Presentation : Improvement Science Process Mapping Prepared by: June ~Watters

1. Presentation : Improvement Science Process Mapping Prepared by: June ~Watters

2. Increase knowledge of the improvement methodology Learn how to use Process Map Learn how to design processes to reduce harm Learn to identify weaknesses in current process Hearing from others on its use Produce your own process map Questions / points of clarification Aims of the session

3. What is improvement? • Its about developing care that delivers for patients. • Its about breaking the • "We've always done it like this!" • culture, encouraging both patients and staff to challenge and change healthcare services for the better.

4. Subject Matter Knowledge Profound Knowledge Subject Matter Knowledge: Knowledge basic to the things we do in life. Professional knowledge. Improvement Profound Knowledge: The interaction of the theories of systems, variation, knowledge, and psychology. (W Edwards Deming)

5. Healthcare Change in Healthcare = people changing Complexity Patients / staff Estimated 80% of change projects failure = failure to manage the people issues Need to understand the ways people react to change minimize the risks of failure maximizes skills and talents of the team

6. Table exercise – 10 mins Think of a time when you were successful in making an improvement at work Think of a time when you were unsuccessful in making an improvement at work Write down the differences between the two situations

7. Change is difficult and can be threatening Change can be time-consuming Change involves understanding people, systems and processes Healthcare systems are often complex and fragmented

9. Leading Improvement – people • While there are many tools and methodologies underpinning continuous improvement in healthcare, we need to recognise that it is people, and not tools or methodologies, who cause change to happen.We will need people who are capable of identifying problems, introducing change and monitoring the outcomes to create sustainable change in NHSScotland. In short, we will need people who can lead improvement.

10. Leading improvement - models • Process mapping – today’s focus • PDSA • Lean • Demand and capacity • Six-sigma

11. What is a Process map • Visual representation of relevant procedures and administrative processes. • Shows how things are and what happens rather • Simple or complex processes can be mapped • Processes have evolved

12. Let’s have a go at our own process map • MAKING A CUP OF TEA/COFFEE • TRAVELLING TO WORK TODAY 15 minutes

13. Process mapping shapes • Represents and activity • Represents a decision

14. Process mapping symbols • Represents a Delay • Represents Transport/Movement

15. Process mapping symbols • Represents Storage/Filing

20. Why process map? • Reduce delays • Highlight improvements for patient and staff • Unnecessary delays • Unnecessary steps • Unnecessary handovers • Duplication of effort • Duplication of waste • Things that don't make sense • Likely hotspots, bottlenecks

21. When to use? • Area where there is a gap in understanding • Area which requires improvement

22. What will you need? • Define start and end point of process to be mapped • Invite all members of the multi-disciplinary team involved in that process to a mapping event (allow approximately 2 hours and give adequate notice). • Do not be too concerned if you can't get all members of the multi-disciplinary team to attend. After the event you can take the map to them. • Send out some preparatory information on process mapping for participants to read prior to the event.

23. What will you need? • Brown paper or flipcharts • Post-it® notes • Marker pens • At the event, start by outlining the process to be mapped and then encourage participants to start writing their part of the process on Post-it® notes. • Process mapping events often require strong facilitation to keep people on track with the task and prevent distractions caused by discussing the issues in detail.

24. What will you need? • Encourage people to write issues and ideas for improvements on separate Post-it notes and park them on a flipchart. • Reinforce the importance of mapping the process as it usually happens, not the ideal or how it should happen, but what happens for the majority of patients. • Arrange the Post-it notes to ensure they capture the patient journey in the correct sequence. • Where relevant capture times, delays, waits, hand-offs etc. • Thank all participants for their involvement, and reinforce the need for a follow-up meeting to agree the map and actions to be progressed.

25. Walk the patient journey and involve patients to gain an understanding of their experience and to capture their ideas for improvement. Show the process map to the relevant individuals from the multi-disciplinary team Display the process map in the relevant clinical area and encourage all staff to amend/update and put forward ideas for improvement. Type up the process map, issues and ideas and send out to all participants with a date for a follow-up meeting quite soon afterwards, to maintain momentum. What will you need

26. Follow up meeting- identify risks and potential harm • How many times is the patient passed from one person another (hand off)? • Where are delays, queues built into the process? • Where are the bottlenecks? • What are the longest delays? • What is the approximate time taken for each step (task time)? • What is the approximate time between each step (wait time)? • What is the approximate time between the first and last step?

27. Identifying potential risks and harm • What are the longest delays? • Is work being batched? • Where are the problems for the patient? • At each step is the action being undertaken by the most appropriate staff member? • Where are the problems for staff? • Where is the greatest amount of time currently lost or wasted? • Can any processes be carried out simultaneously? • Consider what patients complain about.

28. Identifying potential risks and harm • What is the approximate time between each step (wait time)? • What is the approximate time between the first and last step? • How many steps are there for the patient? • How many steps add no value for the patient? • Are there things that are done more than once? • Look for rework loops

29. NhsloTHIAN CRAIGMILLAR MEDICAL CENTRE - INR PROCESS MAP Joan Fletcher Ashley Tait 15 minutes

30. Practical example Process Map your current system for: Prescribing and monitoring of patients on Warfarin or DMARDS (such as methotrexate) 20 minutes

31. What will it take to improve? • Winning the hearts and minds of the staff • Focusing on improvement not targets • Develop testing • What to test ……how to test • Leadership • Integration - Making it daily work • Creating infrastructure • Creating capability and capacity • Measurement that has meaning • Just enough data… interesting versus useful

32. CQI Tool Box But remember, tools are there to help you. Use the right tool at the right time. They are not the beginning or end of your Quality Journey! 32

33. Well done everyone Thank you for your participation and enthusiasm Good Luck Any questions?