DEWITT ARMY HOSPITAL Fort Belvoir, VA

1. DEWITT ARMY HOSPITALFort Belvoir, VA

2. OUTLINE • Definition of Process Mapping • Parts of Process Mapping • Steps of Process Mapping • Tools for Process Mapping • Final Checking of Process Mapping • Examples of Process Mapping • How Process Mapping fits into the QSEs • Common Mistakes in Process Mapping

3. Process Mapping • Is a graphical representation from start to finish. • Flow chart

4. TEMPLATEFlow Chart Oval: Show the input to start the process Arrows show direction or the flow of the process Box or Rectangle: Show a task or activity performed in the process Diamond: Shows where a Yes/No question is asked or a decision is required No Yes Make sure every feedback loop is closed, Every path takes you either back or forward to another step Usually only one arrow out of an activity box. If more than one arrow, you may need a decision diamond. Oval: Show the output at the end of the process

5. Tools for Process Mapping • Pen and paper • Post-It notes • Software: PowerPoint, Visio, etc.

6. Quality System Essentials Organization

7. QUALITY SYSTEM ESSENTIAL Organization

8. Quality System Essentials Safety

9. NEEDLESTICKOr other blood borne pathogen exposure APPLY FIRST AID !!! OR REPORT TO ER IMMEDIATELY ATTENDING MD SUPERVISOR NOTIFY SUPERVISOR Supervisor/ employee complete the assigned forms What is the status of the employee? • SF 558 or progress notes. Give to injured employee • Consent FORMS for HIV on both source & injured employee • Order & draw lab tests STAT: “NEEDLE SOURCE” (order set name) Tubes: 1 red, 1 purple, & 1 HIV Tests: Rapid HIV-1; HIV; Hepatitis B Surface AG; Hepatitis C Antibody “NEEDLE EMPLOYEE”(order set name) Tubes: 2 red, 1 purple, & 1 HIV Tests: HIV, Hepatitis B Surface Antibody, Hepatitis C Antibody; CBC, CMP, HCG (female childbearing age) • Decide on Tetanus shot • If necessary, consult Community Health Nurse for psychological assistance Patient, Contract , Student, Volunteer, Visitor DA 4106 Military DA 4106 DD 689 FM 879 GS Civilian DA 4106, FM 879, DD 689 CA-1 & CA-17* *when applicable • Ensure paperwork is properly filled out • Forward Paperwork to designated area. REFER TO BACK PAGE. • Report event to Infection Control Report to ER for emergent care Report to ER for emergent care Report to ER for emergent care Report to your respective Contract Representative Office or Primary Provider for follow- up care Report to Occupational Health within 72 hours of injury for follow-up care, (bring SF 558) CA-1 should be submitted to Safety Manager within 5 workdays of the injury • Decide on PEP (post exposure prophylaxis) therapy • If YES, contact WRAMC Infectious Disease for follow up 202-782-1663 END UPDATED 11-23-2004 Phone #s: ER (805-0518); Occ Health (805-0443); Infection Control (805-0044); Safety Manager (805-0157); Patient Safety (805-8048);CPAC (703-704-2743)

10. ACCIDENT/INJURY REPORTING FIRST AID FIRST!!! IF UNCLEAR, REPORT TO ER IMMEDIATELY NOTIFY SUPERVISOR Supervisor/ employee complete the assigned forms What is the status of the employee? • DD 689 – Individual Sick Slip Form –Supervisor will give a signed form to injured employee to seek medical attention at ETR or Occupational Health • DA4106 – Quality Assurance/Risk Management Form – On duty injuries must be reported to Patient Safety • MEDDAC FM 879 – DeWitt Army Hospital Supervisor Mishap Report –Required to be submitted to Safety Management Office within 5 days of injury/accident. DA 285-A-B-R may be substituted to report POV incidents for military. • CA1 – Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation – Supervisors are required to fill out form and bring it to Safety Management Office to be submitted to Department of Labor. Form is required to be submitted within 3 days of injury/accident. • CA17 – Duty Status Report – Supervisor will fill out column A of form and give to injured employee if limited duty is applicable. Employee will provide form to provider and return to supervisor. SUPERVISOR Military DA 4106 DD 689 FM 879 (Both On and Off Duty accidents must be reported) GS/WG Civilian DA 4106, FM 879, DD 689 CA-1 & CA-17* *when applicable Contract , Student, Volunteer, Visitor DA 4106 • Ensure paperwork is properly filled out • Forward Paperwork to designated area. REFER TO BACK PAGE. • Report event to Safety Management Office at 703-805-0157 Report to ETR for emergent care and OH for first aid (DD 689 required) Report to ETR for emergent care and OH for first aid (DD 689 required) Report to ETR for emergent care Report to Occupational Health within 72 hours of injury for follow-up care and bring DD 689 and ETR Report (SF558) if seen at DACH ETR. For GS/WG civilians, medical documentation is required. Report to your respective Contract Representative Office or Primary Provider for follow- up care UPDATED 02-04-2005 END Phone #s: Safety Manager (805-0157);Occupational Health (805-0443); Infection Control (805-0044); Patient Safety (805-8048);CPAC (703-704-2743)

12. Quality System Essentials Occurrence Management

14. QSE: Purchasing and Inventory & Process Control

15. QUALITY SYSTEM ESSENTIALSPURCHASING AND INVENTORY

17. QSE: Process Improvement

18. Urine Collection Process in the Outpatient Phlebotomy Area Ship to reference lab? Start Print & Verify Labels Patient Arrive No Yes Label samples Specimen transport to UA section Log in CHCS Patient Collect Sample Met Requirements ? Yes Patient turn in sample Transport to Shipping dept Give instructions to patient No

19. INPUT STEPS OUTPUT (Adjustable, Specifications?) (Valuable, Measurable?) BEGIN END

20. IMPROVE CUSTOMER SERVICE IN THE PHLEBOTOMY ROOM INPUT PROCESS OUTPUT (Adjustable, Specs?) (Valuable, Measurable?) Patient arrive Log in CHCS Verify Labels Collect samples Transport to lab

21. Example of Measurable Output CUSTOMER SERVICE ( Patient Satisfaction Survey 2007)

22. Example of Measurable OutputCUSTOMER SERVICE

23. QUALITY SYSTEM ESSENTIALSASSESSMENTS PHLEBOTOMY WAITING TIME

24. QUALITY SYSTEM ESSENTIALSASSESSMENTS 2007 PATIENT RECALL (Threshold: < 1%)

25. Example of Measurable OUTPUT peers Your lab

26. Steps of Process Mapping • First identify the PROCESS • Provide OUTPUT variables for each step before the INPUT variables • OUTPUT : Valuable or measurable • INPUT: Controllable and enter specifications • P and 5 M (People, Machine, Materials, Method, Mother Nature, Measure)

27. Improve Customer Service In The Phlebotomy Room INPUT PROCESS OUTPUT (Adjustable, Specs?) (Valuable, Measurable?) Patient arrive Log in CHCS Verify Labels Collect samples Transport to lab

28. Finalizing the Process Mapping • Review the process, by observing or asking the operator • Are the operators following the process as charted? • Do you have a consensus? • Do you need to add or remove steps?

29. Process Mapping Mistakes • Map is too detailed, too much information and does not emphasize the importance.

30. Process Mapping Mistakes • Process is not focused on your main goal i.e. create value for your customer (customer satisfaction) • Map the process without showing how the results will be measured

31. QUESTIONS