Process Mapping Tool
The Process Mapping Tool is widely used in improvement activities. It depends on recording the stages required for a definite process and this will help in quickly identifying the poorly organized flows. From this it is possible to know which improvements to implement and to prioritize key processes according to the impact on the patient, as shown in Figure 1. Gilbreth (1921), Sousa (2002), Aken and Greebeck (2008), and American Society for Quality describe that unmanaged processes produce random results and high numbers of defects,since measurements are not in place, starting and ending points are not clearly stated, and no single executive is responsible for managing each process except the CEO. [1, 2, 3]
Figure 1: Example of process mapping chart in a hospital’s lab [4]
The Importance of Process Mapping
The manual on process mapping and redesign and the website of sentinel-event (2006, 2008) stated that managing the process in the system will help mangers in tracking the problems and creating ways for improvements. The next step is an evaluation of the work and learning from mistakes, so that in the next round a higher standard of work will be achieved. The improvement should be planned and what the process improvement that will be piloted, who will do the pilot, how will it be piloted, when will it be tested, and what data must be collected to measure the improvement. This should be identified and agreed by the team in hospital responsible for managing the process. [5, 6]
Furthermore, the Juran Institute depicts the rapid improvement of business and how the organization should analyze business processes to find opportunities that can be improved. This process enables quick reduction in costs, faster quality improvement, and increased customer satisfaction. Finally, by redesigning business process, waste, non-value added activities, and redundancies can be eliminated. [7]
Other Approaches for reducing waste in hospitals
Health care is faced with the challenges of many concerns about quality, safety, cost, and a perpetual workforce shortage. Health systems can participate in finding solutions by providing approaches that lead, not just to improvements in specific process, but also to developing approaches that lead to system transformation. Denver Health is an example of this kind of transformation. The project team at Denver created the concept of a puzzle that includes the following 5 pieces:
- Right Physical Environment
- Right People
- Right Process
- Right Communication and culture
- Right Reward System
For each piece of the puzzle, a strategy for implementing transformation in that domain was adopted. For the right process, Denver Health selected Lean Toyota Production System as a tool for redesigning health care processes and reducing waste, while improving efficiency. Denver believes that training and effective system for communication is important for coordination among teams. [8]
In Jury Hospital, a 350 bed public psychiatric hospital in France, a 20-month quality project has been completed to improve the patient admission process. The project team consisted of 2 physicians, 3 heads of nursing, 1 senior manager, 1 member of the admission staff, and 1 secretary. A pharmacist acted as internal facilitator. The team used a problem solving methodology to identify and correct any shortcomings in the admission office, the team has been trained on working in an effective team and data were collected before and after corrective actions that helped the hospital in improving the customer expectations and needs which enhanced team’s contribution to the quality improvement strategy . [9]
In Whittington Hospital in England, management sought to improve the quality of services in emergency and radiology through process mapping techniques to identify the bottlenecks and constraints within the system. The quality team in Whittington Hospital found that they should understand the variation in the system, so they could take the suitable actions. [10]
However, other studies such as the one undertaken in the Sultanate of Oman in 2000, used the Data Envelopment Analysis (DEA) to assess the operational efficiency of hospitals in many countries. This approach depends on comparing hospitals according to a set of outputs representing total outpatient visits and major surgical procedures, and inputs representing the number of beds and manpower. The efficiency of hospitals will be given as scores and will be relatively measured to the best hospitals. Hospitals will do bench-marking with the best hospital so they can improve work. [11]
In short, the literature shows that use of quality improvement methodologies such as process mapping can transform inefficient hospitals or departments. Often a team-based approach is the most effective in implementing changes to improve efficiency.
References
1- Gilbreth, F.(1921). Presentation ‘Process Charts-First Steps in Finding the Best Way”.http://www.en.wikipedia.org/wiki/SADI.Accessed :10April 2008
2-Sousa G.W., Aken , E.M.& Greebeck, R.L. (2002).”Applying and enterprise engineering approach to engineering work: A focus on business process modeling”, Engineering Management Journal,Vol.14 №3,pp.15–24. http://www.en.wikipedia.org/wiki/SADI.Accessed :10April 2008
3- American society for quality. Process mapping next step. http://www.asq.org/qic.display-item/index.pl?item=18311.Accessed :14 April,2008
4- Faris Ghazal(2008). Improving Processes in Diagnostic Services at Damascus Hospital, Syria. Master Thesis .Frankfurt School of Finance and Management, Frankfurt am Main, Germany. https://drive.google.com/open?id=1AftcFiVPKzX1807orPyrC2EzC-H6Ijsa
5- Manual on Process Mapping and Redesign. Republic of Yemen. Ministry of Public Health and Population Support to Administrative Reform Project,2006
6- Health care performance solution. http://www.sentinel-event.com/focus/ppframe.htm. Accessed: 05/04/2008
7-Juran Institute(2007), Inc., Southbury , Ct, U.S.A. http://www.juran.com/HomeLeftNav/quality_control.aspx. Accessed : 03/04/2008
8- Agency For Health Care Research and Quality(AHRQ). Managing and Evaluating Rapid –Cycle Process as Vehicles for Hospital System Redesign. http://www.Ahrq.gov/qual. Accessed: 13/07/2008
9- Lepaux, Dominique. Improving the Quality of the Admission process in a French Psychiatric Hospital: Impact on the Expertise of the Professional team. International Journal for Quality in Health Care, 13:333–338,2001
10- Whittington Hospital, NHS trust, service improvement 2004/2005. http://www.whittington.nhs.uk.Accessed:12/07/2008
11 — Ramanathan, Ramakrishnan .Operations Assessment of Hospitals in the Sultanate of Oman. January 2005
