1. UNDERSTANDING PROCESS Heidi Johns Quality Leader BCPSQC April, 2013

2. Objectives What are processes and why are they important to systems? Various ways to communicate processes. What is Mapping and when to use these techniques.

3. Avedis Donabedian “ Another approach to assessment is to examine the process of care itself rather than outcome.” Avedis Donabedian, Evaluating the Quality of Medical Care, Milbank Quarterly. Volume 83, Issue 4

4. What is a Process? Process is NOT the system [structure]. A system allows for process. A system is made up of processes. In simple terms processes are sequences of actions with: Inputs + Process = OUTPUT

5. OUTPUT INPUT PROCESS

7. What is process mapping? “shows people what their jobs are and how they should interact with one another… describes the flow of materials, information and documents, displays various tasks contained within the process [and] indicates the decisions need[ed] “ » www.cps.gov.uk »

8. Why understand process – the benefits Reduces Assumptions Improves Clarity Enhances Linkages There is no substitute for knowledge." -W. Edwards Deming

9. Process Difficulties !!!

10. Why understand process - the difficulties Can be biased Too much time stuck in details Language barriers Mixed groups

11. Process tools There are various tools available to evaluate a process.

12. Process Analysis tools Fault Tree Analysis Relationship Maps Cross- functional Process Maps [swim lane] Value Stream Mapping [will be discussed in LEAN] System Mapping Patient Journey Mapping Touch Point Mapping

13. Fault Tree Analysis [FTA] Deductive approach Regressive looking Uses symbols Relationship of events To design systems that work correctly we often need to understand and correct where they can go wrong. Dan Goldin, NASA Administrator, 2000.

14. Fault Tree Analysis Diagram

15. Relationship Diagrams/Mapping Visual representation of parts of the organization What the organization produces How work flows Internal or external supplier- customer relationships Source: Robert Damelio, The Basics of Process Mapping

16. Relationship Map What does this map show you? Source: Robert Damelio, The Basics of Process Mapping

18. Cross Functional Map Illustrates workflow Shows an organization in it’s entirety Relationship between supplier and customer

19. Cross Functional Map Source: Robert Damelio, The Basics of Process Mapping

21. Systems mapping Illustrates the functions in the system. What is it that you actually do? Very useful for Boards and Executive to have a high level understanding of the system Allows for drilling down into aspects [departments] of the system Swim lane design with ability to see duplications

24. Patient Journey Maps Patient’s perspective Providers see the system and its gaps different perspective More than one mapping tool can be utilized

29. Touch point mapping Customer experience mapping Customer intersect with the system Where a patient values each point of medical intervention

30. www.entwinedigital.com

31. All maps will highlight Unnecessary : –delays –steps –handovers Duplication Bottlenecks Gaps www.institute.nhs.uk

32. Quick Review Cross functional maps - can be used when analyzing: cost reduction, time reduction, quality improvement defect reduction, measurement and evaluation, satisfaction, benchmarking Relationship maps – Measurement System design and evaluation, Satisfaction questions Fault Tree Analysis – emergency planning, contingency planning, system designing Systems Mapping – system design, understanding the functions of a system, clarifying a system Patient journey mapping – understanding a system from the patient’s perspective Touch point mapping – critical analysis of key access points into the system

33. Quick Review - continued Process mapping is a means not an end. Not all tools are appropriate ASK QUESTIONS!!!

34. Question, Question, Question. Ask questions, dig deep to understand a process, don’t assume.

35. Stop sign process http://youtu.be/Wac3aGn5twc

36. Exercise In your groups design the process for the output given to you. Who is your audience? Do you have all of the information required to complete the task? The process should be clear to follow and the result must allow for exact replication.

37. Sources Concept mapping: an introduction to structured Conceptualization in health care., William Trochim, Mary Kane Int J Qual Health Care 17 (3): 187-191. 2005. Process Mapping: one of three, New, special quality tools for management, quality and all other professionals. Ronald P Anjard Microelectron Reliab., Vol. 36, No. 2 223-225, 1996 Process management tasks: a conceptual and practical view, Rafael Paim, Heitor Mansur Caulliraux, Rodolfo Cardoso, Business Process Management Journal, Vol. 14 No 5 2008 Damelio, Robert. The Basics of Process Mapping. Productivity Press. © 1996. Avedis, Donabedian, Evaluating the Quality of Medical Care, Milbank Quarterly Volume 83, Issue 4, pages 691–729, December 2005 http://www.processexcellencenetwork.com/ https://idc.northernhealth.ca/qt/System%20Maps/Forms/AllItems.aspx