Process mapping in healthcare

A simple process map is depiction of sequence of information and material flow involving business entities (actors) using a standard set of symbols (BPMN/ADONIS) [1]. In 1921, Frank Gilberth introduced the first structured method for documenting process flows. Enhanced process mapping depicts functional units and roles using swim lanes. They start with level zero and progressively increase showing higher level of granularity. Although not exhaustive, the paper briefly describes the objectives, types, and best practices in process mapping.
Objectives of process maps
Process maps are fundamental to information capture. It is the building block of any new or improvement project.
 Even though not always entire objective, a process map reproduces pre-existing reality. It allows us to contrast actual flow to the ideal flow.
 They help getting past organizational silos [2].
 We may employ process maps in a variety of scenarios like B2B (between organizations as in case of revenue cycle management), B2C (hospital patient interaction like outpatient and inpatient procedures), and B2E (employee to hospital interaction).
 Discover complexity, redundancy, and blocks in the process, help to revaluate underlying assumption and predispositions
 Identify location where there is a need to collect additional data and investigate [3].
Different types of process map
Process map comes in several flavors each highlight a different aspect and intended for a different audience.
 High-level process flow shows core process within the organization. It shows the interaction between entities. Low-level process flow shows decision gates and loops
 Cross-functional maps that use swim lanes, which allow the slotting of the activities among department or roles indicating the organizational structure and complexity involved.
 Value stream maps that capture wait times, and additional attributes like inventory, throughput, and flow time.
 SIPOC diagram which shows the high-level visual between suppliers, inputs, process, outcomes, and customers (refer to appendix).
There may be other variations of process maps, either tailored or derived to meet specific circumstances
Best Practices
 Articulate the problem clearly and specifically using information available.
 Involve the stakeholder group to participate in the modeling process
 Determine the boundary or scope of the process to facilitate data collection and retain focus.
 Determine and sequence the steps identifying the start and the end-points and the customer.
 Start with high level and drill down progressively. Maintain consistency at each level.
 Test for completeness of the map at each level.
 The mapping exercise must be led by a facilitator who
 Must have a neutral stand
 Must set ground rules of engagement
 Will create an environment for brain storming
 Keep the exercise on track by parking contentious issues, keep focus on “value to the customer”

Conclusion
Process mapping spans across the “Define” and “Measure” phase of DMAIC framework of 6-Sigma and discovery of the “hidden plant” used in Lean. Define-Measure-Analyze-Improve-Control (DMAIC) is a framework for 6-Sigma implementation. The Define phase identifies the opportunity set for improvement and Measure phase quantifies the current state in terms of contextually relevant indicators. Hidden Plant is a lean construct denoting the unreported rework and scrap that goes into the outcome of a process.
Patient focused Integrated Care Pathways (ICP) is a good derivative of process map. They act templates to deliver care fostering evidence based medical practice. The ICP is not rigid but allows the variation in the clinical intervention depending on unique needs of the patient. The ICP serves as a reminder to document the variations in care from published guidelines. This in turn supports management of clinical risks and modification of the contents of the ICP.
Process mapping lays the foundation of any problem solving assignment. It also is an excellent tool to capture and transmit best practices in the organization and in the industry. Sophisticated information systems integrate process maps with packaged application making configuration and customization simpler and easy to maintain. Lean Six Sigma uses this methodology extensively to evaluate as-is state and create to-be state. It allows easy visualization of check- points to measure, monitor, and sustain activities in the process.

References
[1] eBusiness in Healthcare From eProcurement to Supply Chain Management Series: Health Informatics Hübner, Ursula; Elmhorst, Marc A. (Eds.)
[2] What’s in a care pathway? Towards a cultural cartography of the new NHS Ruth Pinder,Roland Petchey,Sara Shaw,Yvonne Carter. Sociology of Health & Illness Vol. 27 No. 6 2005 ISSN 0141–9889, pp. 759–779
[3] The Premier Healthcare Alliance. http://www.premierinc.com/about/mission/social-responsibility/cares/process-maps.pdf
[4] What is an integrated care pathway? Sue Middleton, Jane Barnett, David Reeves. Hayward Medical Communications. www.evidence-based-medicine.co.uk
[5] A toolkit for Redesign of healthcare. AHRQ. http://www.ahrq.gov/qual/toolkit/tkformf.htm
[6] http://facultyweb.berry.edu/jgrout/processmapping/Swim_Lane/swim_lane.html
[7] http://www.hfma.org/Templates/InteriorMaster.aspx?id=21198