Process Mapping for Quality Improvement
DR.
PARMINDER GAUTAM
NHSRC
PROCESS MAPPING
Process approach to Quality
Saturday, 22 February 2025
Dr. Parminder
Gautam
1
Donabedian’s Model of Quality of Care
Input Process Output
22-02-2025
QI-NHSRC Delhi
3
Input
Process
Output
WHAT IS A PROCESS
A process is a set of interrelated or
interacting activities which transforms
inputs into outputs
A process is defined as “a series of
steps which convert one or more
inputs into one or more outputs.”
Saturday, 22 February 2025
Dr. Parminder Gautam
4
What is a process map ?
0
Graphical representation of the series of steps of a
process
0
A pictorial representation of the sequence of actions
that comprise a process.
0
It traces the flow of physical product and information
through the steps
0
If there is no physical product, the map is used to
document the step-by-step activities involved in
providing a service
Saturday, 22 February 2025
Dr. Parminder Gautam
5
Why process mapping ?
Saturday, 22 February 2025
Dr. Parminder Gautam
6
Why Process Mapping?
0
Visually represents
the work process
0
Before you can improve a process, you must
understand
it.
0
Provides a
common understanding
of the entire process
and specific roles and contributions of process
participants.
0
Identifies
problem areas
and opportunities for process
improvement
0
Process maps are a
great problem solving tool
0
Helps us determine what is the problem/what it is not
0
You don’t learn to Process Map,
You Process Map to learn.
(Dr.Myron Tribus)
Saturday, 22 February 2025
Dr. Parminder Gautam
7
Why Process Mapping
0
Increase efficiency
0
Eliminate non-value-added activities
0
Reduce cycle time
0
Expand service capabilities
0
Simplify work flow
0
Minimize dependencies
0
Gain buy-in and organizational support for change
Saturday, 22 February 2025
Dr. Parminder Gautam
8
Why is Process Mapping Important?
0
It provides an opportunity to learn about
work that is being performed.
0
Dr. Myron Tribus said
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.
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Most processes today are
undocumented.
Saturday, February 22, 2025
9
Dr. Parminder Gautam NHSRC
Saturday, 22 February 2025
Dr. Parminder Gautam
10
Looking at patient processes
0
30 - 70% of work doesn’t add value for
patient
0
up to 50% of process steps involve a ‘hand-
off’, leading to error, duplication or delay
0
no one is accountable for the patient’s ‘end
to end’ experience
0
job roles tend to be narrow and fragmented
Symbols used to Process Map
0
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.
Saturday, 22 February 2025
Dr. Parminder Gautam
11
Important Points
0
Process Map what is, not what you would like the
process to be.
0
Process Mapping is dynamic. Use Post-it notes, dry
erase markers, pencil, etc.
0
All Process Maps must have start and stop points
.
Saturday, 22 February 2025
Dr. Parminder Gautam
12
Compiling a Process Map
Saturday, 22 February 2025
Dr. Parminder Gautam
13
Name of the person
completing task
+
verb
Who does what and when?
Process Bottlenecks
occurs when a step is the limiting
rate of the process
The step takes a significant time, and slows the whole process
down.
Saturday, 22 February 2025
Dr. Parminder Gautam
14
Saturday, 22 February 2025
Dr. Parminder Gautam
15
FUNCTIONAL BOTTLENECK
Value adding
The activity transforms the patient and moves
them towards the next defined outcome
The activity is something that the patient cares
about
Non-value adding
Do not serve any purpose (aim to remove these)
Necessary non-value adding
Do not directly benefit patient but are necessary
e.g. completion of forms, logging patient details
onto systems, numerous checks of details
Saturday, 22 February 2025
Dr. Parminder Gautam
16
VALUE / NON-VALUE ADDING
STEPS
Value-added Task
0
It is done right the first time with no waste
or rework.
0
It is value-added or it is waste (non-value
added)
Saturday, 22 February 2025
Dr. Parminder Gautam
17
WASTE IS A SENSITIVE ISSUE
0
Its critical to eliminate “waste”
0
Its also critical to recognise that the non value
adding activities may have been a core part of
someone job for many years
0
It’s the activities that are non value adding not
the person
Saturday, 22 February 2025
Dr. Parminder Gautam
18
Wastes in Hospitals (MUDAS)
0
1. confusion
0
2. Motion/conveyance.
0
3. waiting
0
4. over processing
0
5. inventory.
0
6. defects
0
7. over production
.
Saturday, 22 February 2025
Dr. Parminder Gautam
19
Wastes in Hospitals (MUDAS)
0
1. Confusion:
0
Nurses spend 65% of their time looking for things
they could not find, clarifying unclear instructions and
doing redundant paperwork.
(Jimmerson et al. 2005).
Confusion includes questions like:
0
What do I do with this requisition?
0
What does this order mean?
0
Where do I have to store this item?
Saturday, 22 February 2025
Dr. Parminder Gautam
20
Wastes in Hospitals (MUDAS)
0
2. Motion/conveyance:
0
Physical movement required to get a simple task done
and to move people from place to place.
0
Redundant reaching for items.
0
Walking to another location only to return to the
starting point.
0
Conveyance of patients and materials from room to
room or department to department.
Saturday, 22 February 2025
Dr. Parminder Gautam
21
Wastes in Hospitals (MUDAS)
0
3. waiting:
0
Waiting for :
0
a procedure to be done,
0
a medication to arrive,
0
or a doctor’s order to be given.
Saturday, 22 February 2025
Dr. Parminder Gautam
22
Wastes in Hospitals (MUDAS)
0
4. over processing:
0
Doing more activities than is necessary to complete a
work.
0
Multiple entries of patient’s demographic details
during the hospital visit.
Saturday, 22 February 2025
Dr. Parminder Gautam
23
Wastes in Hospitals (MUDAS)
0
5. Inventory:
0
Stored supply that are:
0
Obsolete.
0
Duplicated.
0
Unnecessary.
0
Missed charges for items used.
Saturday, 22 February 2025
Dr. Parminder Gautam
24
Wastes in Hospitals (MUDAS)
0
6. defects:
0
Medication errors.
0
Wrong site surgery.
0
Leaving instruments in patient’s body.
0
Wrong blood group errors.
0
Bed sores.
0
Incidence of fall from bed.
Saturday, 22 February 2025
Dr. Parminder Gautam
25
Wastes in Hospitals (MUDAS)
7. Over Production:
Doing more work than necessary.
Redundant Paper work. (Waste of patient time,
possibility of error, )
Saturday, 22 February 2025
Dr. Parminder Gautam
26
Analysing the process map
How many steps in your process?
How many duplications?
How many hand-offs?
What is the approximate time of or between each
step?
Where are possible delays?
Where are major bottlenecks?
How many steps
do not add value
for patients?
How many types of wastes are there between each
step?
Where are the problems for patients and staff?
Saturday, 22 February 2025
Dr. Parminder Gautam
27
Add
value
Remove
waste
Saturday, 22 February 2025
Dr. Parminder Gautam
28
Remember always aim to
Basic Process Redesign
Techniques
0
Eliminate non-value-added activities
0
Eliminate duplicate activities
0
Combine related activities
0
Identify and remove waste at each step.
0
Process in parallel
0
Use decision-based, alternative process
flow paths
Saturday, 22 February 2025
Dr. Parminder Gautam
29
Process mapping facts
0
Process mapping is basic and simple — the best way to
learn it is to
do it!
0
Process mapping is a repetitive process, maps should
never be thrown away but
reviewed and updated.
0
Display
the maps so all staff can see them and
contribute to ongoing improvements
Saturday, 22 February 2025
Dr. Parminder Gautam
30
Value Stream Map
Movement of Nursing Staff
" If the world were perfect,
it wouldn't be”
Yogi Berra
Thank You
What gets Measured
Gets Focused
What gets Focused
Gets Improved
What gets improved
Gets Appreciated
What gets Appreciated
Gets Institutionalized
A process map is a graphical representation of a series of steps in a process, essential for understanding, identifying problem areas, and improving efficiency in service delivery. Process mapping visually represents work processes and aids in gaining organizational support for change.
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Presentation Transcript
PROCESS MAPPING Process approach to Quality DR. PARMINDER GAUTAM NHSRC Dr. Parminder Gautam Saturday, 22 February 2025 1
Donabedians Model of Quality of Care Outcome Process Structure
Input Process Output Pre- Post- Analytical Analytical Analytical Output Process Input 22-02-2025 QI-NHSRC Delhi 3
WHAT IS A PROCESS A process is a set of interrelated or interacting activities which transforms inputs into outputs A process is defined as a series of steps which convert one or more inputs into one or more outputs. Saturday, 22 February 2025 Dr. Parminder Gautam 4
What is a process map ? 0 Graphical representation of the series of steps of a process 0 A pictorial representation of the sequence of actions that comprise a process. 0 It traces the flow of physical product and information through the steps 0 If there is no physical product, the map is used to document the step-by-step activities involved in providing a service Saturday, 22 February 2025 Dr. Parminder Gautam 5
Why process mapping ? Saturday, 22 February 2025 Dr. Parminder Gautam 6
Why Process Mapping? 0 Visually represents the work process 0 Before you can improve a process, you must understand it. 0 Provides a common understanding of the entire process and specific roles and contributions of process participants. 0 Identifies problem areas and opportunities for process improvement 0 Process maps are a great problem solving tool 0 Helps us determine what is the problem/what it is not 0 You don t learn to Process Map, You Process Map to learn. (Dr.Myron Tribus) Saturday, 22 February 2025 Dr. Parminder Gautam 7
Why Process Mapping 0 Increase efficiency 0 Eliminate non-value-added activities 0 Reduce cycle time 0 Expand service capabilities 0 Simplify work flow 0 Minimize dependencies 0 Gain buy-in and organizational support for change Saturday, 22 February 2025 Dr. Parminder Gautam 8
Why is Process Mapping Important? 0It provides an opportunity to learn about work that is being performed. 0Dr. Myron Tribus said You don t learn to Process Map, You Process Map to learn. 0Most processes today are undocumented. Saturday, February 22, 2025 Dr. Parminder Gautam NHSRC 9
Looking at patient processes 030 - 70% of work doesn t add value for patient 0up to 50% of process steps involve a hand- off , leading to error, duplication or delay 0 no one is accountable for the patient s end to end experience 0job roles tend to be narrow and fragmented Saturday, 22 February 2025 Dr. Parminder Gautam 10
Symbols used to Process Map 0 Start & End: An oval is used to show the materials, information or action (inputs) to start the process or to show the results at the end (output) of the process. 0 Activity: A box or rectangle is used to show a task or activity performed in the process. Although multiple arrows may come into each box, usually only one arrow leaves each box. 0 Decision: A diamond shows those points in the process where a yes/no question is being asked or a decision is required. 0 Break: A circle with either a letter or a number identifies a break in the process map and is continued elsewhere on the same page or another page. Saturday, 22 February 2025 Dr. Parminder Gautam 11
Important Points 0 Process Map what is, not what you would like the process to be. 0 Process Mapping is dynamic. Use Post-it notes, dry erase markers, pencil, etc. 0 All Process Maps must have start and stop points. Saturday, 22 February 2025 Dr. Parminder Gautam 12
Compiling a Process Map Name of the person completing task + verb Who does what and when? Saturday, 22 February 2025 Dr. Parminder Gautam 13
Process Bottlenecks occurs when a step is the limiting rate of the process The step takes a significant time, and slows the whole process down. Saturday, 22 February 2025 Dr. Parminder Gautam 14
FUNCTIONAL BOTTLENECK Saturday, 22 February 2025 Dr. Parminder Gautam 15
VALUE / NON-VALUE ADDING STEPS Value adding The activity transforms the patient and moves them towards the next defined outcome The activity is something that the patient cares about Non-value adding Do not serve any purpose (aim to remove these) Necessary non-value adding Do not directly benefit patient but are necessary e.g. completion of forms, logging patient details onto systems, numerous checks of details Saturday, 22 February 2025 Dr. Parminder Gautam 16
Value-added Task 0It is done right the first time with no waste or rework. 0It is value-added or it is waste (non-value added) Saturday, 22 February 2025 Dr. Parminder Gautam 17
WASTE IS A SENSITIVE ISSUE 0Its critical to eliminate waste 0Its also critical to recognise that the non value adding activities may have been a core part of someone job for many years 0It s the activities that are non value adding not the person Saturday, 22 February 2025 Dr. Parminder Gautam 18
Wastes in Hospitals (MUDAS) 01. confusion 02. Motion/conveyance. 03. waiting 04. over processing 05. inventory. 06. defects 07. over production. Saturday, 22 February 2025 Dr. Parminder Gautam 19
Wastes in Hospitals (MUDAS) 0 1. Confusion: 0 Nurses spend 65% of their time looking for things they could not find, clarifying unclear instructions and doing redundant paperwork. (Jimmerson et al. 2005). Confusion includes questions like: 0 What do I do with this requisition? 0 What does this order mean? 0 Where do I have to store this item? Saturday, 22 February 2025 Dr. Parminder Gautam 20
Wastes in Hospitals (MUDAS) 0 2. Motion/conveyance: 0 Physical movement required to get a simple task done and to move people from place to place. 0 Redundant reaching for items. 0 Walking to another location only to return to the starting point. 0 Conveyance of patients and materials from room to room or department to department. Saturday, 22 February 2025 Dr. Parminder Gautam 21
Wastes in Hospitals (MUDAS) 0 3. waiting: 0 Waiting for : 0 a procedure to be done, 0 a medication to arrive, 0 or a doctor s order to be given. Saturday, 22 February 2025 Dr. Parminder Gautam 22
Wastes in Hospitals (MUDAS) 0 4. over processing: 0 Doing more activities than is necessary to complete a work. 0 Multiple entries of patient s demographic details during the hospital visit. Saturday, 22 February 2025 Dr. Parminder Gautam 23
Wastes in Hospitals (MUDAS) 0 5. Inventory: 0 Stored supply that are: 0 Obsolete. 0 Duplicated. 0 Unnecessary. 0 Missed charges for items used. Saturday, 22 February 2025 Dr. Parminder Gautam 24
Wastes in Hospitals (MUDAS) 0 6. defects: 0 Medication errors. 0 Wrong site surgery. 0 Leaving instruments in patient s body. 0 Wrong blood group errors. 0 Bed sores. 0 Incidence of fall from bed. Saturday, 22 February 2025 Dr. Parminder Gautam 25
Wastes in Hospitals (MUDAS) 7. Over Production: Doing more work than necessary. Redundant Paper work. (Waste of patient time, possibility of error, ) Saturday, 22 February 2025 Dr. Parminder Gautam 26
Analysing the process map How many steps in your process? How many duplications? How many hand-offs? What is the approximate time of or between each step? Where are possible delays? Where are major bottlenecks? How many steps do not add value for patients? How many types of wastes are there between each step? Where are the problems for patients and staff? Saturday, 22 February 2025 Dr. Parminder Gautam 27
Remember always aim to Add value Remove waste Saturday, 22 February 2025 Dr. Parminder Gautam 28
Basic Process Redesign Techniques 0Eliminate non-value-added activities 0Eliminate duplicate activities 0Combine related activities 0Identify and remove waste at each step. 0Process in parallel 0Use decision-based, alternative process flow paths Saturday, 22 February 2025 Dr. Parminder Gautam 29
Process mapping facts 0 Process mapping is basic and simple the best way to learn it is to do it! 0 Process mapping is a repetitive process, maps should never be thrown away but reviewed and updated. 0 Display the maps so all staff can see them and contribute to ongoing improvements Saturday, 22 February 2025 Dr. Parminder Gautam 30
What gets Measured Gets Focused What gets Focused Gets Improved What gets improved Gets Appreciated " If the world were perfect, it wouldn't be Yogi Berra Gets Institutionalized What gets Appreciated Thank You
