scott d. duncan, md, mha, faap. science of safety we cannot improve quality and safety of healthcare...
Post on 23-Dec-2015
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Science of Safety
We cannot improve quality and safety of healthcare until we view the everyday
delivery of healthcare as a science
Flow Charts
“If you can’t describe what your doing as a process, you don’t know what you’re doing”
W. Edwards Deming
•A written description of a process requires a common definition of terms, fluency with the concepts, and the absence of an agenda by the author and reader.
"Draw a flowchart for whatever you are doing. Until you do, you do not fully understand what you are
doing. You just have a job.“
"The first step in any organization is to draw a flow diagram to show how each component depends on others. Then everyone may understand what their
job is. If people do not see the process, they cannot improve it."
SIPOC+CM
• SIPOC is a data collection form that is used before we start to construct a flow chart since it helps us to gather relevant information about the process.
• Assists in gathering information about Suppliers, Inputs, Process, Outputs, and Customer of the process.
• SIPOC is high level view of the “As Is” state of a process under investigation.
SIPOC+CM
When to use it:• When first starting to investigate a process
and a team needs to understand the basics that make up the process.
• When a team needs a way to get the collective knowledge of the team members about a process recorded in an easy to view format.
• When we need to make a concise communication to others about a process and the parameters that it encompasses.
Process/Activities:
Begins With:Ends With:
Inputs:
Suppliers:
Outputs:
Customers:
Constraints:
SIPOC+CM Collection Form
Measures
Flow Charting
• Flow charting is the first step we take in understanding a process
• Organized combination of shapes, lines, and text
• Flow charts provide a visual illustration, a picture of the steps the process undergoes to complete it's assigned task
• From this graphic picture we can see a process and the elements comprising it
• Shows how interactions occur• Makes the invisible visible
• Puts a spotlight on waste • Streamlines work processes • Defines and standardizes the steps and
sequence • Promotes deep understanding • Builds consensus • Key tool for continuous quality improvement
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Flow Chart Benefits
Flow Charting Construction
• Clearly define the process boundaries to be studied
• Define the first and last steps – start and end points
• Get the right people in the room• Decide on the level of detail
– Complete the big picture first – macro view– Fill in the details – micro view
Flow Charting Construction
• Gather information of how the process flows: – Experience– Observation– Conversation– Interviews– Research
• Clearly define each step in the process– Be accurate and honest
Flow Charting Steps
• Use the simplest symbols possible – Post-Its • Make sure every loop has an escape • There is usually only one output arrow out of a
process box. Otherwise, it may require a decision diamond.
• Trial process flow – walk through people involved in the process to get their comments
• Make changes if necessary
• Identify time lags and non-value-adding steps.
Flow Chart Symbols
Activity:Operation/Inspection
Decision
Start/EndBookends
Document
Wait/Delay
Storage
Data Base
Transport
Input
Output
A Connector
Forms
CommentCollector
Input/OutputData
ManualOperation
Preparation
ManualInput
Display
Unfamiliar/Research
Process Mapping: Initial Workflow
HIV Positive Patient comes
to Clinic
Enrollment Process with RN
Patient scheduled to see MD
Registration Process with Receptionist
Patient returns to clinic for
appointment
Patient registers
Pt has access to
ARVs?
Intervention:· Counselling · CD4 test not
ordered
Intervention:· Counselling· CD4 testing
ordered
Lab open?
Yes
NoNo
Yes
Patient scheduled
for CD4 count
Blood for CD4 count drawn
Patient schedules
appointment to review results of
CD4 count
Patient returns to lab
for appointment
Patient returns to clinic for
appointment
Patient registers
Patient seen by Physician
Patient seen by Physician
Treatment plan is
developed.
CD4 count reviewed with patient, and significance explained.
Patient Leaves Clinic
Patient Leaves Clinic
Patient Leaves Clinic
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Analyzing A Flow Chart
Assessing the current process map with the goal of improving patient flow by looking for steps that:
i) Definitely add valueii) Add no value, but are unavoidableiii) Add no value, but are avoidable
Once completing a process map, return to the site and discuss it with employees to ensure its accuracy. Together, consider how the map could be used to make improvements to the system.
Analyzing A Flow Chart
Examine each:– Activity symbol – value/cost? – Decision point – necessary/redundant?– Choke Points – bottlenecks?– Rework loop – time/cost?– Handoff – is it seamless?– Document or data point – useful?– Wait or delay symbol – why?/reduce/eliminate– Transport Symbol – time/cost/location?– Data Input Symbol – right format/timely?– Document/Form Symbol – needed/cost/value?
HIV Positive Patient comes
to Clinic
Enrollment Process with RN
Patient scheduled to see MD
Registration Process with Receptionist
Patient returns to clinic for
appointment
Patient registers
Pt has access to
ARVs?
Intervention:· Counselling · CD4 test not
ordered
Intervention:· Counselling· CD4 testing
ordered
Lab open?
Yes
NoNo
Yes
Patient scheduled
for CD4 count
Blood for CD4 count drawn
Patient schedules
appointment to review results of
CD4 count
Patient returns to lab
for appointment
Patient returns to clinic for
appointment
Patient registers
Patient seen by Physician
Patient seen by Physician
Treatment plan is
developed.
CD4 count reviewed with patient, and significance explained.
Patient Leaves Clinic
Patient Leaves Clinic
Patient Leaves Clinic
Process Mapping: Areas for Improvement
26
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