Map the current process Process Improvement Map the current process In this session we will look at process mapping and the various models that can be use to map out the current way that the process is being done. There are several exercises at the end of this presentation, and it is recommended that you practice the skills that you will learn on process mapping. 1

Map the Process What are process maps? Process maps are flow charts which graphically represent how an interrelated series of activities take place. Process maps are flow charts which graphically represent how an interrelated series of activities take place. They are simple but powerful tools used in Quality Improvement. It is important to note that these process mapping techniques do not apply well to policy issues. 2

Process Mapping Iterations “As Is” or “Current Process” map Allows process improvement teams to build a common understanding of how a process works Helps teams identify opportunities for improvement “To Be” or “Future Process” map Defines how the process would work more effectively and/or efficiently Drives the implementation plan You start with mapping out the current or “as is” process. This is developed with the core team and may have to be verified by an extended team. You will identify opportunities for improvement during this process. Document them but put them aside for reference when you start to map the future process. Once you have completed the current process map, and completed an analysis of it, you can then develop the “to be” map. 3

Different Types of Maps for Different Purposes Overview Map High Level View Linear Map Activities over time Swimlane Map Activities over time and WHO is doing what We are going to look at three different kinds of maps: overview, linear, and swimlane maps. As you will see, they each have a different purpose. Overview maps provide a high level view of a process. Linear maps show activities over time, and swimlane maps show not only activities over time, but also who is doing what.

Start with an Overview Map Gives a high level overview of the key functions of a process & establishes boundaries An overview map gives a very simple picture of the process. You can use it in a large process to define the boundaries of which processes you are including and which you define as being out of the scope of your mapping. This example is looking at incident management. The processes involved with preparation and recovery are defined as being outside of the scope of this mapping. 5

Then analyze details with Linear Maps Linear maps describe activities over time, but do not show who is performing the activity Linear maps show activities over time, but not who is performing them or who is responsible for their completion. In this example, you get up, get dressed, and then ask the question “Is it raining?” If it is you take an umbrella, and you drive to work. If it is not raining you drive to work. Notice the diamond shape. Activities are put into rectangles, and questions or decisions go into diamonds. All questions must have a yes and a no coming from them. 6

Then analyze details with Linear Maps Here is a public health example. This is an application to open a restaurant. The client submits the application. The application and plans are reviewed. Are they OK? If no, the issue must be addressed, and the application and plans are again reviewed. This continues until they are OK and then the restaurant is inspected. Again, we have another question or decision. If the inspection is not OK the issues must be addressed and the restaurant re-inspected until it is OK. Then the permit is issued. Linear maps work very well when you have only one person involved in a process. 7

Then analyze details with Swimlane Maps Swimlane maps describes activities over time and who is performing each activity Next we look at a swimlane map. This not only describes activities over time but also shows you who is performing each activity. This type of map is used more often than the linear map because we usually need to know who is doing what. This is a simple generic process of shopping. The customer comes into the store and selects items to purchase. She/he brings them to the clerk who rings up the sale. The customer pays and the clerk receives payment. These activities are in line with one another because they are concurrent tasks. The clerk then bags the purchase, and the customer takes it to the car. 8

Then analyze details with Swimlane Maps Here is a public health example. A patient arrives for a flu shot. The receptionist provides the patient with the paperwork. The patient completes the paperwork and gives it to the nurse. The nurse screens for contra-indications. Is the patient OK to receive the shot? If yes, the nurse gives the shot and the patient receives it. If not OK, the nurse provides the patient with alternate instructions. 9

Questions for Facilitating Swimlane Maps What happens next? Who does it? When developing a swimlane map you have two questions that you keep asking until the process is completed. They are “What happens next?” and “Who does it?”

Exercise 1: Swimlane Map Opportunity Statement: Increase the amount of revenue received from grants to 100% of the award. When the Business Administrator receives an approved grant contract, s/he meets with the Program Supervisor to establish a budget for personnel, and if supplies are chargeable, a budget for supplies. The Business Administrator then creates the grant record in the system. The Program Supervisor manages the grant deliverables. If supplies are chargeable to the grant the Program Supervisor submits the purchase request forms to the Purchasing Clerk. The Purchasing Clerk codes the purchases to apply to the grant. (The system will automatically apply personnel costs to the grant.) Quarterly the Business Administrator reviews and audits the charges to the grant and submits a voucher to the grantor for payment. Pause the module and take 15 minutes to develop your map. This is a simple exercise to practice doing swimlane maps. You can do process maps on Visio or by using simple tools such as butcher paper, post-it notes, and markers. Please take 10 to 15 minutes to map out the above scenario. Notice that we start on the top with the opportunity statement. This should also be on top of your map. There are no wrong ways of doing this. Whatever your team thinks best describes a process is the answer. 11 11

This is how we thought the process could be mapped This is how we thought the process could be mapped. Please check yours to make sure that you have both a yes and a no for each decision and that the arrows from them go to some activity. That activity can be that the process ends. We also added a row at the bottom where you can put comments or “business rules”, which we talk about in the next module. Some examples of comments might include that something is only done once a week or once a month. 12

This is how we thought the process could be mapped This is how we thought the process could be mapped. Please check yours to make sure that you have both a yes and a no for each decision and that the arrows from them go to some activity. That activity can be that the process ends. We also added a row at the bottom where you can put comments or “business rules”, which we talk about in the next module. Some examples of comments might include that something is only done once a week or once a month. 13

Opportunity Statement Swimlane or Linear Maps Review of the steps Opportunity Statement Overview Map To review quickly, you start with an opportunity statement which is used to define a desired improvement for a process. You then use an overview map to define the key activities and establish the boundaries of a process. You then move to either a swimlane or linear map. Swimlane or Linear Maps

Linear or Swimlane? Linear Swimlane The logic is more important than who does it For example, if there are many decisions You are describing work done by, or from the perspective of, one person Swimlane Objective is to understand how many players interact Which type of map do you use? Linear or swimlane? This slide helps you make that decision.

Mapping the “To Be” or Future Map Defines how the process would work more effectively and/or efficiently Drives the implementation plan Use the same type of map that you used for your “as-is” map Map out how the team thinks the process should work Develop an implementation plan based on the new model Don’t get too detailed at first Once you have mapped the current process and your core and extended teams validate it, you then move onto the analysis of your current process. We discuss ways to do this in module 4. After the analysis is completed, during which you identify possible improvements, you then map out the future process with the needed improvements included. You might end up with several variations of your future map. As you develop your implementation plan you can identify which is most doable.

Exercise: More Practice with Swimlane Maps For the practice exercise you select: Map out the “as is” process Think of at least three ways to improve the process Map out the “to be” process on a separate map or show the changes on your “as is” map Pause the module after each exercise description and take about 10-15 minutes to complete. Our “as is” answer will follow each exercise. We have provided you with 3 scenarios if you wish to practice more mapping. Each one is followed by our example of how we would do the map. Remember, there is no wrong way as long as it describes the process to both your core and extended teams and to leadership.

Practice Exercise A Opportunity Statement: Improve the efficiency of logging restaurant operating certificate renewals. Letters for renewal of operating certificates for restaurants are sent out twice a year, with 50% of them going out in January and 50% of them going out in July. When the fees and renewal applications are received, the clerk who receives them writes down the name of the restaurant, the date received and the amount received on a hand kept spreadsheet. She then gives the applications with the fees to another clerk who enters them into an Excel spreadsheet. 18 18

Practice Exercise B Opportunity Statement: Reduce the time it takes to approve purchase requests. Each unit within the LHD prepares their own purchase request using a paper request form. The form is then given to the division director who signs it for approval. The form is then given to the purchasing agent in the department who codes it and enters it into the county electronic purchasing system. The purchasing agent then e-mails the department’s Director of Administration that there are items waiting for his approval and sign off in the system. The Director of Administration then goes into the system, reviews each request and signs off electronically. He then notifies the Commissioner/Director by e-mail that there are purchase requests in the system waiting for his approval. The Commissioner/Director then goes into the system and reviews the requests and signs off. His request is then automatically sent to the county purchasing department for purchase. 20 20

Practice Exercise C Opportunity Statement: Improve the efficiency of clinical services billing. Clients register onto a patient database at a central registration desk for clinical services including immunizations and dental services. They are given a hand written billing form for the particular services that they are going to receive with their name, address, and insurance coverage on it. The clients bring the form to the clerk in the clinical area where they are going. After receiving the services the person who provided the service marks off which services they provided. The patient gives the form to the clerk. The clerk then brings the billing sheets at the end of the day to the billing clerk who is locate in the department’s business office. The billing clerk completes the billing forms for submission to private insurance and mails them out. She enters the information electronically for Medicare and Medicaid claims. 22 22