1. Improving Office Practice: Process Flows Mark Murray, MD, MPA Mark Murray and Associates

2. Objectives Identify key office processes. Flow map a key process at your site. Begin to think about how you might redesign that key process. Review the High Leverage Changes for improved office flow and efficiency. © Murray

3. Why ? Office Efficiency is the next level of delay Streamline the work processes Decrease workload Smooth flows Decrease the likelihood of error Create a rational environment for patients, staff and providers Save money

4. The Link Between Access and Efficiency Efficiency requires reducing delays across the office as well as streamlining work processes This increases throughput More efficient processes and throughput increase capacity

5. Components of Work Flow System Process Task

6. Components of Work Flow System – Group of processes working together to achieve aim Tools: System process flow map

7. Components of Work Flow Process – Group of tasks or activities working in an orderly fashion to achieve an aim Tools: Workflow or process flow analysis

8. Components of Work Flow Tasks – A specific job or piece of work Tools: Activity analysis

9. Office Efficiency Tools Flow map and analyze a process Synchronicity Task Analysis: What is work? Who does it?

10. The Metrics Lead Time = start to end The sum of the cycle times + delays For the whole process The visit The referral Medical record retrieval Each segment of the process = cycle time Appointment booking, reminder, registration, greeting, waiting room, rooming, vital signs, value added vs non-value added time, © Murray

11. Lead Time Measurement Check inMA to RoomCheck outMD LeavesMD Enters Process Greet Check in/registration Get chart Prepare information Vital signs Interview Prepare information Greet interview Exam Closure Prepare information Closure Over-arching Information transfer Communication, pre, during, post visit Synchronize patient, provider, information, equipment Standardize rooms - means to an end….universal room usage Choreography - co-location, multi-processing staff Batch vs. continuous flow processing Measurement- cycle time/leadtime Audit - sampling

12. Lead Time Measurement Check in MA to Room MD Enters MD Leaves Check out

13. Identifying Flow problems… Walk through Patient complaints Provider and staff complaints Processes with high variation Brainstorm examples……. What makes you frustrated? What makes your patients frustrated? Where are the piles? Wheres the re-work? ©Murray

14. Redesigning a critical process…. Identify the bottleneck Identify the associated process Understand current process, in detail Design the ideal process…Flow Map Test changes to process Measure process cycle times throughout Measure lead time – avoid sub-optimizing Batching vs. continuous process flow ©Murray

15. Whats a Work Process? A work process is made up of steps, tasks or activities and has a beginning and an end. Key concepts… Input…the materials, equipment, information, people, money or environmental conditions needed to carry out the process. Output…the product or service that is created by the process; that which is handed off to the customer.

16. Understanding the current process Flow mapping Record each step in sequence Put the steps in order Record who is responsible for each step Add forgotten steps Agree to all of the above ©Murray

17. Flow Mapping Example… Brushing your teeth Open toothpaste toothpasteWettoothbrushApplypaste to brush to brushBrushteeth Turnofflight Put away pasteandbrush RinsemouthRinsebrush

18. Flow Mapping Example Pre-appointment registration process 9 a.m. appointment Client enters Reception line 8:45 Client Greeted 8:50 Client Registered 8:53 Demos and Financials confirmed 8:55 Provider greets client and escorts to office. 9:09 Announce Client to Provider 9:08 Client fills out forms, Clerk finds MR Client returns forms 9:00 Forms and Instructions given 8:58 5 min.3 min.2 min. 3 min. 2 min. 8 min.1 min. When did client arrive? What was appointment time? When did appointment start? Why? What could be done differently?

19. Team Exercise Pick a work process Flow map the current process in detail Record your current process Where are the bottle-necks? Where are the opportunities? What improvements could be tested? Prepare to share what you learned ©Murray

20. Medical Office Efficiency High Leverage Changes Balance Capacity and Demand Synchronize Patient, Provider, and Information Predict and Anticipate Patients Needs Optimize Rooms and Equipment Manage Constraints

21. References… Managing the Unexpected, Karl E. Weick and Kathleen M. Sutcliffe, University of Michigan Business School, 2001 Mapping Work Processes, Dianne Galloway, ASQC Quality Press, Milwaukee, Wisconsin Mastering Patient Flow, Elizabeth Woodcock, MGMA Englewood, Colorado, 2000