Next steps in our process mapping journey

1. National Unscheduled Care Analysts Event
Using Information to support improvement
AIMS OF SESSION
NEXT STEPS IN OUR PROCESS MAPPING JOURNEY
Claire Bell
Explore how to turn process maps into a compelling and
informative story to support improvement.

2. ANYTOWN GENERAL HOSPITAL
In preparation for Mapathon – prepared a process map of their Minors Service Flow 1
What does this tell us ?
Not a Lot !
At the moment it is a
graphical
representation of the
steps involved in a
process or portion of a
process
What does it not tell us ?
How many patients go through the process (by
week, day hour) ?
How fast do they progress from step to step
How long do they stay overall ?
How many are delayed and stay > 4 hours ?
What caused the delay ?
Is it the same each day of the week or different ?
Are there specific time periods where there is
more pressure on this service ?
What resources are in place to provide and
support this service ?
To really understand this
process and identify
opportunities for improvement
we need answers to lots of
questions….
Minors
Minors
Waiting
area

3. ANYTOWN
GENERAL
HOSPITAL
 BACKGROUND
 37896 minor attendances
over 12 month period
 1439 patients were > 4
hours (96.2% compliance)
 Flow 1 patients > 4 hours
account for 26.8% of all
patients > 4 hrs
 Flow 1 is the highest
volume flow accounting
for 62.2% of the total ED
attends.
 The minors area is a 6
cubicle area, with a small
internal waiting area (4
chairs) which is within the
ED footprint. It is open
from 8am – 10pm and
staffed by 2 ENPs and 1
CSW, however staffing
can be flexed with the
main department.The
cubicles are closed from
10pm – 8am with minors
patients being seen in
majors.
 DEMAND
Mon Tue Wed Thu Fri Sat Sun
Minimum 94 63 73 52 56 58 78
25th percentile 113 93 93 92 84 86 95
Average (Mean) 121.9 105.9 103.4 101.3 93.4 93.7 107.3
85th percentile 139.5 123 117 120 104 107.5 124.5
Maximum 157 149 147 132 124 126 148
Median 122 106 102 101 94 93 107
Range 94-157 63-106 73-102 52-101 56-94 58-93 78-107
Summary Statistics FLOW 1
 PERFORMANCE
Top 3 Reasons
Account for 76% of
delays
Minors
Waiting
Area

4. ANYTOWN
GENERAL
HOSPITAL
 Top Reason for Delay -TTFA  Length of Stay  Occupancy GAP Grids
FLOW 1: Average TTFA By Arrival Day and Hour
Hour Mon Tue Wed Thu Fri Sat Sun 0-59 Green
00 110 123 93 96 85 75 109 60-69 Amber
01 114 123 97 109 92 81 106 70+ Red
02 113 125 99 105 87 83 102
03 86 96 92 93 82 81 90
04 76 99 94 87 76 76 92
05 64 84 84 84 78 61 92
06 60 75 68 71 75 51 81
07 53 61 45 49 61 51 65
08 39 57 31 34 49 36 49
09 38 48 32 33 54 40 51
10 54 48 40 38 46 51 56
11 62 51 46 40 48 58 72
12 67 51 49 41 53 66 81
13 61 53 48 47 48 66 80
14 67 47 43 50 47 69 84
15 68 50 47 47 52 68 82
16 65 50 45 46 58 66 81
17 74 53 47 45 63 72 89
18 78 55 55 48 66 79 86
19 75 55 49 54 64 82 101
20 89 59 57 60 63 98 109
21 99 71 62 74 70 114 122
22 102 72 76 84 74 116 140
23 116 109 121 71 112 122 129
FLOW 1
Occupancy
Average Hourly
Occupancy 8am -
10pm (Minors Area)
Average Hourly
Occupancy 10pm -
8am (Flow 1in
Main ED)
Maximum
Recorded
Mon 16.5 11.5 23.1
Tue 12.5 9.1 18.7
Wed 12.2 8.6 18.5
Thu 12.0 8.4 18.1
Fri 11.6 8.3 18.5
Sat 12.6 8.7 19.5
Sun 16.0 11.3 23.4

5. Following this process for your Maps
TheValue of Adding
Meaningful Data toYour Maps
Process Map Process Map with Data
Limited Information Map provides the steps
Steps in process Flow 1 attendances are slowly increasing across the year.
Monday and Sunday’s typically have the highest attendance levels,
and lowest UC%
The range of attendance levels across many days is wide.
The hourly arrival pattern indicates that levels increase rapidly from
7 am, and remain high throughout the day, starting to reduce in the
evening and overnight.
The top 3 reasons for delay account for 76% of total delays. Time to
1st Assessment is the highest recorded reason for delay
Monday and Sundays are the most challenging in terms of TTFA.
Particularly in the early evening and overnight. Most patients breach
due to TTFA in these periods.
The length of stay distribution highlights a ‘long tail’ in length of
stay. The cumulative profile confirms that 52% of patients are
discharged within 2 hours.
Occupancy within the minors area is high (8am-10pm). From 10pm
minors patients are seen within the main ED and again the
occupancy of this cohort is significant overnight.
Adding data to your MAP -The Process
Confirm process map review team (Clinical Teams, Improvement Teams, Analysts etc)
Decide which map to start with first.
If the map contains multiple flows, decide if this is ok or would it be more meaningful to split
Clearly Define your cohort for analysis (e.g. flow 1 patients)
Define you time period for analysis – this will create a baseline for your improvement projects
For each stage in the journey review what data is available and would be most meaningful.
Start creating you data story
OTHER USEFUL DATA TO CONSIDER
• Age profile of patients using the service
• Qualitative data can be very powerful when building a story. Consider shadowing some patients through
their journey at different days/time of day, and different patient cohorts (e.g. elderly, young etc)
Make your process maps dynamic. Keep them up to date. When you undertake any improvement projects
update your map, highlighting when the test of change was undertaken, and keep your data up to date to
evidence the improvement that has been made.
Use visual methods to share the journey and the impact improvements have made to the quality of care and
patient/staff experience. Share success 
Breakout Session After Lunch – opportunity to ask any questions about your maps / adding data to
your maps