QUERI – Quality Enhancement Research Initiative

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Quality Improvement Methods

36. Process Mapping

a. Definition: A Process Map is a diagram showing the components, relationships and sequence in which a system functions and it is often a good way to understand that system being diagramed. There is a standard set of symbols that are commonly used. The resulting drawing can be useful for analyzing or explaining the work done by an organization. The level of detail can be relatively simple or very complex. It is also often referred to by other names such as a work flow diagram, process chart, flow chart or flow map.

A complex system, such as all the steps of a hospital visit or a simpler set of steps such as a particular treatment, can be described in diagram form. This is often a good way to begin the study of an area or for use in a Kaizen Event (see Section 22) where research or an improvement is planned. The process of diagramming forces the researcher, and others involved, to be specific and understand how each step occurs.

Process maps are also referred to as flow charts, workflow diagrams and other variations of these terms.

b. Literature:

  • Process charts have been in use since the 1920's, which were first popularized in Gilbreth, Frank Bunker, and Lillian Moller Gilbreth "The quest of the one best way."
  • Diagramming software is available with specific tools for such diagrams in MS PowerPoint, MS Visio, ABC Flowcharter.
  • Damelio, Robert. The basics of process mapping. Productivity Press, 2011.
  • Pluto, Delores M., and Barbara A. Hirshorn. "Process mapping as a tool for home health network analysis." Home Health Care Services Quarterly 22.2 (2003): 1-16.
  • Rath, Frank. "Tools for developing a quality management program: proactive tools (process mapping, value stream mapping, fault tree analysis, and failure mode and effects analysis)." International Journal of Radiation Oncology* Biology* Physics 71.1 (2008): S187-S190.
  • Cendan, Juan C., and Mike Good. "Interdisciplinary work flow assessment and redesign decreases operating room turnover time and allows for additional caseload." Archives of Surgery 141.1 (2006): 65.
  • Trebble, Timothy M., et al. "Process mapping the patient journey through health care: an introduction." BMJ 341.7769 (2010): 394-397.

c. Example: There are many different formats for such maps.

process map

Diagrams can be arranged in various formats. Typically time flows from left to right or top down. One popular version, called a "swim lane" map, involves segmenting the map by organizational unit. The swim line map demonstrates when work on a process moves from one organizational unit to another. Many such movements back and forth between units may be an indication of waste.

process map

d. Steps:

1) Define a process or system to be analyzed by the diagram.

2) Determine the type and level of detail necessary. Often, such diagrams are first sketched simply and the details and rearrangements are done as the understanding of the system emerges. It is possible to do an overall diagram and then to do separate more complete diagrams of the details of each area.

3) Draw the diagram from the start of the process, indicated by the "start" symbol, through the endpoint, with an "end" symbol. Many process mapping efforts at hospitals are started with "sticky notes" stuck on a wall as part of a group discussion or Kaizen. Then, the resulting diagram may be transferred to a more formal drawing or perhaps the exercise on a wall is sufficient.

4) Once a first draft is done, review the diagram with the people who directly do the processes diagrammed to see if they concur, and revise accordingly. This may mean reviewing the diagram with nurses, doctors or technicians but the graphic nature of the diagrams makes them relatively easy to explain.

5) Review the resulting diagram for bottlenecks, unnecessary steps and other opportunities for simplification or improvement in the system drawn.