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NHSIQ held a “Introduction to Process Mapping” webinar for strategic clinical network and mental health teams. The aim was to provide staff with a grounding or refresher into using this powerful service improvement tool.
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Welcome!
We will start shortly, but are waiting for people to join, don’t worry if you can’t hear anything yet.
Before we start we will be going through some E-Seminar housekeeping items, so that everyone can participate fully in the online meeting
If you are having difficulties joining the meeting please call Sue O’Neil on 0116 295 0081
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
• During the E-Seminar we will mute all delegate’s lines throughout the presentation.
• If at other times you are in a noisy environment please mute your line by pressing the mute button on your screen (this can be found on the right hand side of the screen)
• If you would like to ask a question please use the raise hand button (this can be found on the right hand side of the screen)
• This is an interactive session, please add your comments, and thoughts into the chat box as we go through the presentation.
• At the Q&A session, type your question into the chat, or raise your hand, we will un-mute all lines during the Q&A.
• If you are having any technical problems, send a message to the Host via the chat panel or call Sue O’Neil on 0116 295 0081
• We will now start recording this Webinar
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/
• [email protected]• [email protected]
You will be sent a link to both the recorded presentation and slides