Welcome to Core Skills 3

1. Welcome to Core Skills 3

2. Objectives of the day • Understand Systems and Processes • Process Mapping • Value Stream Mapping • Flow • Understand the purpose, application and structure of the Model for Improvement • To appreciate the importance of Measurement for Improvement

3. Understanding the Patient Journey Process Mapping and Flow Analysis

4. CONTEXT We design in the system capability ‘80% of the problem is in the system not the people’Deming

5. Why Process Map?

6. Process mapping…. • Views the system from the patient perspective following their journey across organisational boundaries • Helps staff understand how complex and confusing processes appear to the patient • Organisation specific • Diagnostic and used as a basis for redesign, actively involving frontline staff in the process. (Shows how things actually are)

9. High level process map 6 – 12 steps • Generate in set time e.g. 20 minutes • Use to identify scope and identify problem • No rework loops and minimum complexity Low Level or Detailed process map dozens of steps • To establish loops and complexity • Good to establish roles and relationships within process • Use again in later phase to show effect of redesign

10. GP Referral – Attend OPD Appointment Referral 1 – 3 days 1 – 3 days Tertiary GP Cons - Cons Appts. An Hospital Appts. AN Hospital Register on System Consultant Secretary Consultant Screening Consultant Secretary High Level Map 1 Day -12 weeks AN other Hospital Appts. Patient Attends OPD Appts. AN hospital Appt. made Letter sent

11. GP Referral – Attend OPD Appointment Referral 1 – 3 days 1 – 3 days Tertiary GP Cons - Cons Appts. An Hospital Appts. AN Hospital Register on System Consultant Secretary Consultant Screening Consultant Secretary Increasing level of detail Low level Map 1 Day -12 weeks AN other Hospital Appts. Patient Attends OPD Appts. AN hospital Appt. made Letter sent

12. When undertaking a process map sessionthink about!!!! • SCOPE – where does the process start and end? • What demand is placed on it • Who should be involved in the mapping process? • Decide the level of detail • Map what actually happens

13. Compiling a Process Map Name of the person completing task + verb Who does what and when?

14. ‘Ground rules’ for the Process Mapping workshop • Everything is confidential • Everyone has a valuable contribution to make • Value the diversity of the group • ‘Park’ issues • Keep to time

15. Activity In groups try some process mapping… • Read through the instructions • Then take 20 minutes to map the process for Clinic B

16. Remember the following... • Define where the process starts and ends • Consider who you would involve in the mapping exercise? • Use post-its to record the activities including time • Assemble the post-its to create the journey (remembering that some activities happen in parallel) • Keep a note of issues and opportunities

17. Stage 2: Analysis

18. Analysing the process map • How many steps in your process? • How many duplications? • How many hand-offs? • What is the approximate time of or between each step? • Where are possible delays? • Where are major bottlenecks? • How many steps do not add value for patients? • Where are the problems for patients and staff?

21. Process Bottlenecks occurs when a step is the limiting rate of the process The step takes a significant time, and slows the whole process down.

22. Functional Bottlenecks occur when a resource is used by more than one process

23. Look for Batching Requests sent in batches Results return in batches Dr sees patients individually

24. Identify examples of:1- batching2- bottlenecks3- waiting4- duplication Activity:

25. Examples bottlenecks All forms are returned to nearest centre Every patient appt is 30 mins 1 physio to triage referrals Phyllis multi-tasking / no cover for AL. batching GP dictating at end of day Mail picked up daily Phyllis had 10 appts to make Physio reading all referral letters at once

26. Examples waiting Referrals are posted on to the centre No cover while Phyllis on AL May 1st-May 4th- 3 days to process referral. 1st appt received on May 6th – new appt sent out May 23rd. duplication Electronic and paper systems Rebooking of patient appointment.

27. Walk the Patient Journey for yourself

28. Value / non-value adding steps Value adding • The activity transforms the patient and moves them towards the next defined outcome • The activity is something that the patient cares about Non-value adding • Do not serve any purpose (aim to remove these) Necessary non-value adding • Do not directly benefit patient but are necessary e.g. completion of forms, logging patient details onto systems, numerous checks of details

29. Non value added steps for patient

30. Waiting • The process STOPS • Inhibits FLOW • Does not add value for the PATIENT • As a Clinician do you see the wait?

31. Waste Is a Sensitive Issue • Its critical to eliminate “waste” • Its also critical to recognise that the non value adding activities may have been a core part of someone job for many years • It’s the activities that are non value adding not the person

32. Categories of Waste

33. Analysis Summary Waste • Transport • Injuries • Motion • Inventory • Waiting • Over processing • Over production • Defects • Staff Steps Total number of steps Number of value steps Value steps as % of total steps e.g. 2/24 = 8% Time Total time Hrs:Mins Time of value steps Value Time as % of total time e.g. 40/119520=0.03%

34. Stage 3: Redesigning Processes

35. Focus on the future process • Think creatively/generate ideas • Focus on ideas and opportunities • Are the right people involved? – whole system approach where needed

36. Defining patient groups Runners No. in each category within the group Specials Strangers Group of patients

37. Tools for defining patient groups RunnersSpecials Share common characteristics Customised High volume Lower volume Fast throughput Predictable Highly predictable Share some steps but require Standard –patient routes extra steps Up to 90% pre-scheduled Can be pre-scheduled Strangers Low volume, unique requirements Unpredictable demand pattern Route unpredictable and complex Throughput time tends to be longer

38. Opportunities for Redesign

39. Linked processes • Current processes often operate in isolation from each other, particularly departments and directorates • Each area needs to be linked to the one before, to ensure that they always have capacity to deal with what they are receiving

40. Remember always aim to Add value Remove waste

41. Activity • Read side 2 of the scenario • At your table, answer the questions at the end of the scenario

42. Key elements to Process mapping • Map what actually happens – most of time • Time Lines • Identify the types of waste? • What value/waste is in the process? • Include parallel processes • Display the maps so all can see • Allow comments • Don’t redesign for redesign sake

43. Discuss How you will go about doing this? Who will you ask to attend? When will you hold it? Where will you hold it? What obstacles might you face? How will you address them? What will your role be during the session? What will Mark’s role be? What will the outcome of the session be if it is successful?

44. Questions?