DEWITT ARMY HOSPITAL
Fort Belvoir, VA
OUTLINE
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Definition of Process Mapping
Parts of Process Mapping
Steps of Process Mapping
Tools for Process Mapping
Final Checking of Process Mapping
Examples of Process Mapping
How Process Mapping fits into the QSEs
Common Mistakes in Process Mapping
Process Mapping
• Is a graphical representation from start
to finish.
• Flow chart
Oval: Show the input to start the process
Arrows show
direction or the
flow of the
process
Box or Rectangle: Show a task or
activity performed in the process
T
E
M
P
L
A
T
E
Flow
Chart
Diamond:
Shows where a Yes/No question is asked
or a decision is required
No
Yes
Usually only one arrow out of an activity box.
If more than one arrow, you may need a
decision diamond.
Oval: Show the output at the end of the process
Make sure every
feedback loop is
closed, Every
path takes you
either back or
forward to
another step
Tools for Process Mapping
• Pen and paper
• Post-It notes
• Software: PowerPoint,
Visio, etc.
Start …………………….End
Links to another process or flow chart
Arrow
Steps (Procedure)
Questions ???
Feedback loop
Quality System Essentials
Organization
QUALITY SYSTEM ESSENTIAL
Organization
DeWitt Army Community Hospital
Department of Pathology
DCCS
Chief, Pathology
Quality Management
NCOIC
Lab Manager
Administrative Support
Soldiers
Assistant Lab Manager
MLT Phase II
Safety
Anatomical
Pathology
Histology
Clinical
Pathology
Decentralized
Labs
Client
Services
Chemistry
Central Processing
POCT
Blood Bank
Phlebotomy
Rader
Microbiology
Shipping
Woodbridge
Hematology
Organizational Chart
6/28/2007
Fairfax
Quality System Essentials
Safety
NEEDLESTICK
Or other blood borne pathogen exposure
APPLY FIRST AID !!!
OR REPORT TO ER IMMEDIATELY
ATTENDING MD





SF 558 or progress notes. Give to injured
employee
Consent FORMS for HIV on both source
& injured employee
Order & draw lab tests STAT:
“NEEDLE SOURCE” (order set name)
Tubes: 1 red, 1 purple, & 1 HIV
Tests: Rapid HIV-1; HIV; Hepatitis B
Surface AG; Hepatitis C Antibody
“NEEDLE EMPLOYEE”(order set name)
Tubes: 2 red, 1 purple, & 1 HIV
Tests: HIV, Hepatitis B Surface
Antibody, Hepatitis C Antibody; CBC,
CMP, HCG (female childbearing age)
Decide on Tetanus shot
If necessary, consult Community Health
Nurse for psychological assistance

Decide on PEP (post exposure
prophylaxis) therapy
• If YES, contact WRAMC
Infectious Disease for follow
up 202-782-1663
SUPERVISOR
NOTIFY SUPERVISOR
Supervisor/ employee complete the assigned forms
What is the status of the employee?
Military
DA 4106
DD 689
FM 879
GS Civilian
DA 4106,
FM 879, DD 689
CA-1 & CA-17*
*when applicable
Patient, Contract ,
Student, Volunteer,
Visitor
DA 4106
Report to ER for
emergent care
Report to ER for
emergent care
• Ensure paperwork is
properly filled out
• Forward Paperwork to
designated area. REFER TO
BACK PAGE.
•Report event to Infection
Control
Report to ER for
emergent care
Report to Occupational Health within 72
hours of injury for follow-up care,
(bring SF 558)
CA-1 should be submitted to Safety
Manager within 5 workdays of the injury
END
Report to your
respective Contract
Representative Office
or Primary Provider
for follow- up care
UPDATED
11-23-2004
Phone #s: ER (805-0518); Occ Health (805-0443); Infection Control (805-0044); Safety Manager (805-0157); Patient Safety (805-8048);CPAC (703-704-2743)
ACCIDENT/INJURY REPORTING
FIRST AID FIRST!!!
IF UNCLEAR, REPORT TO ER IMMEDIATELY





DD 689 – Individual Sick Slip Form –
Supervisor will give a signed form to
injured employee to seek medical
attention at ETR or Occupational Health
DA4106 – Quality Assurance/Risk
Management Form – On duty injuries
must be reported to Patient Safety
MEDDAC FM 879 – DeWitt Army
Hospital Supervisor Mishap Report –
Required to be submitted to Safety
Management Office within 5 days of
injury/accident. DA 285-A-B-R may be
substituted to report POV incidents for
military.
CA1 – Federal Employee’s Notice of
Traumatic Injury and Claim for
Continuation of Pay/Compensation –
Supervisors are required to fill out form
and bring it to Safety Management Office
to be submitted to Department of Labor.
Form is required to be submitted within 3
days of injury/accident.
CA17 – Duty Status Report – Supervisor
will fill out column A of form and give to
injured employee if limited duty is
applicable. Employee will provide form
to provider and return to supervisor.
NOTIFY SUPERVISOR
Supervisor/ employee complete the assigned forms
What is the status of the employee?
SUPERVISOR
Military
DA 4106
DD 689
FM 879
(Both On and Off
Duty accidents
must be
reported)
Report to ETR for
emergent care and
OH for first aid
(DD 689 required)
GS/WG Civilian
DA 4106,
FM 879, DD 689
CA-1 & CA-17*
Contract , Student,
Volunteer, Visitor
DA 4106
*when applicable
Report to ETR for
emergent care and
OH for first aid
(DD 689 required)
Report to Occupational Health within 72
hours of injury for follow-up care and
bring DD 689 and ETR Report (SF558) if
seen at DACH ETR. For GS/WG
civilians, medical documentation is
required.
• Ensure paperwork is
properly filled out
• Forward Paperwork to
designated area. REFER TO
BACK PAGE.
•Report event to Safety
Management Office at 703805-0157
Report to ETR for
emergent care
Report to your
respective Contract
Representative Office
or Primary Provider
for follow- up care
END
Phone #s: Safety Manager (805-0157); Occupational Health (805-0443); Infection Control (805-0044); Patient Safety (805-8048);CPAC (703-704-2743)
UPDATED
02-04-2005
DA 4106
SAFETY
MANAGER
FM 879
(Incident
Report)
(Dewitt Army
Community Hospital
Supervisor’s Mishap
Report)
COPY
ORIGINAL
CA-1
(Federal Employee’s Notice
of Traumatic Injury and
Claim for Continuation of
Pay/Compensation)
COPY
COPY
CA-17
SF 558
(Duty Status Report)
(Emergency Care and
Treatment- Dewitt ACH)
COPY
COPY
(Electronically
submitted)
OCCUP
HEALTH
PATIENT
SAFETY
DD 689
(Individual Sick
Slip)
COPY
COPY
COPY
COPY
ORIGINAL
ORIGINAL
ORIGINAL
COPY
COPY
COPY
COPY
COPY
COPY
ORIGINAL
*CPAC
(Civilian only)
EMPLOYEE
FILE
LAB PI
COPY
COPY
COPY
COPY
COPY
COPY
# OF COPIES
2
2
4
4
4
5
Quality System Essentials
Occurrence Management
NOTIFICATION / DOCUMENTATION CRITICAL VALUES
*** START***
Confirmed
CRITICAL VALUE
Outpatient, ER and
Outlying Clinics
(Fairfax+ Woodbridge)
Inpatient
(Wards )
Patient’s
location?
Ask for :
Normal duty hour?
(Refer to Clinic hours)
1st: ORDERING PROVIDER
2nd: RN in charge of patient
or charge nurse
YES
Call clinic and
ask for
ORDERING
PROVIDER
Successful
Reporting ?
NO
Page
ORDERING
PROVIDER
YES
HOW TO DOCUMENT IN CHCS:
(Example)
“Critical read back by Dr. Jane
Doe, ER, 7/06/06@0800 GHY”
Note: Have Health Care Provider
read back critical lab results with
patient’s name
NO
Document in CHCS
*** END ***
CALL MOD
( after minimum
of 2 attempts )
YES
Normal duty hr:
-Inform supervisor,
lab manager, QI, or
pathologist
Successful
Reporting?
NO
Off duty hr:
-Call pathologiston call
QSE:
Purchasing and Inventory
&
Process Control
QUALITY SYSTEM ESSENTIALS
PURCHASING AND INVENTORY
PROCESS
IN EVALUATING CRITICAL MATERIALS/
SERVICES
REQUEST FOR CRITICAL
EQUIPMENT/SUPPLIER/SERVICES
DOCUMENT QUALIFIERS REQUIREMENTS
(REFER TO PROCESS VALIDATION FORM)
REMOVE FROM
LIST
NO
Deliver to the
section
SECTION
CHECKS/
DOCUMENTS:
-supplies: lot #,
expiration dates,
temperature, qc
-equipment:
calibration,
scheduled qc
Meets requirements?
YES
NO
CHECKS WITHIN
ACCEPTABLE LIMITS?
For equipment/
services:
For supplies:
BACK TO
MAINTENANCE
OR SUPPLY
OFFICER
APPROVED BY LAB MANAGER
YES
1.
Request for
3953 (Purchase
request and
commitment)
2. Accounted by
property book
(check annually)
3. Med Maint will
do functional,
preventive
checks
4. Provide ER 24-7
DMLSS
(common
use, not in
contract)
CONTRACT
(request for
3953, yearly)
1.
Received by
authorized or
designated
personnel
(supply officer)
2. If high priority,
will notify
telephonically
CREDIT CARD
(for emergency
request)
READY FOR USE
Page 1
QSE: Process Improvement
Urine Collection Process in the
Outpatient Phlebotomy Area
Start
Ship to
reference
lab?
Print &
Verify Labels
No
Patient Arrive
Yes
Label samples
Log in CHCS
Met
Requirements
?
No
Patient
Collect Sample
Specimen
transport to
UA section
Yes
Patient turn in
sample
Give
instructions
to patient
Transport to
Shipping
dept
INPUT
STEPS
(Adjustable, Specifications?)
OUTPUT
(Valuable, Measurable?)
BEGIN
END
IMPROVE CUSTOMER SERVICE IN THE PHLEBOTOMY ROOM
INPUT
PROCESS
(Adjustable, Specs?)
Greet patient with a smile
(Valuable, Measurable?)
Patient
arrive
A
Phlebotomist Available
Log in
CHCS
Request for at least 2
IDs (DOB and name)
Labels ; printer
Verify
Labels
Labeled cups
Verbal instruction “script”
A
Instruction sheet
A
Sterile cups with wipes (not
expired)
Who will deliver ?
A
Time to deliver (within 1hr)
A
Back-up plan when busy
A
OUTPUT
Collect
samples
Transport
to lab
Patient Satisfaction
Survey
V,M
Patient Waiting Time
V,M
Patient Identification
V
Verification of the
printed label
V
Eliminate mislabeled
sample
V,M
Patient recall
V,M
Repeat Testing
Delivered in a timely
manner
V,M
Example of Measurable Output
CUSTOMER SERVICE
( Patient Satisfaction Survey 2007)
Example of Measurable Output
CUSTOMER SERVICE
COMPLAINTS
25
20
1st Q
15
2nd Q
3rd Q
10
4th Q
5
0
Access
Policy
Staff Behavior
Quality of Care
Misc
QUALITY SYSTEM ESSENTIALS
ASSESSMENTS
PHLEBOTOMY WAITING TIME
Percent Served <= 15 Minutes (Threshold: 90%)
100%
95%
90%
85%
80%
75%
2006
70%
2007
65%
60%
1
2
3
4
5
6
7
8
9
10
11
12
QUALITY SYSTEM ESSENTIALS
ASSESSMENTS
2007 PATIENT RECALL
(Threshold: < 1%)
# of patient seen
% of pateint recalled
4500
2.0%
4000
1.8%
3500
1.6%
1.4%
3000
1.2%
2500
1.0%
2000
0.8%
1500
0.6%
1000
0.4%
500
0.2%
0
0.0%
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
Example of Measurable OUTPUT
% Urine Contam ination
50%
40%
30%
20%
10%
0%
previous
current
peers
Your lab
16%
84%
25%
male
male
female
female
75%
Steps of Process Mapping
• First identify the PROCESS
• Provide OUTPUT variables for each step
before the INPUT variables
• OUTPUT : Valuable or measurable
• INPUT: Controllable and enter
specifications
– P and 5 M (People, Machine, Materials,
Method, Mother Nature, Measure)
Improve Customer Service In The Phlebotomy Room
INPUT
PROCESS
(Adjustable, Specs?)
Greet patient with a smile
(Valuable, Measurable?)
Patient
arrive
A
Phlebotomist Available
Log in
CHCS
Request for at least 2
IDs (DOB and name)
Labels ; printer
Verify
Labels
Labeled cups
Verbal instruction “script”
A
Instruction sheet
A
Sterile cups with wipes (not
expired)
Who will deliver ?
A
Time to deliver (within 1hr)
A
Back-up plan when busy
A
OUTPUT
Collect
samples
Transport
to lab
Patient Satisfaction
Survey
V,M
Patient Waiting Time
V,M
Patient Identification
V
Verification of the
printed label
V
Eliminate mislabeled
sample
V,M
Patient recall
V,M
Repeat Testing
Delivered in a timely
manner
V,M
Finalizing the Process Mapping
• Review the process, by observing or
asking the operator
• Are the operators following the process as
charted?
• Do you have a consensus?
• Do you need to add or remove steps?
Process Mapping Mistakes
•Map is too detailed, too much information and does not emphasize the importance.
Process Mapping Mistakes
• Process is not focused on your main goal
i.e. create value for your customer
(customer satisfaction)
• Map the process without showing how the
results will be measured
QUESTIONS