In this session, we will be discussing Process Mapping. This method complements value streams. It is primarily used during Rapid Improvement Events called RIEs. This approach is generally more granular than a value stream. The teaching example we used to explain value streams, medication administration by our bedside nurse, Wendy, was very granular. However, more often, value streamed analysis is used to assess a larger system or macro system. For example, patient flow in an emergency room. Process boundaries would begin with the arrival of the patient to the emergency room. And end when the patient is discharged or admitted to the hospital. Such a value stream map is, in most ERs, would identify multiple bottlenecks and nonvalue added steps. And Process Mapping could then be used to dissect each of these individual problem areas. Value stream mapping identifies the barriers to flow. And process mapping in combination with Rapid Improvement Events, can be used to create the detailed fixes. The process map is a visual tool that is created by and actively involves the frontline staff, allowing them to visualize their workflow and create effective solutions. This approach identifies the proper sequencing of procedural steps. Generally a macro system, value stream will generate eight to ten process maps and Rapid Improvement Events. Process mapping should document work flow from the customers' viewpoint. The team should start with mapping the current state, and this should be followed by mapping the future state. And, finally, map the ideal state. This approach is very helpful for identifying all nonvalue added steps. Most important because process mapping requires active input from those who are doing the work, the process of drawing the maps creates buy-in by those on the front lines. After they the present future and ideal state maps, they understand the whys. The steps for process mapping should be first identify the primary customer. This will usually be the patient. This helps to define the value added. Second, just as value stream maps define the process boundaries. And third, identify all steps between the beginning and end by performing a waste walk. After mapping the present state, create the desired future state. How do you start? First, as in all projects, you need the proper materials. Sticky Notes, use different colors. By convention, purple is often used for a process step. Pink for waste, blue for information. Green for information route and yellow for operators. Team members may want to use other colors. And that is okay as long, as everyone agrees what each color will represent. In addition to sticky notes, you will want to purchase colored felt pens and, or different colored yarns. By convention, black is often used to indicate seamless flow. Yellow flow, that is too fast or too slow. And red, a serious defect or flow stoppage. Here is a process map of the present state for patient check-in for an operating room. The process boundaries are indicated in the upper right of this real example. I apologize for the crossouts, but that does happen in real life. The process boundaries for this map began with the patient check-in and ended when the patient arrived in the operating room. The first horizontal row depicts the time during the check-in process, as well as the names of each work cycle. Check-in in this example began at 7:15AM and ended at approximately 8AM. The steps in the process were, step one, 7:15, the purple sticky note, far left, patient turns up or arrives. Step two, 7:20, patient is escorted by Nurse 1. Nurse 1 is shown as a left yellow sticky note and all of her work is shown in this first operator horizontal row, or swim lane. Below her, there are four additional rows, or swim lanes, where the work of the other four operators will be depicted. As shown in this step, the nurse verbally attains information from the patient, that's the lips on the green slip. She identifies that patient by asking birthdate and name, the blue sticky note. She places an armband, the second blue sticky note, and scans the hospital record number into a computer, the green slip showing a schematic computer. You can see potential problems are delays in pink. The problem of no shows or late arrivals may result in the nurse sitting idle and waiting for patients. The same process mapping is performed for the other operators that enter the process at subsequent steps. In addition to representing the work, information transfer and potential problems using sticky notes, the flow of the process is assessed by the team. Black yarn is used for seamless flow. Yellow for flow that is too fast or too slow, and red for serious defects or flow stoppage. The top priority for improving a process should be addressing the red yarn. For example, red yarn is shown when the patient is being transported from the admission office to the operating room. Because the distance the patient has to travel is excessively long, and delays patient arrival to the OR. The team will need to consider if an admission office can be relocated to a site that is physically closer to the operating room. As you can see, process mapping is less time consuming than value stream mapping and is usually more granular. This is a group activity that involves those working on the frontlines. And requires that they agree on how each step is being performed and subsequently will require everyone to agree on the best fixes. Process mapping is intuitive and visual and makes wasteful steps obvious. Performing this activity creates buy-in by those on the front lines because they understand why. Thank you.
