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NHS Improving QualityProcess Mapping

1. Welcome and Introduction2. Housekeeping3. Process mapping for those new to service improvement

4. Decide what is to be process mapped5. Engage with key stakeholders and plan a process mapping session6. Create the current state process map7. Value streams8. Analyse and improve the process map9. Shaping a future state process map10. Mapping top tips11. What use is mapping?12. Links and Contacts details

AGENDA

NHS Improving QualityProcess Mapping

www.nhsiq.nhs.uk

Welcome and Introduction

Elaine KempProgramme Delivery ManagerLiving longer Lives

Jeri HawkinsMental Health and Dementia Delivery Support Manager

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What is a process map?

• A process map describes a series of steps or actions which deliver an output

• Maps are a visual way of describing a process• Everyone works in a process• A learning opportunity bringing teams together to take a

step back and look at how the work gets done

What is a process map?

What will you process map and why?

Process maps help clarify what we do and why we do it – highlight opportunities for improvement

Identifies –• Bottle neck – delays• Unnecessary steps – don’t add value/waste• Duplication and rework

Engage with key stakeholders and plan a process mapping session

• What is the purpose of the session?• Who should lead the session?• Who should attend the session?• Communication and engagement?• What are the proposed start and end points?• What level of detail is required?• Can leaders walk the process beforehand?• Who is the service for?• Any key data that can be collected beforehand?

Lift receiver

Dial Number

Let phone ring

Say Hello

Have Conversation

Say Good Bye

Hang up receiver

Answered?Yes

No

Start \ Finish

Task

Decision or Choice

Direction of flow

Key

Create the current state process map

Levels of Mapping – example from outpatientsEnters OPD

All Internal Processes

Leaves OPD

Sees admin

Sees nurse

Sees Consultant

Has Tests

Sees Consultant

Etc etcHigh

MediumEnters room

Takes history

Asst with undress

Take weight , BP etc

Etc Leaves room

Asst patient onto scales

Zero scales

Take reading

EtcLow

Overall parameters

Etc

Choose & Book(C&B)

Fully Booked System

Admin post x

GP Paper Referrals

Partially Booked

Non GP

• DVLA• Consultants• Community

Services• Dental

• Self Referral

Print off ‘Work List’ of new

received referralsDaily in AM

Update form with• UBRN • NHS No• Hospital No• Breach date• Appointment Date• Clinic Code• ConsultantSee Example form XX

Attach completed UHL’s C&B ‘Referral

Tracking Form’

Take referral letters and Referral Tracking

form (C&B only) to Medical Secretary

Daily in AM for Consultant Grading

OPW List Team receive graded referral

letter back from Medical Secretary and

any signed test request cards

Rejected

Accepted

OPW List Team update the HISS system

GP not always creating and attaching referral letter to the C&B system within 48 hrs. Takes time to chase.

The ‘Status column on the work list does not update from ‘Never Reviewed Status’’. Useful if could identify if letters have been printedSee Example form XX

Check C&B System for Referral Letter Print off Referral Letter

Check HISS for UBRN

Creation date &

Clinician

Letters not always attached on the C&B system in a Word Format. Takes time to convert from ‘Rich Text, and print them off. There is no facility to resave the Word version on the system by the OPW List team

Not all GP’s are able to attach more than one document to the system and fax over other documents. Not going to a central number

Work list does not identify: • Consultant

to be seen

• Date UBRN created.

Have to check on Hiss

Letter received by and is date stamped by

• OPW List Team

• Medical Secretary – gives to OPW team

Check HISS to identify if patient has been seen in the hospital previously to ensure there is only one set of medical notes

Register the referral letter on HISS

Stamp Letter with ‘Outcomes List’’

See Example XXThis creates and opens an episode

Patients may have more than one UHL number. Need to get them merged via

medical recordsCan have system numbers

OPW List team can allocate U number

Referral Received

Referral letters do not always have all

the information required on them.

Will now go on Booking List with Partial Booking

Team and chased weekly if not

returnedIf test required card requests are

taken to the Investigations

Dept by the OPW List Team

Update with • Tests required• Breach date• Appt date for clinic

Not all GP’s are using the system

ProcessWhat is done Issues

OPW List team send appointment confirmation to patient.

Discharged

Letter cc to GP by Medical Secretary

Referred onto another consultant (cardiologist / cardiac surgeon)

Due to lack of information on C&B website, the initial referral was sent to wrong cardiology consultant

Map Number 19 C&B Referral acceptance process

Name and date

Rebooked

Referral is accepted/rejected

by consultant

s or rebooked to another

date

How long?

How many each day?

Is it a Value Stream or Process Map?

• What the heck is a “Value Stream”?• Why does it matter to me?• What is the difference between a Value Stream

Map and a process map?• When should I use a Value Stream Map

Value Streams• Concept from Lean (Toyota Production System)• Mapping and visualisation of complexity brings about

shared understanding– Real benefit in the mapping process itself

• Value stream = broad & wide view– Use for identifying improvement opportunities across

departments/organisations

• Process map/chart = detailed micro-level– Use for identifying specific improvements and waste at a

detailed level

• Which to use – Both!

Tools and techniques that can help with mapping

We’ve got a process or value stream map – now what?

• Secure map!(Use tape to secure post-its – otherwise they will fall off)

• Amendments / comments added(in different coloured post its?)

• Consensus agreed – is the map accurate?• Documentation of the process(Photograph the map? Make electronic copy (Visio)?)

• Circulation to all stakeholders orbring stakeholders to map for explanation?then Process / service redesign

St Elsewhere – PICU Admissions – 8th Jan 2014

Tip: If storing map, write title & date on outside

Analyse and improve the process map

• How many steps and handoffs (passing the patient/service user from one person to another)?

• Time between each step - any delays and why?• Where are the bottlenecks or queues?• Steps that do / do not add value?• How many steps for the patient/service user and are

they built in for a reason?

Analyse and improve the process map (2)• Where are the problems?• What do the patients / service users complain about?• Where are there things done more than once?• What does staff complain about?• Have you got all the data you need? • If not what is your plan to complete the map?• Can you eliminate any waste?• Can you eliminate any steps?

Shaping a future state process map

0.25 Hrs

0.25 Hrs30 sec2.0 Days

0.5 Hrs1.5 Hrs

0.25 Hrs

30 sec0.5 Hrs

1 min

Samplearrives Results

To GP

Key: Process step Decision Issue / problem

St Elsewhere – PICU Admissions – 8th Jan 2014

0.5 Hrs

0.25 Hrs

1.5 Hrs

30 sec

0.25 Hrs

1 min

0.25 Hrs

Tip: Use your current state map as your starting point to develop your future state map, but keep them separate as your current state is a reference benchmark.

Shaping a future state process map

Look at the current state map problems – prioritise - list required changes. Create a high level change plan – consider any constraints - time, money, peopleDetermine if this will be a fix of the current state or a complete new process

Create future state mapMapping future state typically (but not always) takes only 25-35% of the time to map the current state

Don’t stop at 2!

Implement!Confirm results

We now have a new current state – how does thatcompare with our future state plan. Can we close our project or start our next iterative PDSA cycle?

Mapping

+ -

Mapping Top Tips• Plan, plan, plan, plan! A complex mapping event can

take several days and you need the right people.• Good facilitation for your mapping event is worth its

weight in gold!• Current state mapping is not about process redesign.• Don’t be afraid to get out there and see the process

or stream for yourself – warts and all need to be included in the current state.

• Don’t forget the data.

What use is process mapping?Example 1:

• A series of multidisciplinary process mapping events were undertaken in NHS Fife to commence the development of Integrated Care Pathways in Mental Health. As part of the development of Integrated Care Pathways (ICPs) in Mental Health, process mapping sessions were carried out for the five diagnostic specific and the generic ICPs.

What use is process mapping?

This is a process map of the records management process at a healthcare organisationA team of 14 people took a half day mapping training to record the current processOutcomesIdentified savings of: £2000 per annum in document storage costs 12 square meters document shelving freed up Computerised document management system made redundant (replaced by simple visual controls) ~160 hours per year of admin time freed upJUST from the training event…!

Any Questions?

Click links to see - A simple guide to service improvementBringing lean to life

CLOSE

THANK YOU FOR JOINING US TODAY

• For further information please see our website http://www.nhsiq.nhs.uk/

• Elaine.kemp@nhsiq.nhs.uk• Jeri.hawkins@nhsiq.nhs.uk

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