Definition of a Process Map

A process map is a visual display

of a process using symbols and
formats.
 Benefits of Process Mapping
• Provides a visual representation of the process
• Requires verification and objectivity
– Hands-on exposure to local activities

• Identifies rework loops and redundancies

• Gives insight into bottlenecks, cycle times, and inventory
• Identifies non-value added steps
• Helps identify when and where to collect data
• Identifies where different work teams use different processes
• Serves as a training and orientation tool
Components of A High Level Process Map (SIPOC)

• Supplier: Whomever provides the inputs to the

process
• Input: Materials, resources, and data required to
execute the process
• Process: The activities and resources applied to
the inputs to convert them to outputs
• Output: The tangible products or services that
result from the process
• Customer: Whomever receives the outputs of
the process – internally or externally
 SIPOC Process Mapping

CTQs CTQs

_____
• •_____
_____
• •_____
S _____
P _____
C
• •
_____
• •_____

Suppliers Inputs Process Outputs Customers

 Step 1 Example: “Pasta” High Level SIPOC
Map

Pasta High Level Process Map

Cooking
Suppliers Input Pasta Output Customers

Restaurant Owner Raw Pasta Cooked Patrons

Grocery Store Pan Pasta Owner
H2O Cook
Cup
Stove
Spoon
Salt
Oil
SIPOC - Relation to a Detailed Process Map

_____
• • _____
_____
• • _____
S _____
P _____
C
• •
_____
• • _____
Inputs Process Outputs

X X

Process
Map
X
Common Detailed Process Mapping Symbols

– Process Step or Operation (White)

– Delay (Red)

– Quality Check, Inspection or Measurement

(Yellow)

– Storage (Yellow)

– Decision (Blue)

– Transport or Movement of Material or

Transmission of Information (Yellow)
 Versions of a Process
At Least Three Versions
(Usually)

What It Is Thought What It Actually Is… What It Should Be…

to Be…
 Process Mapping and the Hidden Factory

Hidden
Factory
 Step 2 Example: Identify All Process Steps
Pasta Process Map
Designate steps as value-added or non-value-
added
Rework
.01 DPU

No
.5 MINUTE 6 MINUTES .25 MINUTE 9 MINUTES

Add water, Boil Add Cook

Input salt & oil
Done? Output
Water Pasta Pasta Yes
Cooked
Raw Pasta
VA VA VA VA
Pan Pasta
H2O
Stove
Spoon
Salt
Oil Add cycle time, defect/yield data and ALL rework loops
Step 3 Example: Determine Outputs For Each Step

Pasta Process Map

Rework
.01 DPU

No
.5 MINUTE 6 MINUTES .25 MINUTE 9 MINUTES

Add water, Boil Add Cook

Input salt & oil
Done? Output
Water Pasta Pasta Yes
Cooked
Raw Pasta
VA VA VA VA
Pan Pasta
H2O
Stove Boiling Water Properly Cooked
Spoon Water Remaining
Salt Steam
Oil

What are the outputs for the other steps?

 Step 4a Example: List Inputs For Each Step

Pasta Process Map

Rework
.01 DPU
VA VA VA VA
No
.5 MINUTE 6 MINUTES .25 MINUTE 9 MINUTES

Add water, Boil Add Cook

Input salt & oil
Done? Output
Water Pasta Pasta Yes
Raw Pasta Boiling Water Properly Cooked
Cooked
Pan Amt. of Salt Water Remaining Time Pasta
H2O Amt. of Oil Steam Lid or Not
Stove Lid or Not Type of Pasta
Spoon Altitude Amount of Pasta
Salt Ambient Temp Altitude
Oil Time Ambient Temp
Minerals in H2O Cooking instructions
Pan Material
Pan Size
Pan Condition
Boiling Instructions
BTUs
 Process Map Exercise

Using one or two process tasks from your

SIPOC, work with others at your table to
create an “As-Is” detailed process map.
Step 1 :Identify the
cross functions in the
process
Step 2 :Identify the sub
processes and list it down

Step 3 :All the relevant

details of the process are
mapped

Step 4 :Join all the

successive steps of the
process

Step 5 : Get the approval

from all the stake holders
SPAGHETTI DIAGRAM
SPAGHETTI DIAGRAM
Before
SPAGHETTI DIAGRAM
Current process

CLINIC
DIET
PFT
ECHO/
TMT
 Tracking Movements – Spaghetti Diagram

Educating Medication
Rounds
Discharge With
Process Doctor

Booking
Investigation

1. Events recorded after 30

minutes walk around with the
Nurse at 5th Floor Call Bell &
Bedpan
2. Ward Nurses travel 4 km per
shift.
Patient and information flow analysis (PIFA)
 Patient and information flow analysis (PIFA)
What is the ▪ Create a holistic view of the entire (end-to-end) current system on one
purpose ? piece of paper
▪ Provides framework for solution development and future operations

1. Select an existing flow e.g., patient movement from emergency room to

Key Steps wards
2. Discus in team to identify:
– Start and finish point, frequency of activity
– Key steps in the flow
– Time required at each steps
– Participants, existing tools and materials, etc.
1. For each step in the flow, identify the information which made it
possible to move to the next step, and complementary information (in
particular, staff information)
2. Identify the source of information and trace its path
3. Identify key issues in the flow

▪ A visual map of how patients and information flow from end-to-end of the
End Product chain and where is the flow interrupted by inefficiencies
 Patient information flow analysis with key Delay due to other
teams / external issue

issues 2
Delay due to local
Very busy spot with ~130 team / internal issue
interactions per hour and people
queuing for information
1 6 9 10 11
Complexity of board and ▪ 60% doctors & nurses Variability in Waiting for Waiting for Waiting
notes management ▪ 15% patients how staff ‘TIS’ Technician or test results for A&E
currently requires senior ▪ 10% phone Majors and how tests doctor (e.g., (don’t know doctor
nurse, pulling scarce ▪ 15% other (tech, ▪ X-ray ~40% are launched to take blood) when ready)
capacity out of the team ambulance, student, porter) ▪ Bloods ~60%
▪ Referral ~25%

43%
Ambulance
Patient Board Nurse Allocation • Tests*
Take files, put
arrives in • 'Hello” • Chair Patient called TIS • Specialist A&E Doctor
card on board
Majors • Notes • Cubicle • Treatment
Reception 8-12 min 20–40 min
57%
3 ▪ Minors ▪ Minors
Slow PCs ▪ Resus ▪ Resus
▪ Walk In Centre 18–26 min
▪ Walk In Centre 25–35 min
▪ GP
18
Nurse often needed 4 5 7 8
Waiting for Multiple Changing Awaiting test results
to accompany Language barrier,
senior staff to checking by equipment Bloods: 70–110 min (chem), 60–80 min
patient to ward and waiting for health
handle transfer 17 TIS patients doctors and (ECG, (haem lab), 5–20 min (haem near-patient)
advocate
to bed No admin and slow writing wheelchair, from bleeding to results authorised
(10-10 service only)
photocopier of notes keys, etc.)
support at night
72%
Notes Home
photocopied Decision • Tests* • Tests*
discharge/ • Specialist Specialist • Specialist
admit • Treatment • Treatment
Get bed
Porter arrive Bed ready Request bed
allocation
28%
(from specialist
called to arrival)
60-80 min
16 50-80 min
Delays in porter arriving ~75 min 15 ~45 min 14
to transport patient to Delays when Delays from requesting
bed to identification of 12
bed or allocated beds are 13 Waiting for Specialist –
in finding and actually occupied ‘available’ bed Potential further Time from TIS to
copying notes cycle of tests – specialist arrival
~5% of cases 120–200 min
 Golden rules for observing a PIFA
Do Don’t
Take the time to follow the whole process Neglect to explain objectives
to the staff member you followed
(observations do not focus on individual
performance!)

Let the staff members act naturally Interact with the employees during
observation

Write down all activities of the sequence Try to justify inefficiencies observed
observed

Analyze activities observed in teams (after Try to confirm an assumption

observation!)

Be fact-based and critical… to better Find a culprit!

improve the process
 CT/MRI scan process flow Critical phase

If
Verify bill If ok plain
Doctor advices Type of Appointment Patient arrives
at
CT scan scan scheduled at reception
reception
6 hrs
If contrast

Ask for:
Send to If not ok Doctor/tech - Blood values
respective
informed - Special
consultant
preparation

Handover
Correlate image Explain process If ok Verify details Verification and
datasheet and
with clinical Scanning and take and check blood report, registration at
consent form to
history consent form if contrast reception
Doctor/tech

Post processing File, datasheet

Image and
Patient informed of image enclosed in a Jr. doctor writes
report review by Sent for typing
despatch time (pacs/print) and cover and sent report
consultant
documentation for reporting

If not ok

Check
report
Sent to Report enclosed If ok
despatch in respective Report signed
counter cover
 PIFA process for X-ray
Patient reaches X-ray Patient is given a token and
Doctor advises X-ray Patient pays bill in op billing
reception asked to wait for his turn

If image not proper Iss

Patient
Patient ch ues
given des- an – O
Issue – Return ge
departure
patch time Confirm roo nly 1
of the wet film Image m
patient -
ok Patient
Image Patient is
under goes
check asked to
X-ray
change
Handover film to Yes Wet film Image
patient – ask to
request print/pacs
return for report Patient
Yes Patient
arrives Token no.
at X-ray available displayed
Issue – PACS counter
No
No

Later arrival
Yes
Wet film Send for
received reporting Issue –
Inappropriate
clinical history

No

Accept- No
Or to
able Check Appropriate Write Doctor error Send to
check film Report Sign the
Stop for clinical report on to check despatch Stop
clarity and typing report
history presc. report counter
quality
Poor Not Error/
quality Appropriate modify
Issues – Typing
Send for errors & IT
Repeat Wait for interface
rectification/
X-ray patient
modification
 Ultrasound process flow
Appointment
Reaches
Doctor advises Patient pays scheduled and Patient arrives
ultrasound
scan the bill patients at reception
reception
instructed
1
hour
Issues –
Waiting time
Patient to wait

If not
ok
If Check Verification,
ok patient pre- Handover Fill data sheet
Report written Procedure registration,
paration sheet to ultra- and paste
by doctor done and token no.
sound room sticker
given

If
Sent for system Patient Films and ok
Check
entry informed about report enclosed Send for typing Report signed
report
(pacs/print) despatch time in cover

If not ok

Issue – PACS Issues – Typing

errors & IT Sent to Report enclos-
interface despatch ed in respec-
counter tive cover
Thank You!