Process Mapping:
Process maps are one of the most effective ways of
gaining an understanding of existing processes. Process
maps are intended to represent a process in such a way that it
is easy to visualize and understand. A process map
is considered to be an aid for picturing work processes that
show how inputs, outputs and tasks are linked.1 It
has been described as being one of the “most important
and fundamental elements of business process re-engineering.”2
Process maps have several benefits:3 (1) they give a
clearer explanation of a process than words; (2) the process of
working on maps imparts understanding of the tasks and problems
faced within the organization; (3) they rapidly allow
participants in individual tasks to see the entire process and
help clarify their interactions with others involved; and, (4)
they prompt new thinking. It is important to be sure process
maps are clearly understood.4 We used the American
Society of Mechanical Engineers mapping standard that is widely
used in manufacturing and increasingly popular in office and
service environments.
Our
goal was to map the entire discharge process at BMC to
determine what the process actually looks like. From this, we
then began to investigate what worked, what did not, and how we
could improve the process. To map the hospital discharge
process, we recommend utilizing time at your weekly working
group meetings and monthly advisory committee meetings. Using
an iterative group process, you will explore all elements of
your hospital discharge. Then using ASME process mapping
standards, each step in the process should be reviewed and
modeled to document how that step is currently performed. It
may be helpful to create a graphic of your Process Map on
poster-sized paper to review with residents, nurses, and
ancillary staff, then revise it based upon their feedback. Your
final process map represents the usual care received by
patients at your hospital.
Anjard, R.P. (1998)
Process Mapping: a valuable tool for construction management
and other professionals. MCB University Press. Vol. 16, No ¾,
pp 79-81.
2
Soliman, F. (1998) Optimum level of process mapping and least
cost business process re-engineering. International Journal of
Operations & Production Management. Vol 18, No 9/10, pp
810-816 MCB University Press.
3 Peppard,
J. & Rowland, P. (1995) The essence of business process
re-engineering. Hemel Hempstead: Prentice Hall, Europe.
4
Curtis, B., Kellner, M. & Over, J. (1992) Process
Modeling. Communications of the ACM, September 1992, vol 35, no
9
Root
Cause Analysis: Root Cause Analysis provides
in-depth insight into errors that have actually occurred, in
this case, preventable readmission to the hospital. The focus
is primarily on systems and processes, not individual
performance. We recommend conducting two sessions of Advisory
Committee meetings, two hours each, for root cause analysis.
Discuss the admission history of one of your frequently
admitted patients and do some further, in-depth analysis into
the details of each admission. Review the systems and processes
that are at work to further exacerbate the patients’
medical and psychosocial social status and the resulting
contact and movement through the hospital system. The second
session at a monthly Advisory meeting should include the
presentation of four patient scenarios by various members of
our study team. Each patient scenario should be presented to
the group and, together, you will address the patient and their
multiple admissions using standard root cause analysis
procedures. These sessions should be useful and informative in
helping to determine what systemic issues and processes could
be adjusted and/or improved to improve patient health and
management of medical care. It should also help to identify the
specific failures of the hospital discharge system and help
inform an improved discharge process.
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