Workflow and Process Redesign

Delay

"D" shape

What is motivation and measurement? (Enabler of Process)

Explicit and implicit reward systems of the organization. It is how people, processes, organizations are assessed, and associated rewards and punishments.

What is Policies and Rules? (Enablers of Process)

Guides or constrains process

Outcome Measure

1. A health state of a patient resulting from health care. 2. It can be used to assess quality of care to the extent that health care services influence the likelihood of desired health outcomes. 3. Reflect the cumulative impact of multiple processes of care.

What is a process?

1. A series of steps 2. Carried out in a sequence 3. Creates values 4. Provides service 5. Makes product

What is the process to workflow diagram in Process Analysis?

1. Add implementation details to the process design 2. Identify inputs, outputs, handoffs, and bottlenecks.

Process Measures

1. Assesses a health care service provided to, or on behalf of, a patient. 2. Often used to assess adherence to recommendations for clinical practice based on evidence or consensus. 3. Can identify specific areas of care that may require improvement at a greater extent than outcome measures.

What is an example of transportation in healthcare?

Moving patients to tests

Manual Data Entry

Parallelogram shape

What is a support process?

Processes that produce products that are invisible to the external customer but essential to the effective management of the business.

What is a primary process?

Processes that result in a product or service that is received by an organization's external customer.

What are the four common types of process maps?

1. Simple (aka flow chart) 2. Swim Lane diagrams 3. Value Stream Map 4. Spaghetti Diagram

What is information technology? (Enabler of Process)

Automation of steps and capture or presenting information.

Decision Point

Diamond Shape

What is Necessary and Non-Value Added

Required by a stakeholder or regulatory body, but not of value to the customer. Examples: OSHA regulations, data collection, billing activities

Process Effectiveness

The extent to which the outputs expected from the process are being obtained by all.

What is Facilities? (Enablers of Process)

Workplace design, physical infrastructure

ADT

admission, discharge, transfer

Value Added Activity

an activity that transforms or shapes (for the first time) material, services, or information to meet customer requirements.

What are examples of excessive processing in healthcare?

asking patients the same questions multiple times, documenting same information in multiple places, EHR transcription by nurse or MA.

What are examples of "Pain Points" in Process Analysis?

bottlenecks, repetition, bureaucracy, no ownership, management frustration, and confusion

What are examples of wasteful activities in a workflow?

interruptions, patient waiting, hand-offs, location or looking for (equipment, meds, supplies, info, people), communication events (EHR messaging), moving the patient, waiting (dr. availability/records, labs, test results), and EHR inefficiency

What are examples of movement?

looking for missing data, handoff of report forms, walking to a fax machine

LEAN shifts from managing results to _____.

managing process plus results.

What are examples of defects?

medication errors, documentation errors, entering data on wrong patient, defective lab sample

What are Non-Value Added Wastes

overproduction, excess inventory, waiting, motion, excessive processing, defects, transportation, human resources

What are examples of overproduction?

redundant data capture, printing electronic information for back up, creating charts "just in case"

Complete the sentence: "data is less than information, information is less than knowledge, and information processing _________."

should be isolated from workflow.

What are healthcare examples of excess inventories?

stacks of charts/labs to be reviewed, out of date items like meds or vaccines

What information is in a process map?

1. Sequence of tasks 2. Involvement of people 3. Use of documents, systems and other sources of information

How do you map solutions in Process Analysis?

1. Create "future state" map 2. Use Plan, Do, Study, Act to identify solutions 3. Identify metrics to measure success

What are the steps to creating a simple process map?

1. Define the process 2. Assemble the right team 3. Walk the Process 4. Discuss and map the current process 5. Validate with colleagues/peers

How do you "frame" a process?

1. Develop an understanding of process (who are the participants? are there high-level categories?) 2. Develop documentation 3. Document culture, skills, and management style/structure.

What is the Process Analysis methodology?

1. Frame the process 2. Understand the "current process" 3. Identify pain points 4. Identify opportunities 5. Map to solutions 6. Understand the "new process" 7. Make efficiency improvements

How do you understand the "current process" in Process Analysis?

1. Identify key processes for evaluation 2. Identify goals of the process 3. Develop process diagrams (swim lanes, actors/stakeholders) 4. Identify the impact points

How do you make improvements in Process Analysis?

1. Implement identified improvements 2. Use Plan, Do, Study, Act 3. Revise as ncessary

What is 'Lean" also called?

1. Just in Time 2. TPS (Toyota Production System) 3. Agile

How can you identify opportunities in Process Analysis?

1. Map the pain points to the impact points (needs assessment) 2. Decide on the approach (abandon project, keep as-is, improve/tweak process, redesign/overhaul) 3. Prioritize

What are the four Key Attributes of a process?

1. Transfrom inputs into outputs 2. deliver particular results to a customer 3. are measurable 4. Triggered by a specific event

How do you understand the "New Process" in Process Analysis?

1. Understand the who, why, and what of the new process 2. What new resources will/will not be needed 3. What are possible pain points

What to look for in Workflow Diagrams

1. Which processes require documentation 2. Which processes require data 3. Which processes require a hand-off 4. Where is someone waiting for something 5. Where is the confusion

Name the Enablers of a Process

1. Workflow design 2. Information Technology 3. Motivation 4. Human Resources 5. Policies 6. Facilities

What are the four goals of LEAN?

1. improve quality 2. eliminate waste 3. reduce cost 4. customer focus

LEAN represents a philosophy and system that focuses on these two linked steps:

1. the continuous elimination of waste 2. the creation of value from a customer perspective

What are some consequences of waste?

1. underutilized employees 2. ineffective response to errors 3. missing or incomplete information 4. missed or untimely appointments 5. wait times for patients and employees 6. inefficient transfer of information

How many MU (Stage II) quality reporting measures are there? (Not CORE) How many are Clinical Outcome measures?

64, 9

How many MU (Stage II) "CORE" quality reporting measures are there? How many are Clinical Outcome measures?

9, 1

Define "process"

A series of steps designed to produce a product or service.

What is a workflow design? (Enabler of Process)

A work plan for responding to an event. It is a sequence of steps, decisions, and handoffs.

What are examples of workflow categories of concern?

ADT, care coordination, care delivery, communication, documentation, medication, patient movement, and supplies & equipment.

Which processes does LEAN focus on adding value?

All processes

Start/Finish, Terminator

Capsule shape

Statutory and Policy Compliance

Certain parts of a process may decrease efficiency but are necessary to meet regulatory requirements. Example: OSHA, HIPAA.

Internal Control

Is represented by a sub-process that limit extreme variability in a process.

What is Human Resources? (Enabler of Process)

Knowledge, skills, and experience of the workers

Traditional View: 1. Rewards the individual 2. Guard information 3. expert - driven 4. internal focus

LEAN view 1. group sharing 2. share information 3. process-driven 4. patient focus

Traditional View: 1. Functional silos 2. Direct Management 3. Benchmarks breed complacency 4. Blame people

LEAN view 1. interdisciplinary team 2. managers as teachers/enablers 3. continual improvement and absence of waste 4. FIVE whys

Steps in a process

Square Shape

Document or Report

Square shape with curvy bottom

Process Efficiency

The ability of a process to deliver its outcome in the least amount of time, with the least amount of steps and the least amount of resources.

Non-Value Added Activity

Those activities that take time or resources but do not add to the customer requirements

What can be observed in a Workflow

Wasteful activities