Presentation on theme: "Understanding the Current Condition"— Presentation transcript:
1 Understanding the Current Condition Process Maps (Flow charts)Making Observations8 Wastes
2 A3 Roadmap for Performance Improvement at Penn Medicine
3 What Adds Value? Value Added: It changes the form, fit or function It is done right the first timeThe customer would pay for it – more of it is betterNon-Value Added (Waste):Any activity that does not meet the value criteria above:Unavoidable waste- necessary in the process due to regulatory or supporting value. These activities should be simplified, reduced, or combined whenever possible.Avoidable waste - activity that is not value or enabling should be completely eliminated!
4 The 8 Wastes D O W N T I M E Defects Over Production Waiting kNowledge wasted - confusionTransportationInventoryMotionExcess Processing
5 Eight Wastes: Healthcare Examples DefectsOverproductionWaiting TimekNowledgeExample:Making more IV bags than are needed.Preparing 4 units of blood “just in case” for the ORExample:Lab tests are performed twice because of errorsAn x-ray is read incorrectlyWrong site surgeryExample:Delayed Cases waiting forinstrumentsExample:A resident’s bright idea is “lost”, or the resident is confused about how to do a taskExtra ProcessingUnnecessary TransportationWasted MotionInventoryExample:Nurse records respiratory rate in multiple places in the chartMultiple copies of the same pathology report – in EPIC, in Medview, in SCM, on paperExample:Patient gets wheeled back and forth between the floor and radiology for multiple tests instead of taking one trip for all of themExample:Medicines held over the shelf-life because of excess orderingExample:Pharmacy tech walks back and forth looking in multiple places for a particular med5
6 Process Mapping Purpose Key Principles Visually document a process Understand the existing process and problemsQuickly identify improvement opportunities within the processHelps communicate inside and outside the organizationKey PrinciplesDocumentation is not substitute for observationA flowchart is a means not an endYour scope defines the boundaries of your mapInvolve a cross-representation of those who work in the process to create the mapProcess maps are meant to be used as working documents
7 Which Process Map is For You? DescriptionWhen to UseHigh Level Process MapView from 30,000 FeetDepicts major elements and their interactions5-8 steps totalEarly in the project to identify boundaries and scopeDetailed Process MapA detailed version of the High Level Process MapFills in the all the steps within the high level stepsTo see a detailed process in a simple viewHelps to identify and follow decision pointsSIPOCProcess snapshot that captures information that is critical to a projectTo come to agreement on project boundaries and scopeTo verify that process inputs match the outputs of the processQuality issueVSM (Value Stream Map)Captures all key flows (of work, information, materials) in a process and important process metricsRequires a current and future state to be doneTo identify and quantify wasteHelps visualize the improvement opportunitiesFlow or time issueSwim Lane FlowchartEmphasizes the “who” in “who does what”To study handoffs between people and/or work groups in a processEspecially useful with administrative (service) processesSpaghetti MapDepicts the physical flow of work or material in a processTo improve the physical layout of a workspace (unit, office, floor)
8 High Level Process Map View from 30,000 feet Used early in the project to identify boundaries and scope5 – 8 steps total
11 Versions of a Process Map Any Process Has At Least Three VersionsWhat You Think It is . . .Verify What It Actually is . . .What You Would Like it to Be . . .The struggle is that this is where everyone wants to start.
12 How to Go and See NEVER accept opinion ALWAYS walk the process ALWAYS walk the process multiple times
13 Guidelines for Observation Agree on a starting point for observation, for example patient enters a department.Make sure you introduce yourself to the customer and inform them of what it is you are doing and why.Try to talk to patients and/or staff when they are waiting, to avoid prolonging the time it takes to complete an operation.You may need to observe staff AND products/patients separately.Product/patient observation - stay with the product/patient and record what the product/patient is going through. If the product/patient waits, you wait.Staff observation – stay with your staff member continuously.Not too much detail – just enough.Always do multiple observation sessions.Observers should summarize lessons learned and present them to the whole team. Discuss the results.It is essential that time be spent on the floor observing the process and identifying wastes. Here are some guidelines for doing observations.