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Process/Value Stream Mapping

Improvement-Journey-Graphic-1

Process Mapping is a tool used to develop a ‘map’ of a process within a system. It will help you to map the whole patient journey or related processes with a range of people who represent the different roles involved.

Process mapping can be used to help a team visualise and understand where the problems are and identify opportunities for improvement. It can identify duplication, variation, and unnecessary steps.

It is a great way of revealing the complete process – rarely does a single healthcare worker know all the processes / people involved in the patient journey. It will help staff understand how complicated the systems can be for patients, showing how many times the patient has to wait (often unnecessarily) and how many different people a patient meets.

How to use it

The aim of process mapping is to make things clear and to provide insight. The best map is often the simplest.

There are different approaches to process mapping. Which one you select will depend upon what you need to know, what level you are working at (whole pathway or a small part of it), resources available and timescales.

Start with a high level process map of say five to ten steps, for which you set a time limit to achieve, say 20 minutes. This helps to establish the scope of the process and identify significant issues.

Here is a simple example of a high level process map (ref NHSIII):

process map

Key to process map

Box: shows the activities of the process.
Diamond: represents the stage in the process where a question is asked or a decision is required.
Oval: shows the start of a process and the inputs required. Also used to mark the end of the process with the results or outputs. The symbol is the same for the start and end of a process to emphasis interdependency.
Arrows: show the direction or flow of the process.

There is software that can help you to develop process maps but in a group setting you can use rolls of paper (lining paper from a DIY store); marker pens, post-it notes in different colours to represent the four different symbols, a flip chart to ‘park’ issues and display ground rules for your session.

Once you have your high level process map you will start to be able to understand how the process works and where there are problems, drilling down into these with more detailed process maps. Further work maybe required to analyse the problem areas identified, eg seek stakeholder feedback or further data collection.

The information and level of detail required will depend on the scope of your project. Driver diagrams/ logic models may be useful tools to help you clarify this.

Scope

  • What do you need to know?
  • How simple can you go?
  • Are you working at a high-level or focusing in more detail?

Knowing whose views you will need to inform the improvement is important. You should consider:

  • Whose views do you need?
  • How will you engage those individuals?
  • How will you capture their views?

Ideally you will know what your problem areas such as the point in your process where a constraint causes flow to be slowed. This may already have been identified right at the start of the improvement journey when developing your project charter.

Tips for planning a mapping session

To get you started, here are some things to think about when starting to plan a mapping session:

  • What is the purpose of the session?
  • Who will you invite to get a broad perspective of the process?
  • You need to meet with clinical, managerial and service leaders beforehand to ensure that they feel involved in, and committed to, the process. Remember, the process map will only be as good as the list of people who attend, there will be gaps in it if some staff do not attend.
  • Which staff groups are involved in the relevant stage of patient care? Invite 15-25 representatives of those groups to map the patient journey. Don’t forget to include staff like porters and administrative staff who often have quite different and useful perspectives of patient and diagnostic pathways from clinical staff
  • Where will you hold the session?
  • What is the knowledge level of the audience? For example, when involving service users and carers, do they need additional preparation to feel comfortable contributing to the session?
  • How long will the session last? Make sure you allow time for analysing the map and developing an action plan to test improvements.
  • Plan the follow up sessions at the start.
  • Would it be useful to have an external/neutral facilitator to help run the session?
  • Do you need to use an icebreaker? This can be useful if people do not usually work together.

Tips for running a mapping session

1. Using the right materials to physically produce the map makes life easier, here are some suggestions:

  • Paper (lining wall paper is cheap and effective)
  • Marker pens
  • Post-it notes
  • Flip charts (to hold your idea and issue parks and display the ground rules)
  • Sellotape
  • Blu tack

2. Remember that there is almost certainly someone in your organisation who has facilitated a process mapping session before, so if you are new to this, don’t hesitate to ask for help and use their experience.

3. Involve stakeholders right at the beginning – planning ahead enables you to give people plenty of notice. Find more on stakeholder mapping here.

4. Don’t map everything. When some people find out about process mapping they spend the next two years mapping every process in their organisation. Only map the process that you have chosen to improve.

5. Let your process map cross functional boundaries. You want to see the whole, end-to-end process, not just the piece of the process inside your department. Improving one department or section does not always improve a service that flows through several departments. It is always much more important to manage the interactions between departments than it is to manage the actions inside each department.

6. The people who work in the process should be involved in the mapping.

7. Always map what actually happens in the current process rather than what you would like to be happening, or what should be happening according to the book.

8. Having a structured agenda helps run the session smoothly and keep to time.

9. Having an external facilitator can help deal with potentially tricky situations where personalities and views clash.

10. Planning the session near lunchtime usually enables more people to attend.

What next?

Using the process map to initiate redesign

Once the process map has been drawn the next step is to identify where the process can be improved by re-designing or removing elements of it.

The key to success here is to keep the patient at the centre of your plans and to consider the potential for a ripple effect through the organisation. Getting your part of the system right does not help the patient if another part of their journey is made worse as a result. Testing your ideas for improvement will help to show you potential unwanted side effects of your changes. To help you understand the potential impact of a change, you may use the PSDA cycles.

Resources

Further info

Video clips

< Step 1: Define the problem

< The Improvement Journey