Process Mapping Todd Pawlicki, Ph.D. with https://i.treatsafely.org - - PowerPoint PPT Presentation

Process Mapping Todd Pawlicki, Ph.D.

Joint IAEA-ICTP training on patient safety in radiotherapy Trieste, Italy 24 – 28 November, 2014

with https://i.treatsafely.org

What is a Process Map?

• A pictorial representation of the sequence of

steps that comprise a process

Value-Stream Map

• Process Map
• Flowchart

Swim Lanes

• Fishbone
• Ishikawa
• Cause-and-Effect

Benefits of Process Maps

• Immediate
• Communication (“A picture is worth a 1000 words.”)
• Efficiency gains
• Safety gains
• Longer term
• Maps form the basis for several quality improvement tools
• Education and competency training

Recommendations

• Step 1: Decide what process to map. Don’t try to

cover too large of a process.

• Step 2: Form a group and identify a leader. Someone

needs to be in charge and moving it forward.

• Step 3: Create an initial process map. Start with a

draft that captures the workflow at a general level.

• Step 4: Iterative mapping. The process map is refined

with the input from the staff involved in the process.

Creating a Process Map / Flowchart

Treatment Planning Physician Consultation Treatment Delivery Simulation Patient Follow Up Patient Registration

But, too high-level to be useful for improvement. Sufficiently high-level that everyone can agree.

Narrow the Focus

CT simulation Prepare linac table Position patient Acquire images Compare images Treat patient Setup acceptable? No

Daily patient setup for treatment.

(Process Map / Flowchart)

Specify and Look For Bifurcations

CT simulation Prepare linac table Position patient Acquire images Compare images Treat patient Setup acceptable? No

Head and Neck IMRT/VMAT

One way (#1) MD #1 CBCT Linac #1 Any RTT Another way (#2) MD #2 Planar kV Linac #2 Experience RTT (Process Map / Flowchart) #1 #2

Swim Lanes

8 Wash body Turn on Shower Wash hair Dry off Get dressed Put on makeup Wake up

Wake up Turn on coffee machine Drink coffee Wake up Pour cereal Add milk Eat cereal Wake up Make sandwich Wash fruit Pack lunch

(Getting to work example)

Swim Lanes

9 Wash body Turn on Shower Wash hair Dry off Get dressed Put on makeup Wake up

Wake up Turn on coffee machine Drink coffee Wake up Pour cereal Add milk Eat cereal Wake up Make sandwich Wash fruit Pack lunch Wake up Turn on coffee machine Drink coffee

Wash body Turn on Shower Wash hair Dry off Get dressed Put on makeup Wake up

Wake up Pour cereal Add milk Eat cereal Wake up Make sandwich Wash fruit Pack lunch

Swim Lanes

10

Wake up Turn on coffee machine Wash body Wash hair Dry off Get dressed Put on makeup Turn on Shower

Swim Lanes

11

Turn on coffee machine Wash body Wash hair Dry off Get dressed Put on makeup Turn on Shower Drink coffee

Swim Lanes

12

Pour cereal Add milk Eat cereal Dry off Get dressed Put on makeup Drink coffee

Swim Lanes

13

Make sandwich Wash fruit Pack lunch Pour cereal Add milk Eat cereal n p k e

Swim Lanes

Make sandwich Wash fruit Pack lunch Pour cereal Add milk Eat cereal n up k e

Cause-and-Effect Diagram

I injured my toe in the night. Todd Dec 10, 2012 Dec 10, 2012 n/a

15

(Ishikawa or Fishbone Diagram; Causal Analysis example)

Brainstorming Narrative

16

I was hungry in the middle of the night. The lights were off. I decided to get out of bed and get a snack. I did not turn on the lights because I did not want to wake up my

• wife. I kicked the leg of the table that has my alarm clock as I

walked to the door in the dark. I injured my toe and woke up my wife from her sleep.

Cause-and-Effect Diagram

Woke up Injured toe

Hungry

Small dinner Go to bed early

Lights off

No dimmer Light switch on wall

Kicked table

Don’t like food

Table near door

Ishikawa or Fishbone Diagram

Work too hard Mean boss

Creating Useful and Usable Maps

• Everyone should have the same understanding
• f the process steps

– A multidisciplinary can be helpful but not necessary

• Number of steps in the map should be the

smallest number to meet objective, but not less

• Just get it done

– Don’t focus on fancy graphics – There is value in just creating the map

Summary

• A picture is worth 1000 words – maps are useful
• There are many different maps – pick one you

are comfortable with and use it

• Team work and have fun!