Model the Process

Cooking is a process that involves specific, orderly steps with well-defined inputs. For some recipes slight variations are allowed but the basic steps and ingredients must be maintained for a good product. For instance, when my wife makes a marinara sauce, she uses crushed tomatoes, salt, onions, garlic, basil, red wine, fennel and parsley. I, on the other hand, use the same ingredients except the fennel but add a bit of sugar and oregano. The steps in making it are the same for both of us: brown the garlic and onion in olive oil and then add the rest of the ingredients and simmer for about a half hour to an hour.

In business, manufacturing and service industries such as healthcare most activities are performed with well-defined processes. In manufacturing there is no room for variation in order to produce a best quality product. In service industries, there may be some variations as in the slight variations of making marinara but the best outcomes are achieved if each task is performed essentially the same. There is more room for variation in the clinical side of healthcare as an orthopedic surgeon may choose to use tissue from the patellar tendon or hamstring to repair a ruptured ACL. Nevertheless, using standardized processes generally results in best outcomes and these processes should be modeled, according to the structure of Business Process Management, which I have been discussing in previous newsletters.

Modeling a process allows for standardization and identification of best steps to use. If each person in a process adopts the standardized process then outcomes will be predictable, thus pleasing the clients and patients. It also eliminates waste, thus producing savings for the business or provider.

Modeling a process can involve paper and pencil or computer software. Most is done with software now. Two common ways to model a process are to use flowcharts or value stream maps, which are used in Lean process management. I have created a simple flowchart which models the process that I use to analyze data that has already been collected for a client. You can find an image of this map by clicking here.

Since I am the only one who employs this process there is no variation; I am consistent from one application to the next for different clients.

What are the components found in process models? Generally, there should always be a definite beginning and end point. Besides the physical steps you may want to include some are all of the following: people involved in the process, information and data, materials, tools, and environmental factors. These are always used in value stream maps.

You may believe that the processes at your site are fairly standard but the 'present state' of a given process may be quite variable. This is especially true if a process has never been documented. For instance, when a medial assistant is escorting a patient to an exam room at an outpatient clinic, she may stop and take the patient's weight and measure her height before proceeding to the exam room. Another MA may take the weight and not measure the height.

To see if there is wide variation in a process that is unacceptable because it leads to errors or poor outcomes, a team of those involved in a process should work with a process champion (a person designated to own a process and optimize it) to 'map the current state' of a process. It is during the mapping of the current state that the variations will appear. In fact, it may appear that there is very little standardization occurring at all.

I was working with a hospital group once and we were mapping the check-out process. In working with the administration and nurses we found that there was a wide variation in how the check-in staff was notified that there was an empty bed available. In fact, there were many workarounds for this process that had been developed by the floor nurses as the standard process did not work well. So, we made a present state map that represented the steps generally used by most staff. Then, we created a 'future state map' that represented the steps that all should use and that was best in notifying the check-in staff of the availability of beds on a unit. After creating the future state map, the process champion worked with the team to develop a plan to implement the new process and make sure that it was consistently followed by all involved staff. This included identifying indicators that could be measured to indicate the success of the implementation.

One of the important steps that a process champion must do before meeting with the process improvement team is to take a gemba walk. This involves the champion going to the place where a process occurs and patiently watching it unfold. She should do this several times and with different staff involved. By observing the process unfold she will be able to assess the amount of variability in the current state. The champion should also observe a process after it has been successfully implemented to be sure that there is no backsliding to the previous state of the process which was probably highly variable and unsatisfactory.

As you can see, to get best outcomes, a process should be explicitly mapped. From this map, a standardized future state map can be created so that all will carry out the process in the same way, thus providing predictably good results. Patients and clients will be happier, staff will be pleased and the providers will be rewarded with increased income.

Donald Bryant helps healthcare providers meet their challenges. Go to http://www.bryantsstatisticalconsulting.com to get the free article "7 Challenges in Healthcare and How to Solve Them" with tips you can
use to start improving patient health, improving the bottom line, finding more time to get things done and to learn more about Lean Healthcare.


 By Donald Bryant


Article Source: Model the Process