OUTLINE
• 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
Oval: Show the input to start the process
Box or Rectangle: Show a task or activity performed in the process
Diamond: Shows where a Yes/No question is asked
or a decision is required
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
YesNo
Arrows show direction or the flow of the process
Make sure every feedback loop is closed, Every path takes you either back or forward to another step
TEMPLATE
Flow Chart
QUALITY SYSTEM ESSENTIAL Organization
DCCS
Chief, Pathology
DeWitt Army Community HospitalDepartment of Pathology
Soldiers
MLT Phase II
Safety
Anatomical Pathology
Clinical
Pathology
Client
Services
DecentralizedLabs
Histology
Chemistry
Blood Bank
Microbiology
Hematology
Central Processing
Phlebotomy
Shipping
POCT
Rader
Woodbridge
Fairfax
Lab Manager
NCOIC
Quality Management
Administrative Support
Organizational Chart6/28/2007
Assistant Lab Manager
GS CivilianDA 4106,
FM 879, DD 689 CA-1 & CA-17* *when applicable
Report to ER for emergent care
ATTENDING MD
Report to your respective Contract
Representative Office or Primary Provider for follow- up 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
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 HIVTests: 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
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)
Report to ER for emergent care
Decide on PEP (post exposure prophylaxis) therapy
• If YES, contact WRAMC Infectious Disease for follow up 202-782-1663
APPLY FIRST AID !!!OR REPORT TO ER IMMEDIATELY
MilitaryDA 4106DD 689FM 879
Patient, Contract , Student, Volunteer,
VisitorDA 4106
SUPERVISOR
• 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
UPDATED 11-23-2004
NEEDLESTICKOr other blood borne pathogen exposure
NOTIFY SUPERVISORSupervisor/ employee complete the assigned forms
What is the status of the employee?
END
ACCIDENT/INJURY REPORTING
GS/WG CivilianDA 4106,
FM 879, DD 689 CA-1 & CA-17*
*when applicable
Report to ETR for emergent care and
OH for first aid (DD 689 required)
Report to your respective Contract
Representative Office or Primary Provider for follow- up care
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.
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.
Phone #s: Safety Manager (805-0157); Occupational Health (805-0443); Infection Control (805-0044); Patient Safety (805-8048);CPAC (703-704-2743)
Report to ETR for emergent care
FIRST AID FIRST!!!IF UNCLEAR, REPORT TO ER IMMEDIATELY
MilitaryDA 4106DD 689FM 879
(Both On and Off Duty accidents
must be reported)
Contract , Student, Volunteer, Visitor
DA 4106
SUPERVISOR
• Ensure paperwork is properly filled out• Forward Paperwork to designated area. REFER TO BACK PAGE.•Report event to Safety Management Office at 703-805-0157
Report to ETR for emergent care and
OH for first aid (DD 689 required)
UPDATED 02-04-2005
NOTIFY SUPERVISORSupervisor/ employee complete the assigned forms
What is the status of the employee?
END
DA 4106
(Incident Report)
FM 879 (Dewitt Army Community
Hospital Supervisor’s Mishap Report)
DD 689 (Individual Sick
Slip)
CA-1 (Federal Employee’s Notice
of Traumatic Injury and Claim for Continuation of
Pay/Compensation)
CA-17 (Duty Status Report)
SF 558 (Emergency Care and
Treatment- Dewitt ACH)
SAFETY MANAGER
COPY ORIGINAL COPY COPY(Electronically
submitted)
COPY COPY
OCCUP HEALTH
COPY COPY COPY COPY
PATIENT SAFETY
ORIGINAL
*CPAC
(Civilian only)
ORIGINAL ORIGINAL ORIGINAL COPY
EMPLOYEE FILE
COPY COPY COPY COPY COPY
LAB PI COPY COPY COPY COPY COPY COPY
# OF COPIES 2 2 4 4 4 5
*** START***Confirmed
CRITICAL VALUE
NOTIFICATION / DOCUMENTATION CRITICAL VALUES
Inpatient (Wards )
CALL MOD ( after minimum of 2 attempts )
Outpatient, ER and Outlying Clinics
(Fairfax+ Woodbridge)
Patient’s location?
Document in CHCS
*** END ***
Ask for :
1st: ORDERING PROVIDER2nd: RN in charge of patient or charge nurse
Successful Reporting ?
Successful Reporting?
Normal duty hour? (Refer to Clinic hours)
Normal duty hr: -Inform supervisor, lab manager, QI, or pathologist
Off duty hr:-Call pathologist-on call
Call clinic and ask for
ORDERING PROVIDER
Page ORDERING PROVIDER
YES
NO
YES
NO
YES NO
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
QUALITY SYSTEM ESSENTIALSPURCHASING AND INVENTORY
REQUEST FOR CRITICAL EQUIPMENT/SUPPLIER/SERVICES
DOCUMENT QUALIFIERS REQUIREMENTS (REFER TO PROCESS VALIDATION FORM)
Meets requirements?NO
YES
1. Request for 3953 (Purchase request and commitment)2. Accounted by property book (check annually)3. Med Maint will do functional, preventive checks4. Provide ER 24-7
1. Received by authorized or designated personnel (supply officer)2. If high priority, will notify telephonically
Deliver to the section
SECTION CHECKS/
DOCUMENTS:-supplies: lot #, expiration dates, temperature, qc-equipment: calibration, scheduled qc
CHECKS WITHIN ACCEPTABLE LIMITS?
YES
READY FOR USE
NO
REMOVE FROM LIST
Page 1
PROCESS IN EVALUATING CRITICAL MATERIALS/ SERVICES
DMLSS (common use, not in contract)
CONTRACT (request for
3953, yearly)
CREDIT CARD (for emergency
request)
For equipment/services:
For supplies:
APPROVED BY LAB MANAGER
BACK TO MAINTENANCE
OR SUPPLY OFFICER
Urine Collection Process in the Outpatient Phlebotomy Area
Log in CHCS
Print &Verify Labels
Patient Collect Sample
Patient Arrive
Met Requirements
?
Yes
Label samples
Patient turn in sample
Give instructions
to patient
Transport toShipping
dept
Ship to reference
lab?
Specimen transport to UA section
Start
YesNo
No
Log inCHCS
Collect samples
Greet patient with a smile A
Phlebotomist Available
Patient Satisfaction Survey
V,M
Patient Waiting Time V,M
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
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
Request for at least 2 IDs (DOB and name)
Labels ; printer
Labeled cups
INPUT PROCESS OUTPUT
(Adjustable, Specs?) (Valuable, Measurable?)
Patientarrive
Transportto lab
IMPROVE CUSTOMER SERVICE IN THE PHLEBOTOMY ROOM
VerifyLabels
Example of Measurable Output CUSTOMER SERVICE
COMPLAINTS
0
5
10
15
20
25
Access Policy Staff Behavior Quality of Care Misc
1st Q
2nd Q
3rd Q
4th Q
Percent Served <= 15 Minutes (Threshold: 90%)
60%
65%
70%
75%
80%
85%
90%
95%
100%
1 2 3 4 5 6 7 8 9 10 11 12
2006 2007
QUALITY SYSTEM ESSENTIALSASSESSMENTS
PHLEBOTOMY WAITING TIME
QUALITY SYSTEM ESSENTIALSASSESSMENTS
2007 PATIENT RECALL (Threshold: < 1%)
0
500
1000
1500
2000
2500
3000
3500
4000
4500
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1.4%
1.6%
1.8%
2.0%
# of patient seen % of pateint recalled
% Urine Contamination
0%
10%
20%
30%
40%
50%
previous current
25%
75%
male
female
16%
84%
male
female
peersYour lab
Example of Measurable OUTPUT
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)
Log inCHCS
Collect samples
Greet patient with a smile A
Phlebotomist Available
Patient Satisfaction Survey
V,M
Patient Waiting Time V,M
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
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
Request for at least 2 IDs (DOB and name)
Labels ; printer
Labeled cups
INPUT PROCESS OUTPUT
(Adjustable, Specs?) (Valuable, Measurable?)
Patientarrive
Transportto lab
Improve Customer Service In The Phlebotomy Room
VerifyLabels
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