Process Maps

• Where are the quality problems and which problems should I tackle first?
• Ishikawa / Fishbone / Cause & Effect Diagrams
• Process Mapping
• Five Whys
• Pareto Charts
• Failure Modes & Effects Analysis
• Root Cause Analysis

A process map outlines all the different steps that take place in order to deliver a service.  Mapping out these processes helps QI teams identify problems that need to be fixed. 

QI teams should start with a high level process map (e.g. 5 to 12 steps).  They may then choose to drill into greater detail to any particular set of processes where problems are believed to be the greatest, and generate a detailed process map. 

Tips for Process Mapping:

1. Assemble a group with representatives from every type of provider that contributes significantly to the service.  Include users or patients. 
   
   
2. Use a neutral facilitator.  
   
   
3. Agree on the first and last processes to be mapped.
   
   
4. Focus on mapping those processes which account for 80% of what’s happening.  (Don’t waste time on the exceptions.)
   
   
5. Map the actual, not ideal process. 
   
   
6. For each process identified, write it on a yellow stickie and post it on a white board.  (Option:  write on the stickie who did it and where.)
   
   Alternate Methods for Process Mapping:
   
   
7. If key individuals can’t all meet together to process map, try this alternate method:  
• Post a white board with processes partially mapped in a location where providers pass through frequently (e.g. lunch or staff room).  
• Invite providers to post missing parts of the process with yellow stickies.  If there is a major disagreement on how a part of a process is portrayed, they can post an alternate set of processes below the area of disagreement.  
• Leave this board up for a set period of time (e.g. one day, or one week). 
  

Process Mapping Styles for Display:

There are at least three different process mapping styles:

1.    Traditional

Map processes in their usual sequence, using the following symbols:



Example:



Tip:  this is the most basic, recommended for first-time users. 

2.    High-Low Level Map

Place the steps in a high level process map in the line on top.  Under each high level process step, list the detailed steps which take place in order for it to happen. 

Example:
Emergency Department - Initial Evaluation



Tip:  this can be useful if the team is struggling with what level of detail is appropriate when process mapping.  If your team has a lot of detail-oriented people on it, you can park these details while still maintain a view of the big picture. 

3.    Swim Lanes

Example:



Tip:  this is useful for identifying handoffs where a problem might occur, and for keeping track of who is responsible for which process. 

Analyzing Process Maps

Once you have completed your process map, ask the following:

• where are the bottlenecks?
• What are the inconsistencies in how things are done?  What can be standardized?
• Can things be done:
• In a different order?
• In parallel?
• By a different person with better or same quality, at lower or same cost?
• Can steps be located closer to each other to reduce travel?
• Is each step value added?  If not, can it be eliminated?