Process Mapping[1]

Definition of a Process Map

A process map is a visual display of a process using symbols and formats.

Benefits of Process Mapping• Provides a visual representation of the process

• Requires verification and objectivity

– Hands-on exposure to local activities

• Identifies rework loops and redundancies

• Gives insight into bottlenecks, cycle times, and inventory

• Identifies non-value added steps

• Helps identify when and where to collect data

• Identifies where different work teams use different processes

• Serves as a training and orientation tool

Components of A High Level Process Map (SIPOC)

• Supplier: Whomever provides the inputs to the process

• Input: Materials, resources, and data required to execute the process

• Process: The activities and resources applied to the inputs to convert them to outputs

• Output: The tangible products or services that result from the process

• Customer: Whomever receives the outputs of the process – internally or externally

SIPOC Process Mapping

PPSS CCSuppliers Inputs Process Outputs Customers

CTQs CTQs

•_____•_____•_____•_____

•_____•_____•_____•_____

Input OutputCookingPasta

Raw PastaPanH2OCupStoveSpoonSaltOil

Cooked Pasta

Suppliers Customers

Restaurant OwnerGrocery Store

PatronsOwnerCook

Step 1 Example: “Pasta” High Level SIPOC Map

Pasta High Level Process Map

SIPOC - Relation to a Detailed Process Map

ProcessMap

Process

X

X

X

PPSS CC•_____•_____•_____•_____

•_____•_____•_____•_____

Inputs Outputs

– Process Step or Operation (White)

– Delay (Red)

– Quality Check, Inspection or Measurement(Yellow)

– Storage (Yellow)

– Decision (Blue)

– Transport or Movement of Material orTransmission of Information (Yellow)

Common Detailed Process Mapping Symbols

At Least Three Versions(Usually)

What It Is Thought to Be…

What It Should Be…What It Actually Is…

Versions of a Process

Process Mapping and the Hidden Factory

Hidden Factory

Step 2 Example: Identify All Process Steps

Pasta Process Map

Designate steps as value-added or non-value-added

Add cycle time, defect/yield data and ALL rework loops

Input

Raw PastaPanH2OStoveSpoonSaltOil

Output

CookedPasta

Cook Pasta

9 MINUTES

VA

Add water,salt & oil

VA

.5 MINUTE

AddPasta

VA

.25 MINUTE

Done?

Rework

No

Yes

.01 DPU

Boil Water

6 MINUTES

VA

Step 3 Example: Determine Outputs For Each Step

Pasta Process Map

Input

Raw PastaPanH2OStoveSpoonSaltOil

Output

CookedPasta

Cook Pasta

VA

Add water,salt & oil

VA

AddPasta

VA

Done?

Rework

No

.01 DPU

Boil Water

VA

What are the outputs for the other steps?

Yes

Boiling WaterWater RemainingSteam

Properly Cooked

9 MINUTES.5 MINUTE .25 MINUTE6 MINUTES

Step 4a Example: List Inputs For Each Step

Pasta Process Map

Amt. of SaltAmt. of OilLid or NotAltitudeAmbient TempTimeMinerals in H2OPan MaterialPan SizePan ConditionBoiling InstructionsBTUs

TimeLid or NotType of PastaAmount of PastaAltitudeAmbient TempCooking instructions

Input

Raw PastaPanH2OStoveSpoonSaltOil

Output

CookedPasta

Cook Pasta

VA

Add water,salt & oil

VA

AddPasta

VA

Done?

Rework

No

.01 DPU

Boil Water

VA

Yes

Boiling WaterWater RemainingSteam

Properly Cooked

9 MINUTES.5 MINUTE .25 MINUTE6 MINUTES

Process Map Exercise

Using one or two process tasks from your SIPOC, work with others at your table to create an “As-Is” detailed process map.

Step 1 :Identify the cross functions in the process

Step 2 :Identify the sub processes and list it down

Step 3 :All the relevant details of the process are mapped

Step 4 :Join all the successive steps of the process

Step 5 : Get the approval from all the stake holders

SPAGHETTI DIAGRAM

SPAGHETTI DIAGRAMBefore

DIE

T CL

INIC

ECH

O/

TMT

PFT

SPAGHETTI DIAGRAMCurrent process

Tracking Movements – Spaghetti Diagram

Medication

Call Bell &Bedpan

EducatingDischargeProcess

Rounds With

Doctor

Booking Investigation

1.1. Events recorded after 30 Events recorded after 30 minutes walk around with the minutes walk around with the Nurse at 5Nurse at 5thth Floor Floor

2.2. Ward Nurses travel 4 km per Ward Nurses travel 4 km per shift. shift.

Patient and information flow analysis (PIFA)

Patient and information flow analysis (PIFA)

What is the purpose ?What is the purpose ?

▪ Create a holistic view of the entire (end-to-end) current system on one piece of paper

▪ Provides framework for solution development and future operations

Key StepsKey Steps1. Select an existing flow e.g., patient movement from emergency room to

wards2. Discus in team to identify:

– Start and finish point, frequency of activity– Key steps in the flow– Time required at each steps– Participants, existing tools and materials, etc.

3. For each step in the flow, identify the information which made it possible to move to the next step, and complementary information (in particular, staff information)

4. Identify the source of information and trace its path5. Identify key issues in the flow

End ProductEnd Product▪ A visual map of how patients and information flow from end-to-end of the

chain and where is the flow interrupted by inefficiencies

Porter arrive

Notes photocopied

Patient arrives in Majors

Board Nurse• 'Hello” • Notes

Take files, put card on board

Allocation• Chair • Cubicle

Patient called TIS

Ambulance• Tests*• Specialist• Treatment

A&E Doctor

Reception

SpecialistDecision discharge/ admit

Home

Request bed Get bed allocation

Bed ready

• Tests*• Specialist• Treatment

18–26 min

8-12 min

43%

57%20–40 min

72%

28%

~45 min~75 min

• Tests*• Specialist• Treatment

60-80 min50-80 min

▪ Minors▪ Resus ▪ Walk In Centre▪ GP

▪ Minors▪ Resus▪ Walk In Centre

(from specialist called to arrival)

25–35 min

Patient information flow analysis with key issues

Majors▪ X-ray ~40%▪ Bloods ~60%▪ Referral ~25%

1 9 10

15 14

Complexity of board and notes management currently requires senior nurse, pulling scarce capacity out of the team

Waiting for Technician or doctor (e.g., to take blood)

Waiting for test results (don’t know when ready)

Delays when allocated beds are actually occupied

Delays from requesting bed to identification of

‘available’ bed Waiting for Specialist –

Time from TIS tospecialist arrival

120–200 min

12

Delay due to other teams / external issue

6 11

4

13

17

3

18

Very busy spot with ~130 interactions per hour and people queuing for information▪ 60% doctors & nurses▪ 15% patients▪ 10% phone▪ 15% other (tech,

ambulance, student, porter)

Variability in how staff ‘TIS’ and how tests are launched

Waiting for A&E doctor

Language barrier, waiting for health

advocate (10-10 service only)

Multiple checking by doctors and slow writing

of notes

Potential further cycle of tests –~5% of cases

No admin and photocopier

support at night

Waiting for senior staff to TIS patients

Delays in porter arriving to transport patient to

bed or in finding and copying notes

Slow PCs

Nurse often needed to accompany

patient to ward and handle transfer

to bed

Awaiting test resultsBloods: 70–110 min (chem), 60–80 min

(haem lab), 5–20 min (haem near-patient) from bleeding to results authorised

Changing equipment

(ECG, wheelchair, keys, etc.)

7 85

Delay due to local team / internal issue2

16

Golden rules for observing a PIFA

Do Don’t

Take the time to follow the whole process Neglect to explain objectives to the staff member you followed (observations do not focus on individual performance!)

Let the staff members act naturally Interact with the employees during observation

Write down all activities of the sequence observed

Try to justify inefficiencies observed

Analyze activities observed in teams (after observation!)

Try to confirm an assumption

Be fact-based and critical… to better improve the process

Find a culprit!

CT/MRI scan process flowDoctor advices CT scan

Appointment scheduled

Patient arrives at reception

Type of scan

Verification and registration at reception

Handover datasheet and consent form to Doctor/tech

Explain process and take consent form

ScanningCorrelate image with clinical history

Verify details and check blood report,

if contrast

Ask for:- Blood values- Special preparation

Doctor/tech informed

Send to respective consultant

Patient informed despatch time

Post processing of image (pacs/print) and documentation

File, datasheet enclosed in a cover and sent for reporting

Jr. doctor writes report

Image and report review by consultant

Sent for typing

If not ok

If ok

If contrast

If plain

If okReport signed

Report enclosed in respective cover

Sent to despatch counter

Check report

If not ok

6 hrs

Critical phase

Verify bill at

reception

If ok

PIFA process for X-ray

Patient departure

Patient given des-patch time

Image print/pacs

Handover film to patient – ask to return for report

Wet film request

Write report on presc.

Report typing

Stop

Or to check film clarity and

quality

Check for clinical

history

Doctorto check

report

Sign the report

Send to despatch counter

Stop

Wait for patient

Send for rectification/ modification

Patient under goes X-ray

Confirm patient - Patient is asked to change

Send for reporting

Wet film received

Token no. displayed

Patient available

Patient arrives at X-ray counter

Doctor advises X-ray Patient pays bill in op billingPatient reaches X-ray reception

Patient is given a token and asked to wait for his turn

Repeat X-ray

If image not proper

Image check

Image ok

Yes

No

Yes

No

Accept-able Appropriate

No error

Error/ modify

Yes

No

Later arrival

Poor quality

Not Appropriate

Issue – Inappropriate clinical history

Issues – Typing errors & IT interface

Issues – Only 1

change roomIssue – Return of the wet film

Issue – PACS

Patient to wait

Ultrasound process flow

Report enclos-ed in respec-tive cover

Sent to despatch counter

Doctor advises scan

Patient pays the bill

Reaches ultrasound reception

Appointment scheduled and patients instructed

Patient arrives at reception

Sent for system entry (pacs/print)

Patient informed about despatch time

Films and report enclosed in cover

Send for typing Report signedCheck report

Verification, registration, and token no. given

Fill data sheet and paste sticker

Handover sheet to ultra-sound room

Procedure done

Report written by doctor

Check patient pre-

paration

If ok

If not ok

If ok

If not ok

Issues – Typing errors & IT interface

Issues – Waiting time

Issue – PACS

1 hour

Thank You!