Process Mapping in healthcare

1. PERFORMANCE IMPROVEMENT PROJECT
Group D
• Mohamed Donya (600220042)
• Mohamed Shalaby (600220316)
• Walaa (600220036)
• Nancy (600220522)
• Shimaa (600220066)

2. This is a real case from the outpatient department of our hospital
which is a tertiary hospital for pediatric cardiovascular diseases.
Target Service: Pt journey in OPD.
Aim statement: Decrease OPD cycle time for pt with
initial assessment by 30% (Mar-Jun 2022)
Patient Time:
Total OPD cycle time for pt with initial assessment = 3 hours 55 min.
Total value-added time = 93 min.
Total non-value-added time= 120 min.
When we analysed the time spent by the pt in the OPD,
we found that non-value-added time comprises about 56% of the total time spent in the OPD.

3. Our team is composed of each process owner:
1. OPD director
2. Head of Radiology dep
3. Head of lab dep
4. Head of Nursing
5. Finance dep
6. Head of Reception
7. Quality personnel

4. Developing Quality Measures:
- Outcome Measures:
1- Rate of retaking blood samples / rate of defective samples
2- Timeliness of care
3- Pt experience (PROM/ Pt-Reported Outcome Measures)
- Process Measures:
1- The amount of time between taking blood samples & getting its results
2- The amount of time that passes between pt seeing consultant 1 & consultant 2
- Balancing Measures:
1- Does using an in situ lab affect the accuracy of the result of samples?

6. Value Added activities Non-Value added activities
Def: Actions & services that provide important
patient care.
Def: Actions & services that does not provide
improvement to pt's care & could be considered
waste
Taking the pt vital signs Long waiting time to be served
(Waiting waste)
Clinical examination and taking patient’s
symptoms signs and complaint
Reception is not in the same area of clinics
(Motion waste)
Taking the necessary labs & X-ray Too much time wasted during transportation of
lab specimens (Transportation waste)
Performing an echo There is too little inventory in the branch store
(Inventory waste)
Giving the proper diagnosis and prescribing
medications
Sometimes the sample taken from the pt is not
sufficient to perform all the required labs
(Defect waste)
Answering pt’s questions and giving necessary
instructions
Time wasted due to doing a task that is not
necessary (Excess processing waste)

7. Causes of Non-added value activities & Types of Waste:
1- Waiting Waste: - All pts arrive at the same time for registration.
- Reception personnel take a long time to register each pt.
- Too many complicated forms new pts have to fill.
2- Transportation Waste: It takes time to transport labs from OPD to the main lab which is on another floor.
3- Inventory Waste: Little inventory in the branch store, wasting a lot of time to refill from the main store.
4- Defect Waste: Insufficient amounts of blood samples taken from pts to perform all the required labs.
5- Motion Waste: Pts have to get through many stations to reach a final diagnosis & prescription.

8. Solutions:
We categorized solutions into 3:
A- Elimination
B- Simplification
C- Sequence
1A- There was implementation of an advanced mobile
application where the pt can submit all his clinical
history; apply for an appointment, using on-line
payment to book an appointment, even all the required
questions by the pt including the drug prescription &
instructions were added to the pt portal (Elimination
technique).
2C- The pts were divided into two groups with different
time period. Some of them would be booked in the early
morning, while others are booked in the afternoon
(Sequence technique).

9. …Solutions:
3C- Taking lab samples as soon as pt completes
registration, to be parallel with pt circulation (Sequence
technique).
4- Opening more clinics & adding new echo machines so
we managed to greatly reduce waiting times.
5B- Redesigning pt forms (Simplification technique).
6A- Safety stock in branch store (Elimination
technique).
7A- A well-equipped lab was created in the OPD to
perform all the necessary labs in situ thus eliminating
the transportation waste (Elimination technique).

10. Monitoring & Evaluation of the Performance:
- Pt experience surveys were sent to pts through
their mobile application.
- As a result of this action plan,
the total OPD cycle time for pt with radio & lab
decreased from 3 hours 55 minutes to almost 120
minutes (almost half) in about 2 months.