The Healthcare Manager's Playbook

A process map is a step by step diagram that shows how a good or service is delivered. In healthcare, a process map focuses on how patient care is provided, such as an office visit, therapy appointment, or lab draw, to name a few examples. The process map above came from an emergency room (ER) project I was part of. The goal of the project was to reduce wait times. To help achieve this goal, we needed to see, step by step, how patient care was actually being delivered in the ER.

Unfortunately, process mapping is often overlooked in healthcare. Clinicians are already busy and stretched by patient care responsibilities. As a result, process improvement projects often rush toward implementing solutions before fully understanding the process itself. When this happens, gaps in understanding develop, mistakes are made, and improvement efforts eventually lose momentum. What remains are inefficiencies, frustration, and missed opportunities to improve care.

Process mapping offers a better way forward. By taking the time to understand how work is truly being performed, opportunities for improvement become easier to recognize. In the ER example above, process mapping made it easier to see that once all treatment rooms were occupied, wait times increased dramatically. It also highlighted that many patients remained in rooms while simply waiting for tests or results. This created a bottleneck that limited the ER’s ability to continue seeing new patients. Once the process was redesigned so appropriate patients could wait in an intermediate waiting area instead of occupying treatment rooms, patient flow improved and wait times decreased.

If process mapping is new to you, below are a few tips for getting started.

1. Go to the gemba. In order to gather the most accurate information, spend time at the actual place where the work is occurring. Plan to observe several patients moving through the process from beginning to end. Look for differences in how care is delivered. Make note of inefficiencies, delays, and points of stress or strain for both patients and staff. For example, building the ER process map above required time onsite during both day and night shifts while observing stable walk in patients as well as patients arriving by ambulance in need of immediate medical attention.
2. Identify beginning and ending points of the process. In the ER example, the process began when a patient arrived either by personal transportation or by ambulance. The endpoint was discharge home, admission to an inpatient bed, or transfer to the operating room. Clearly defining the beginning and ending points helps establish the boundaries of the process and prevents important steps from being overlooked.
3. Create separate boxes for each step in the process. In the ER example, the steps included triage assessment, nursing care, diagnostic testing, physician evaluation, and discharge. When documenting each step, include key details such as who is performing the task and how long the task takes to complete. Observe at least five cycles of the process to determine whether variation is a factor. In healthcare, variation between patients, staff members, and shifts can significantly affect how well a process performs.
4. Show how each step connects to the next. How does information flow throughout the process? Is communication electronic, verbal, or paper based? How does patient movement occur between steps? Are patients waiting in chairs, beds, or hallways between stages of care? Measure the waiting time and delays between steps. Doing so provides a more complete picture of the total processing time from the patient’s perspective.
5. Look for inefficiencies and waste. Take advantage of having fresh eyes and perspectives and note inefficiencies, frustrations, delays, and rework. It is often easier for new observers to see problems that others have gradually accepted as normal. Refer to prior post on 8 wastes for more information on common examples of waste in healthcare.

Process mapping is a powerful tool for understanding and improving how work happens. It is often one of the first steps toward helping patients receive the care they need in a timely manner, with less frustration, less waste, and at a reasonable cost. That sounds like a map worth following.

About the Author: Shane Haas serves as the National Director of Outpatient Services at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.

References:

Rother, M., & Shook, J. (2003). Learning to see: Value stream mapping to add value and eliminate muda (1st ed.). Lean Enterprise Institute.