Presentation on theme: "Process Mapping—sometimes called Flowcharting or IS Maps"— Presentation transcript:
1Process Mapping—sometimes called Flowcharting or IS Maps
2Quality Improvement Works on Existing Processes A process is a series of steps or actions performed to achieve a specific purpose.A process can describe the way things get done.Your work involves many processes.
3What is a Process Map?A pictorial representation of the sequence of actions that comprise a process.
4Why is Process Mapping Important? It provides an opportunity to learn about work that is being performed.Dr. Myron Tribus said,“You don’t learn to process map,You process map to learn.”Most processes today are undocumented or are evolving.
5What Dr. Deming said“You cannot improve a process until you understand it!”“If you can't describe what you are doing as a process, you don't know what you're doing.”
6Process Maps are Used to: Document the way we do our work.Provide a reference to discuss how things get done.Describe and understand the work we do.Analyze and improve on processes.Identify of areas of complexity and re-work.To generate ideas for improvement.Illustrate process improvements.Most importantly PM are used to provide the baseline for making improvements that are or will ultimately relate directly to the health outcome we seek. PM will help to ensure you make an improvement not just a change.Deming’s focus is often on changing how management thinks, he asserts that if appropriate principles of management are adopted then it is possible to increase quality and simultaneously reduce costs. He says the key is to practice continual improvement and think of public health as a system not as bits and pieces. In other words think of processes not just the piece that you do as defined by your Pd or Organization Chart.
7Preparing to Process Map Assemble the Team.Agree on which process you wish to document.Agree on the purpose of the process.Agree on beginning and ending points.Agree on level of detail to be displayed.Start by preparing an outline of steps.Identify other people who should be involved in the process map creation, or asked for input, or to review drafts as they are prepared.Processes don’t often follow the silos that they were originally created in. So you need involvement from those actually doing the work who may not be on the QI team.
8Symbols used to Process Map Start & End: An oval is used to show the materials, information or action (inputs) to start the process or to show the results at the end (output) of the process.Activity: A box or rectangle is used to show a task or activity performed in the process. Although multiple arrows may come into each box, usually only one arrow leaves each box.Decision: A diamond shows those points in the process where a yes/no question is being asked or a decision is required.Break: A circle with either a letter or a number identifies a break in the Flowchart and is continued elsewhere on the same page or another page.
9Hints and TipsProcess Map what is, not what you would like the process to be.Process Mapping is dynamic. Use Post-it notes, dry erase markers, pencil, etc.All Process Maps must have start and stop points.
10Process Map of Conference Approvals Sample Do a Process Map that documents the process used to obtain approval to attend conferences.
14Hints and TipsBrainstorming and Affinity Diagrams can be used to identify processes you wish to do a process map on.There is no single right way to do a process map. It is a tool to learn about your organization and work.Process Maps can be used in a variety of settings outside Quality Improvement, such as:Orienting new employeesIn-service presentationsBrainstorming possible process changesCreating or revising policies and procedures that support theprocessCreating measuresIdentifying logical outcomes of a processAffinity Diagrams are just getting people together in a group, phasing an issue under discussion into a full sentence, brainstorming for ideas or issues, grouping, documents, and helping to understanding the problem and possible solutions.
15Summing UP Process Map to learn. Process Map to document a baseline to measure improvement vs. change.Process Map to point to where data may be that describes the current process.
16QI Tool Exercises Scenario Highlighting Excellence Health DepartmentImprovement sought-Improved Customer Satisfaction with health department servicesArea of Concentration-Customer Satisfaction SurveyPlease take a moment to read the Scenario write-up that is in your binder
19Check Sheets: Purpose To turn observational data into numerical data From recordsNewly collectedTo find patterns using a systematic approach that reduces biasUse check sheets when data can be observed or collected from your records
20Check Sheets: Step by Step Decide what to observeDefine key elementsEstablished shared understandingStep 2Identify where, when, & how longThink about confounding factorsThat you want to eliminateThat you want to study
21Check Sheets: Step by Step Design your check sheetDevelop a protocolProblem/Project Name:Name of Observer:Other:Location of Data Collection:Dates of Observation:Dates of Data CollectionTotalEventABCGrand Total
22Check Sheets: Step by Step Identify and train your observersPractice & adjustStep 5Collect dataReview & adjustStep 6Summarize data across observations & observersStudy the results
23Hints and Tips Make sure you’re getting clean data Define, train, check, adjust, & repeat!Consider and address potential sources of biasUse “other” categories sparinglyStrike a balanceFine vs. inclusive categoriesFew vs. many categories
24Exercise Use your handout to set up the check sheet for this situation When customers report dissatisfaction with LHD services, staff track the primary reason for customer dissatisfactionThey believe dissatisfaction may be caused by several conditions that they can document:LHD does not offer service client needsNeeded service was difficult to accessWait times were too longInteraction with LHD staff was poorLHD provided inaccurate informationUse your handout to set up the check sheet for this situation
26Pareto Charts: Purpose To identify the causes that are likely to have the greatest impact on the problem if addressed“80% of the effects come from 20% of the causes”To bring focus to a small number of potential causesTo guide the process of selecting improvements to testUse when you have, or can collect, quantitative or numeric data on several potential causes
27Pareto Charts: Step by Step Identify potential causes of the problem you wish to studyStep 2Develop a method for gathering your dataHistorical dataCollection of new dataCheck SheetsSurveys
28Pareto Charts: Step by Step Collect your dataEach time the problem occurs, make note of the primary causeStep 4Order your results & calculate the percentage of incidents that fall into each category
29Pareto Charts: Step by Step Display your data on a graphThe most commonly occurring cause should appear first, and the causes should appear in orderWord or Excel can be used, but paper and pencil work tooLabel the x-axis (horizontal) with the causes, the left y-axis (vertical) with the percentage of occurrences with each cause, and the right y-axis with the cumulative percent.Graph your data
31Pareto Charts: Step by Step Make sense of your results by examining your dataAre a few causes driving the problem?Can this information help you make decisions about the solution you want to try?Does this information impact how you want to structure your aim statement or theory of change (if-then)?Can you use this information to measure your results?
32Pareto Charts: Hints and Tips You’ll only learn about causes that you investigate - be inclusive!Check and double check your dataLittle errors can make a big differenceResults can be used in more than one way and they can be used differently at different points in timeRevisit your Pareto throughout your project – the meaning may change for you as you go
33Pareto Charts: Exercise Problem: Client DissatisfactionName: J. HeanyTime: 9-5Location: Excellence Health Department’s Customer Service DepartmentDates: Week of 9/6, 9/13, 9/20, 9/27, 10/4, 10/11, 10/18DateTotalReason9/69/139/209/2710/410/1110/18Service not offered34219Service was difficult to access1012631Long wait times1Poor staff interaction8Inaccurate information172113580
35Cause and Effect Diagrams Moving from Treating SymptomsToTreating Causes
36Problem Solving – What we usually see is the tip of iceberg – “The Symptom” The Root CausesInvisibleHiddenA big challenge our teams have had is to rush to the solution because we think no, we are sure we know what the solution is before we have worked though the steps. We fix a symptom and not the actual or true root cause of the problem.3636
37Problem SolvingWhen confronted with a problem most people like to tackle the obvious symptom and fix itThis often results in more problemsUsing a systematic approach to analyze the problem and find the root cause is more efficient and effectiveTools can help to identify problems that aren’t apparent on the surface (root cause)
39Fishbone Diagrams: Purpose To identify underlying or root causes of a problemTo identify a target for your improvement that is likely to lead to change
40Fishbone Diagrams: Construction Draw an arrow leading to a box that contains a statement of the problemDraw smaller arrows (bones) leading to the center line, and label these arrows with either major causal categories or process categoriesFor each cause, identify deeper, root causesCause 1Effect/ProblemCause 2Cause 3Cause 4
41Berrien County Fishbone Root causes for lack of BCHD general PH articlesCausesTopicsProcessArticles for events onlyNo time to developEffectConfusion/duplicationMinimal articlesSecluded media teamSporadic writingOne writer, poor healthNo long-term arrangementsPeople/StaffMedia Relations
42Cause and Effect Diagram Pre NatalPracticesEarly FeedingPracticesLife StyleExcess MaternalWeight GainDecreased BreastFeedingBottle PacifierNo Time ForFood PrepTV ViewingJuicesLess Fruits and Veg.Sodas/SnacksOver WeightNewbornNo Outdoor PlayLessIncomeUnsafeMaternal ChoicesObese ChildrenBuilt Environment ForStrollers Not ToddlingUnhealthy Food ChoicesGenesCurriculumFew Community RecreationalAreas or ProgramsSyndromesLess Indoor MobilityNo SidewalksTVPacifierUnsafeHousingOver WeightPre SchoolLess SchoolEnvironmentPolicesGenetics
43Fishbone Diagrams: Hints & Tricks Find the right problem or effect statementThe problem statement should reflect an outcome of a process that you control or influenceBe specificReach consensusFind causes that make sense and that you can impactGenerate categories through:BrainstormingLooking at your dataAsk “why?” to achieve a deeper understandingKnow when to stopStick to what you and your managers can control or directly influenceMake use of your resultsDecide if you need more dataConsider causes that come up again and again, and causes that group members feel are particularly importantMemory Jogger, page 32
44Exercise Fishbone Diagram Customer Satisfaction By TableDraft a Fishbone Diagram listing effect(s), major causes, and data related causes (root)It is OK if data related causes show up in more than one major cause areaHINT: The pareto chart makes a good starting point
45Five WhysThe 5 Whys is a question-asking method used to explore the cause/effect relationships underlying a particular problem. Ultimately, the goal of applying the 5 Whys method is to determine a root cause of a problem.Wikipedia
46Five Whys (cont.) Example My car will not start. (the problem)Why? - The battery is dead. (first why)Why? - The alternator is not functioning. (second why)Why? - The alternator belt has broken. (third why)Why? - The alternator belt was well beyond its useful service life and has never been replaced. (fourth why)Why? - I have not been maintaining my car according to the recommended service schedule. (fifth why, root cause)Wikipedia
475 Why’s and How’sA major advantage to the 5 Whys technique is that it is relatively easy to use and applyIn many organizations, problem solving is a deductive exercise conducted in a meeting room where those doing the problem solving are separated from the actual process where the problem occurred. “Go and See”The 5 Whys requires skill to use well and most important, should be grounded in observation, data, and not deduction.
485 Whys LimitationsUsing 5 Whys does not always lead to root cause identification because:Listing causes in the absence of data.Assumes each symptom has only one sufficient cause.Varying skill with which the method is applied.The method is not necessarily repeatable.Linear approach that does not pick up interactions.Inability to distinguish between causal factors and root causes.If it is used with no data it can lead to bad judgment calls which pick the wrong root cause(s).Solutions are then implemented that address the wrong root cause.These wrong solutions may cause more problems and make the situation worst.
50Exercise 5 Whys Customer Satisfaction By TablePerform 5 whys on the two causes that received the greatest number of responses as shown in the Pareto Chart (Service was difficult to assess and Service not offered).
51Summing UPUse Fishbone and 5 Whys to explore and graphically display in increasing detail all of the possible causes related to the problem.Use Fishbone and 5 Whys to find dominant causes rather than symptoms.Use Fishbone and 5 Whys to identify the root cause of the problem we seek to improve.
52tracking process performance Run Chartstracking process performance
53Run Charts: Purpose Use when you have, or can collect: To study data measured over timeRun charts help to:Study the performance of a processIdentify trendsMeasure change in performance following a change in processUse when you have, or can collect:Quantitative dataOn a measure of the performance of a processOver time
54Run Charts: Step by Step Decide what data you needAre the data you need already tracked?Do the data need to be collected?Determine the timeframe & number of data collection pointsShould you make your count annually, quarterly, monthly, weekly, daily, hourly?Try to gather data from 20+ time points in order to establish a trendStep 2Gather your data
55Run Charts: Step by Step Graph your dataOn the Y-axis, set up a scale that corresponds with your measureOn the X-axis, set up a scale that corresponds with your measurement timeframePlot your data on the chart, placing one dot at each measurement pointDraw a line through your dotsCalculate the mean score and draw a line at the meanMark the timing of your changeExcel, Word, and other programs can help!
57Run Charts: Step by Step Make sense of your results by examining your dataDoes the mean reflect an appropriate level of service or outcome of your process?Is there a trend that should be investigated?Do you see a shift in your data? Are there 8 or more consecutive points on one side of the center line?Do you see a trend in your data? Are there six consecutive jumps in the same direction (up or down)?Do you see a pattern in your data? Does a pattern recur eight or more times in a row?
58Run Charts: Hints and Tips Every process will have some variationBe cautious about assuming that variation from the average has meaningBe sure to track data over a long enough period of timeThis will help you identify the true mean and the true level of variability within the process
59Run Charts: Exercise Month Response rate in ‘08 Response rate in ‘09 January21.8February2.31.9March2.2April2.53.5May2.63.8June3.9July2.14August4.1September4.3October4.5NovemberDecemberEach month the health department tracks customer satisfaction survey data to measure the impact of implementing an integrated service model starting in April 2009.Client satisfaction measured by mean score on survey item:“The health department makes it easy to get the services I need.”