Healthcare Processes and Process Mapping
Process Map Uses
Process Mapping Symbols
Process Mapping Types
Process Mapping Standards for Healthcare
Process Mapping Software
Capturing Process Maps
Storing Process Maps
Process Risk and Control in Healthcare
Associated Process Map Documentation, Metrics and Tools
Changing Process Maps
Healthcare Processes and Process Mapping
At Quality One we believe the first step to process maturity is defining what it is the healthcare organisational does and capturing the steps that deliver
the organisational requirements and the processes that are considered high risk. In short, the organisation process, the process chain and the steps within
those processes. Once identified process mapping captures the detail of the process which allows the organisation to then control the process, analyse the
process through Healthcare FMEA, measure the process and improve the
process where required.
Process mapping refers to the actions and activities involved in defining what a healthcare entity does to deliver the requirements of the organisation and the
organisations customers and patients. It can include, who is responsible, to what standard a process should be completed, and how the success of a process can
be measured and determined. Process mapping is the initial tool that allows the organisation and its processes to become more effective and efficient. A clear
and detailed process map allows the organisation to look at whether or not improvements can be made or need to be made to the current process. Process mapping
can aid in taking specific organisational objectives and goals and determining whether they can be delivered or met and helps to measure and compare the process
objectives alongside the entire organization's objectives to make sure that all processes are aligned with the organisation’s values and capabilities.
Process - Process or processing typically describes the act of taking something through an established and usually routine set of procedures to convert it from
one form to another, as a manufacturing or administrative procedure, such as processing milk into cheese, or processing paperwork to grant a mortgage loan, or
converting computer data from one form to another. Source:
http://en.wikipedia.org/wiki/Process
Business Process - A business process or business method is a collection of related, structured activities or tasks that produce a specific service or product
(serve a particular goal) for a particular customer or customers. It often can be visualized with a flowchart as a sequence of activities. Source:
http://en.wikipedia.org/wiki/Business_process
Healthcare Process - are the activities that make up service delivery within the healthcare environment including activities that directly interact and impact
with and to consumers and patients , for example the activities of administering medicine, patient check in etc and the support processes that allow the direct
contact with consumers and patients to occur such as staff appointments, payroll administration, the implementation of policies and procedures and so on.
A process map is a graphic representation of recognised processes usually based on a set of agreed and common standards and rules. This can be as simple as a
series of instructions or as complex as a diagram that displays how all subsystems work together in one system. The process map or flowchart is a tool to visually
display how a work flow or activity operates. It is a tool that is used to contribute, communicate and capture the body of working knowledge (BOWK) in a healthcare
organisation and is a key input into planning and change. A process maps key elements include inputs, outputs, decisions, tasks, activities and functions that can
developed at any level within an organisation.br/>
Process Map Uses
Process definitions and process maps give an organisation a common language with which to compare processes and discover potential inefficiencies that
facilitate a capability uplift in the products and services the healthcare organisation delivers. Process mapping tools endeavor to capture the who, what,
where and when of the process. All this information is important to the process and to process change. Simply mapping a process can be the first step to
having a full view of the process and its implications, risk and deliverables. Often mapping a process is a secondary action to capturing the associated
data to the process but is necessary to ensure control of the process and its metric data.
Process maps can assist in the identification of:
- where problems may be occurring
- analysis to determine if there are any hidden issues that need examining
- areas for improvement
- The ideal to be state for the process
Process Maps have uses at all levels of healthcare organisational activity including:
- Strategic
- High Level
- Usually contain only actions or descriptors
- Are not concerned with detail
- Can contain sub processes that are delivered by different entities
- Process maps can be as simple as a number of actions placed in a sequence. At a high process level only key actions are listed in the order
in which they occur. These high level actions can be broken down further into subprocesses to give the process detail that can be followed at the
operational and instructional level.
- Operational
- Usually linked to a higher level strategic process
- Contains Decisions and alternate process flows
- Potential can be broken down further to instructional
- Is likely to have swimlanes with resources allocated to each step
- Processes can be broken down into further detail until we reach the instructional/task level. When all action steps cannot be broken down any further
we have reached the bottom of the process hierarchy.
- Instructional
- Used in the execution of the process
- Is the lowest micro level
- Should not have any levels of process below it
- Needs to be analysed for risk that may lead to higher level system process failure
- Is likely to have swimlanes with resources allocated to each step
Induction Training
Healthcare Induction training should be orientated toward the role being inducted. Having a process view of the healthcare organisation supported with process maps
makes this possible. Process standards and process mapping standards should be part of a role specific induction training suite. Process Definition and Process Maps
along with a systems view of where they fit in an induction program is an indicator of process mature healthcare organisation.
Please click for assistance on
Healthcare Process Mapping Facilitation
Process Mapping Symbols
ACHS states the following as standard process mapping symbols
- Activity or Action
- Connectors
- Decision
- Documentation
- Predefined Process
- Data Input
- Terminator
Process or action step. This is the most common symbol in both process flowcharts and business process maps. It is used at all levels of a process hierarchy.
Arrow/Connector. Displays the flow of action through the process. The arrow indicates the direction of inputs and outputs to process steps.
Decision. Indicates a question in the process flow. A decision shape can be used as binary option (Yes/No, Go/No Go) but can also be used when there are alternate
answers to the question. This is usually defined in the organisational process standards.
The Document flowchart symbol is for a process step that produces a document.
Predefined Process: A Predefined Process symbol is a marker for another process step or series of process flow steps that are formally defined elsewhere. This can be
used to define lower level processes in the process hierarchy.
The Data flowchart shape indicates inputs to and outputs from a process. The shape is often referred to as an I/O shape.
Terminators show the start and stop points in a process. When used as a Start symbol, terminators can depict a trigger action that sets the process flow into motion.
Simple is best when creating process maps. There are more symbols and types of process map. The above symbols are key.
Process Mapping Types
Flowchart
Recommended and used in Healthcare
SIPOC
Swimlane
Recommended and used in Healthcare
Value Stream
Micro
Macro
Manufacturing
BPMN
Process Mapping Standards for Healthcare
ACHS lists flowcharts or process mapping as one of the “right” quality tools to use in identification of processes, analyzing processes and data and planning solutions.
It can also be used as a basis for datums in measuring for improvement results. ACHS lists the following as the tool set to deliver quality improvement.
Process Levels as part of a process mapping standard need to be defined within the organisation to enable a consistent approach to:
- Process Design and Development
- Process Change
- Process Risk Analysis
- Organisational Training Programs
Process Levels should be designated from a Process Office within the organisation whose role is to ensure the process hierarchy is up to date.
ISO9001:2015
ISO 9000 is a family of standards for quality management systems. ISO9000 is maintained by ISO, the International Organization for Standardization and is administered
by accreditation and certification bodies. The rules are updated, as the requirements motivate changes overtime. Some of the requirements in ISO 9001:2008 (which is one
of the standards in the ISO 9000 family) include:
- a set of procedures that cover all key processes in the business
- monitoring processes to ensure they are effective
- keeping adequate records
- checking output for defects, with appropriate and corrective action where necessary
- regularly reviewing individual processes and the quality system itself for effectiveness
- facilitating continual improvement
A company or organization that has been independently audited and certified to be in conformance with ISO 9001 may publicly state that it is "ISO 9001 certified" or
"ISO 9001 registered". Certification to an ISO 9001 standard does not guarantee any quality of end products and services; rather, it certifies that formalized business
processes are being applied. Source:
http://en.wikipedia.org/wiki/ISO_9001
Business process mapping refers to activities involved in defining exactly what a business entity does, who is responsible, to what standard a process should be
completed and how the success of a business process can be determined. Once this is done, there can be no uncertainty as to the requirements of every internal business
process. A business process illustration is produced. The first step in gaining control over an organization is to know and understand the basic processes.
(Deming, 1982; Juran, 1988; Taylor, 1911)
ISO 9001 requires a business entity to follow a process approach when managing its business, and to this end creating business process maps will assist. The entity can
then work towards ensuring its processes are effective (the right process is followed the first time), and efficient (continually improved to ensure processes use the
least amount of resources).Source:
http://en.wikipedia.org/wiki/Business_process_mapping
Some broadly used process mapping standards are:
Gilbreth
The first structured method for documenting process flow, the flow process chart, was introduced by Frank and Lillian Gilbreth to members of ASME in 1921 as the
presentation “Process Charts, First Steps in Finding the One Best Way to Do Work”. The Gilbreths' tools found their way into industrial engineering curricula.
In 1947, ASME adopted a symbol set derived from Gilbreth’s original work as the “ASME Standard: Operation and Flow Process Charts.” The symbols used and displayed on
this page and their subsequent use comes from the original Gilbreth presentation and document.
In the year 1949, flowchart began to be used for planning computer programs and quickly became one of the most popular tools in designing computer algorithms and
programs. These tools are now the accepted method to capture processes within organisations.
Click here to view Process Charts by F & L Gilbreth
BPMN
BPMN provides a notation that can be readily understandable by all users
- Business Analysts
- Technical Developers
- Process Operators and Managers
Its structure contains
- Work Flow Elements
- Activities, Events, Gateways, Sequence Flow
- Organising Elements
- Readability Elements
- Special Behaviour Elements
- Messages, Signals, Timers, Errors, Repeaters, Correlation
Value Stream Mapping
A value stream map consists of:
- Everything, including non-value adding activities, that makes transformation from raw information and materials to what the customer is willing to pay for
- Communication all along the supply chain
- The network of processes and operations
Value
- Assumes that you are creating something of value that a customer is willing to pay for
Stream
- Refers to the sequential flow of activities needed to create work units and deliver them to the customer
- Value stream mapping is a graphical flow of activities and work units that produce value for a customer. One of its many benefits is that it clearly identifies
non-value add activities.
Choosing a Value Stream for Improvement
- Look beyond individual processes
- Look at Upstream and Downstream processes
- That share similar characteristics
- People
- Functions
- Databases
- Focus on economies of scale
- Activities when choosing a Value Stream
- Identify any immediate customer concerns
- Perform a work-unit routing analysis
- Prioritize target value streams
Process Mapping Software
MS Word and MS Excel can both deliver process maps - the standard office application for process maps is
MS Visio
There are many specialised process mapping applications available.
Please click here for a comparison.
To capture data and conduct statistical analysis on process metrics, particularly in a healthcare setting investigate the use of
WinSPC
Capturing Process Maps
When capturing processes the team needs to capture the As Is State:
- The As Is state is how the process is currently executed
- The As Is state is not necessarily the captured process map if it exists
- The As Is state requires input from all stakeholders, operators and potentially the process value stream
Process mapping Sessions:
- Are brainstorming sessions that capture the required process as a map
- Uses common brainstorming techniques
- Should include those executing the process
- Should include stakeholders if a process design session
- Should have a facilitator and a scribe as resource
- Should not attempt to capture the process as a standard process map
When capturing processes in a brainstorming session it is helpful to not use a computer. Instead give each resource and asset in the process a different colour post it note.
Each resource can then write on the post it note the action or decision and place in order. As each resource is in a different colour swimlane maps can be produced electronically after the session.
Steps in Creating a Process Map
- Select a process
- Define the process
- Map the main process steps
- Define the inputs
- Map any alternate process steps
- Map any inspection points
Within the process it is important to define:
- the output of the process
- the customers for the output
- the customer requirements
- the process participants
- the process owner
- the key stakeholders
- the process boundaries – the first and last steps of the process
- the inputs to the process and the suppliers of the inputs
Storing Process Maps
Some software applications will organise the storage of the process maps as part of their structure and can also link process maps in a chain and hierarchy. Key
Document Control Management System (DCMS) elements apply in the storage and retrieval of process maps. These elements should include:
- An agreed folder structure
- An approval process should ensure all process maps are stored to standard
- Access should be restricted to approved users for each process
- Associated data and files should be accessible from/with process map storage
- Should be stored as a library for change control purposes
Please click for assistance on Healthcare Process Mapping Facilitation
Process Risk and Control in Healthcare
Healthcare Risk identification in a process is generally identified in the following order:
- safety and regulatory or a catastrophic event
- system/process function failure or a major event
- customer dissatisfaction or a moderate event
- customer annoyance or a minor event
The Healthcare Process Characteristics Matrix reveals which processes in the organisation are aligned to safety and regulatory requirements and other key characteristics
or level of events. It gives the organisation a view into process change risk and where it is affected on internal and external changes. This can also aid in identifying
processes that require HFMEA investigation. Please click for assistance on
Process Risk and Control
Associated Process Map Documentation, Metrics and Tools
Documentation
- Process Definition
- Process Map/Flowchart
- Procedure
- Work Instruction
- Control Plan
- Control Chart Data
Metrics
- Process Capability
- Specification Limits
- Control Limits
- Customer Requirements
- Statistical Analysis
- Critical to Quality
- Time
- Defects
- Capability
- Efficiency
- Process Control Limits
- Rolled Throughput Yield
Tools
- Affinity Diagram
- Bar Chart/Graph
- Brainstorming
- Cause and Effect (Fishbone)
- Control Charts
- Characteristics Matrix
- Failure Modes Effects Analysis (FMEA)
- Flow Chart
- Histograms
- Lean Management
- Pareto Chart
- Patient Journey
- Poke Yoke
- Run Chart/Line Chart
- The 8 Deadly Wastes
Changing Process Maps
When changing process maps the organisation is looking at the process in the "To Be State"
- The To Be state is how the process should run in future
- Should be a efficient as possible
- Should endeavour to eliminate waste
- Should endeavour to eliminate risk
- Should be communicated when active in the business
- Should be accompanied with an appropriate level of training to the roles within the organisation affected by the new or changed process
- Should communicate change to appropriate external stakeholders