush Springwell House Up to 1 week Triaged Braidburn Appointed 6 weeks Appointed GP non prescription up to 8 months other 2 – 6 weeks Clinic RIE WGH Up to 1 week Triaged 3 – 4 weeks Appointed Stock 2 days Non stock 2 weeks Com PT Clinic SMART High Level Current State Orthotics Draft 1 Clinic WGH Return Clinic Up to 1 year RHSC 4- 6 weeks 6 weeks Up to 6 months Return Clinic Review Clinic Process map for manual w/chairs •90% of appt’s made are home visits •80% of referall result in a standard wheelchair being issued without the patient being seen Pt sees GP/OT etc Delays can be caused by budget approval Paper file CHI DB Refe rrals Date Stam ped (print ed out) Referral sent from GP VA NVA 1 sec 4 days 5 hrs 2 User needs Appt Admin VA NVA 2 weeks? 3 Home Assess Staff Gra de Tria ges 4 hrs? VA NVA 5-24 hrs 60 sec? W/C deliv ered to user 60mins? 2hrs 6-8wks min 4 days RETis 90 secs 5hrs? Spe ciali st seati ng mad e in hou ???se Spe ciali st Seat ing orde red Chai r orde red Ots etc sess pt at home Stoc ks rece ive w/c 90 secs 24 hrs Pt attends Appt and chooses type of chair & extras if needed. 60minsRun by physio put put pt on Wait List(?) and book clinic 1appt sec ?? 15 Refer rals logge d on RETi s and ref scan ned secs in Adm in proc ess orde r 1 W/C ordered 90secs 5hrs? ?? W/C & seating delivered to pt & seating fitted W/C arriv es in stoc ks ?? 6 weeks 60mins? 4 days 0 Arrive Goods Inwards VITAMIN B COMPOUND STRONG… AZITHROMYCIN *PP2*… BETAMETHASONE VALERATE… MESALAZINE (Asacol MR) *PP* 400… FLUCONAZOLE *PP* 50 mg in 5mL… Check Report DALTEPARIN PFS *PP* 2500 units … Order PARACETAMOL *PP* 500 mg Caplets METRONIDAZOLE *PP1* TAKE… FILGRASTIM (Zarzio) PFS *PP* 300… JAC Stock ALFUZOSIN *PP* 10 mg Modified… MOMETASONE FUROATE *PP* 0.1… COLISTIMETHATE *PP*… DALTEPARIN PFS *PP1* DAILY AS… DORNASE ALFA *PP* 2.5 mg in… ATORVASTATIN *PP* 20 mg Tablets WGH OVL Process Receipt Onto System 8 7 6 3 2 25 5 0 Quarantine 0 Series29 5 Goods into Sort and Check 10 15 Complete and File OVL Log 25 20 Product 15 Time 5 10 UCL 4 CL 5 LCL 0 1 20 Time Good s Received To 1st Check 20 15 10 Time Access OVL Module and Assign Batch No Print Worksheet 1 Per Batch Access Label Link Print Labels For Batch Product Time Strength Quantity Packed Salbutamol 6 2.5 160Loose Nystatin 5 30 120Loose Diazepan 3 5 100 10 Flucloxacillin 3 250 10 10 Oilatum Cream 3 0 20Loose Cotrimoxazole 5 480 40Loose Isoniazid 2 100 58 2 Relvar Inhahler 5 0 15Loose Macrogol Stachets 22 420 10 Complete Worksheet Move Worksheet Labels and Batch to Checking Area 25 Check Worksheet Against Batch No 20 Time 15 UCL 10 CL 5 LCL 0 -5 0 2 4 6 8 10 1st Check – 1 Stop Time Check 25 20 15 10 5 0 Time Check Labels Against Worksheet Attach Label To Worksheet Move to One Stop Area Move to OVL Area OVL Batch Move to One Stop Area 14,000 12,000 10,000 8,000 6,000 T 4,000 i 2,000 m 0 80 60 40 20 Series29 Series30 0 -20 0 5 10 15 -40 10 20 40 420 15 420 50 Loose Loose 28 Loose Loose 20 7 3 1 1 1 1 1 1 Nicotine… 250 50 480 100 92/22 0 0 Macrogol… 10 6 17 3 4 35 2 1 2 Isoniazid Loose 28 Relvar Ellipta 120 100 40 35 30 25 20 15 10 5 0 Cotrimoxazole 30 5 No Of Labels 1 Oilatum Cream 37 13 Note Large Bulky 1 Label to Each Pack Large Complex Label Flagged to Bottle Inside Outer Packaging Large Uncomplicated 2 Labels to Each Pack Small 3 Labels Not Complex Goes On Foil Inside Outer Package Non Complex Complex Labels Flagged on Primary Packaging Non Complex Non Complex Large Bulky 1 Label to Each Pack WGH Sticker Only JAC OSHELF Flucloxacillin Flucloxacillin Oilatum Cream Cotrimoxazole Isoniazid Relvar Ellipta Macrogol Sachets Nicotine Patches Quantit Packe y d 160 20 Diazepan 4 5 6 7 8 9 10 Time Strenght 10 2.5 Nystatin… 2 3 Product Salbutamol Nystatin Suspension Diazepan Salbutamol No 1 Time One Stop Check Time RIE OVL Process Map Transport Goods From Store Move Transport Goods Goods From From Store Trolley To Pre pack RIE Goods Ready To First 1st Check Against JAC Form Move to Pre Packing Area Check 200 150 100 50 0 -50 -100 Time UCL CL LCL Linear (LCL) Time 140 120 100 80 60 40 20 0 Time Record Batch In Batch Book Print Order Sheet 6 5 4 3 2 1 0 Place Label On OVL Sheet Bethethaisone … Print Labels and OVL Sheet Bethethaisone… Atenolol Methoxypsora… Gancilovir eye … Warfarin Bechlomataso… Tacrolimis Morphine… Montelukast Predmisilone… Estradiol Tabs Naseptin… Quinine… Quinine… Fluconazole… Coxycycline … Isourtan Tabs Montelasone… Sabutamol Brimonidine… Dexamethasol… 4 3 2 1 0 -1 Atenolol Methoxypsoralen Gancilovir eye… Warfarin Bechlomataso… Tacrolimis Morphine… Montelukast Predmisilone… Estradiol Tabs Naseptin Nasa… Quinine… Quinine… Fluconazole … Coxycycline … Isourtan Tabs Montelasone… Sabutamol Brimonidine… Dexamethasol… Enter Batch on IT System 2nd Check Box Against OVL Sheet RIE First Check – One Stop 6 Check 5 Time UCL CL Time Label Box Time 35 30 25 20 15 10 5 0 Move to One Stop Check 60 50 40 30 20 10 0 -10 -20 -30 LCL Final Check RIE One Stop Check Time UCL CL LCL Time Time High Level Process Map Incident Reported Statements gathered Manager considers incident and meets with employee YES Case referral to ER – assessed and agreed next stage 1,2,4,5,6 Formal investigation required Outcome letter to employee Prepare management statement of case and send invite letter Sent to ER Practitioner ERP contacts manager and plans investigation NO Considers involvement of external agencies No investigation required Case to answer refer to next steps under appropriate policy ER Triage Employee advised of outcome after an adjournment or at a follow-up meeting YES Consider all evidence Investigation meeting held and decide if can make a decision Back to investigation No case to answer Outcome letter to employee Collates additional info/meet other witnesses NO • 1. 2. 3. 4. 5. 6. 7. 8. 9. Invite letter and evidence inc witness statements sent to the employee under investigation Collates information/ statements/ confirm meeting dates with witnesses Investigation meetings with witness Manager sends investigation invite letters to witness Project Data Requirements Total referrals by Department and Service 1 year Referrals by Type Count for 1 year External Agencies involvements count by agency 1 year Same for Unions Caseload by ERP Count and Complexity 1 year Same for Union Reps Total time for stages of sampled referrals Staff Experience Quality of Conclusion and Recommendations Priority/payoff matrix Tips: This grid can be used after Brainstorming to array and analyze ideas, or it can be used before Brainstorming as an organization tool to guide the group’s thinking. The term Payoff Matrix is used when the 2x2 chart represents benefit of the change vs. ease of implementation. It is sometimes fun to label each of the boxes. One of the most useful aspects of these tools is that they can help the group save valuable time by not chasing ideas that have little payoff (in this example, “low payoff and hard to change” is obviously not worth the effort). High Impact Easy To Do Low Impact Easy To Do High Impact Hard To Do Low Impact Hard To Do Easy Difficult Effort WHAT DID WE FIND ? TIME & TASK ANALYSIS COW OPD 6 PM % BY TASK 13 VA 20 Value Add = What the patient would pay for VE NVA 67 Value Enable = Things that must be carried to allow VA steps COW OPD 6 PM % BY TIME 25 VA VE 4 NVA 71 Non Value Add = Unnecessary tasks waste Circle of Work – Coordinator ARAU Snapshot - Circle of Work - Coordinator Talking to patient about Reading patient for Phone w ard to results dishcarge/phone handover patient 5% calls/notes etc 8% Checking patients on TRAK 8% Phone porter 2% 12% Chasing bloods taken but not show ing on Getting patient ready to TRAK move to w ard 17% 7% Feeding back to Sorting out return 'DVT' capacity manager patient 8% Discussion w ith med Sorting out 'stroke' reg re:patient Accepting patient patient 3% 3% 12% 15% TAKT Time Rate at which the Patient or Customer pulls from you • TAKT = Total Available Working Time (in seconds or minutes) Total Customer Demand • If the department is staffed for 7 hours a day and the demand for xray is 42 patients per day, TAKT time can be calculated as: 7 hours x 60 minutes (= 420 minutes) 42 patients = 10 mins. • To keep up with the rate at which a patient demands an X-ray, you would need to complete an exam every 10 minutes OR Every 10 minutes there is a patient walking into the X-ray Dept., so every 10 minutes there should be one being discharged – or else there will be a bottleneck TAKT time is not the same as cycle time 30 The 8 wastes in healthcare ‘T I M W O O D S’ Transportation Inventories Movement Waiting Overproduction Over-processing Defects Skills utilisation Transportation •Material, patients or information that is moved unnecessarily or repeatedly, e.g. unnecessary movement of samples. Example Inventories •Anything waiting to be worked on, e.g. excess levels of stock in cupboards and store rooms, specimens waiting to move to next step in process, or people waiting for tests and results. •Example Movement •Unnecessary walking, moving, bending or stretching e.g. looking for equipment placed in wrong location, looking for information/people •Example Waiting Waiting for samples, equipment, staff, appointments or results e.g. patients waiting for test and results, staff waiting for other staff, equipment or information. Example Overproduction •Producing something before it is required, or more than is required e.g. unnecessary/ inappropriate tests, batching samples or tests, multiple forms with same information •Example Over-processing •Duplication of data or repeat testing due to defects e.g. dual data entry, additional steps and checks, clarifying orders •Example Defects •Errors, omissions, anything not right first time e.g. poorly labelled specimens and requests, insufficient or illegible information. Example Skills utilisation •Unused employee skills e.g. highly qualified staff performing inappropriate tasks •Example
