Want to Make Tremendous Gains at Your Healthcare Site? Use Process Mapping! | healthcare

I want to tell you some ways to eliminate waste at your medical site. Am I talking
about physical waste, like soiled bandages or used needles? No, I mean any action
that results in a poor or unintended outcome. I mean taking too long to accomplish
some outcome, like taking too long to get an operating room ready for the next
surgery. The National Institute of Health in “Crossing the Quality Chasm” stated
that any waiting time for a patient is a waste. A patient waiting past the time of his/
her scheduled appointment is an example. A patient having to wait too long to be
admitted to a hospital after being seen in the emergency room is an example of
poor processes–a waste. A patient who develops an infection after being treated or
going through surgery is a good example of waste from unintended outcomes.
These are just a few examples. I am sure that you are aware of many more.Japanese manufacturers are leaders in eliminating waste. One trick they use is to
send a new employee to the manufacturing floor and have him/her watch someone
performing a task; the new employee is told to watch until he/she sees a better way
to do the job. These manufacturers know that the time spent doing this will save
more time and money in due time. Hospitals and healthcare sites are not
manufacturing plants, though. Yet many of the same principals can be applied. The
effort will more than pay for itself. In fact, savings of 3 to 100 times the investment
is not unusual. The movement going on in the healthcare field adapted from the
Japanese manufacturers is commonly called “lean healthcare.” Perhaps you have
heard of some of the terms associated with it, like Kaisen events or poka-yoke. You
don’t have to be a master of these tools and terms to make good use of them,
though. Many are just applying logic with common sense.The tools are best applied in efficient working teams or groups where some
problems with processes or outcomes are already agreed upon. If the working
group is larger than 3 or 4 people I suggest that one tool you use are string and 3
by 5 cards. You are going to use these to map out a process from beginning to end
and see if the group can find waste and suggest ways to eliminate it. Use the cards
to describe what physically happens during a process and use the string to connect
the activities that flow from one to another. For example, you might want to track a
patient in a doctor’s office coming in for a physical. The first card would represent
the patient’s encounter with the first staff person who records the patient’s
presence. From there, strings would indicate communicating with other pertinent
personnel of the patient’s presence and the ensuing events as well a string and card
that would indicate the patient waiting in the waiting room. In all of these mappings
you should be thinking of what you would like to use as variables to measure. You
certainly should be measuring time by all involved parties. You might also want to
count the number of successes/failures in communications. Many unintended
consequences occur at transition points and handoff points due to poor
communication. You might count if a supply was missing and someone had to
scurry to find another one. You will want to later find the mean and standard
deviations of these measures. The goal is achieve a target mean with as small as
possible standard deviation. For example, you should have 0 as a target for the
number of times a supply was missing.After reaching a mapping that all agree represents as best as possible the present
flow of events, the group should brain storm ways to improve the flow. The goal is
to find a significantly better path. If a consensus is reached, fine; implement it. If
not, then perhaps you will want to try the various ways and then decide which is
best, based upon agreed upon measures of outcomes.Once an optimized process is developed by the staff, you should write it down.
Make it a standard operating procedure and try to have all involved parties adopt it.
You might want to allow a little bit of wiggle room for individual differences in
performing a task; the goal of a common target with small standard deviation
should the goal of all, though.Another tool to use is open communication. Too often a staff person or nurse will
see some event unfolding that will lead to poor outcomes. If the work environment
is not conducive to positive communication–communication which does not result
in negative outcomes for the reporting individual–mistakes and waste will always
occur that could easily have been prevented. To reach a high level of positive
communication, the leaders at a site must work long and patiently to build trust. It
is not easy to do, but the payoffs are tremendous. Everyone wins!Most healthcare leaders think of quality improvement as applying to activities that
directly involve the patient. However, the best healthcare providers use these tools
and others to evaluate all the processes at a healthcare site. The admissions and
billings departments are ripe targets, for instance. The result will be happier, more
motivated employees who are working more efficiently. In fact, sites which were
experiencing a shortage of staff often finding themselves well staffed because of
quality improvement processes. I do suggest that you promise all employees
involved in these processes that you guarantee there will be no layoffs. Doing so
will produce better outcomes.If you want more examples of system wide applications of quality improvement in
healthcare facilities, I suggest that you go to the Baldrige Award site on the internet
and read the success stories of winners. Their results will amaze you, I promise.I hope that you seriously consider adopting these tools and research other methods.
Many are described at various healthcare sites. Two of my favorites are Institute for
Healthcare Improvement and the American Academy of Family Physicians.