Process Mapping Guidelines

Transcription

1 Process Mapping Guidelines The most important change in your office workflow will be the advent of the. All patient care will be handled in the. This represents a fundamental change to the way the office operates and interacts with the patient. Patient flow refers to how patients are moved through the office when they come to your practice to receive services. This includes check-in procedures, rooming the patient, any movement of the patient during the visit (for example to an in-house lab), and check-out procedures. In most offices, the triggers that move patients from one part of the process to the next will change drastically as the paper chart is replaced by a computer screen. In order to prepare for the changes to patient flow, which will occur after implementing an, it is imperative to first document current processes and evaluate them for efficiency and patient satisfaction. This documentation and analysis is most effective when a team member from each functional area at the practice has an opportunity to contribute. If an vendor has not yet been selected, these workflows can be used to select a product which matches the patient flow in your office. Once current processes are understood and improved, future electronic workflows should be designed. Resources to assist with future workflow design may include pre-training from the vendor, or other consultants, or your physician organization. It is important that these workflows are developed prior to your training, as the trainer can be asked to train the staff using your newly redesigned workflows. As with all parts of the process, patient safety must be at the forefront of each workflow decision. Processes for urgent patient care matters should be evaluated prior to implementing an, but in many cases they will remain the same with the electronic documentation occurring after the fact. It is important that all staff members understand that electronic workflows, while useful in most situations, should not take the place of common sense when it comes to patient safety. Why Process Map? Create a visual diagram of a process Establish a common language Assist in discussing improvement Provide a blueprint for implementing the process Process Selection A work process is a set of steps, tasks, or activities that have a beginning and an end Inputs Process Output Common Flowcharting Symbols Process Step Decision Pre-defined Process Connector, Process cont d elsewhere Delay Document Generated Process Steps Page 1 of 6

2 Step 1 Determine Boundaries (one rectangular post-it note same color) Where does the process start? (beginning step) Where does it end? (last step) Step 2 Who are the customers for this process? Always keep the customer in mind Can be internal or external There can be multiple customers at different points within the process Step 3 Map out the AS IS Process Current state of the process Write one step of the process on each rectangular post-it note Place these on the map in chronological order (working from left to right or top to bottom) Step 4 Analyze the AS IS Process te all the Queues Places where work can pile up te the areas and potential areas where the process queues (waiting time/holds) with a large Q on the small square post-it notes. Place these on the map between the steps (or on the steps) where the process queues Document all the ideas of how to improve the process te all the Checks/Reviews Steps that involve a review/check Place a on the steps that require a check/review te all the Forks Additional Tips for AS IS Process Mapping Draw a macro-level flowchart first (get the big picture) If possible, walk through the current process physically follow the movement. Follow a document, or a patient, etc. Consider timing steps during walk through to add a level of detail There are bound to be variations; record what happens 80% of the time Analyze the AS IS Process Count the number of: -Steps -Handoffs -Checks -Queues -Forks Step 5 Create the TO BE Process What is the Ideal process? Remove or eliminate wastes (see hints to follow) Improving a Process and Eliminating Waste (based on LEAN methodologies) Types of Waste Page 2 of 6

3 Processing: Redundant and unnecessary process steps, excess processing, excess checking and inspection. Excess use of energy of all types. Correction (Defects): Re-do s, fix-ups, returns, mark-downs, managing complaints. Types of Waste (continued) Inventory (Over-productions): Idle in-progress or finished materials, supplies or information. Wait: Delays and queues of all types. Search Time (Movement): Time spent looking for information, people, supplies, and equipment. Transportation: Multiple handling steps and needless movement of material and information. Space (Storage): Storage of unneeded items, excess inventory or the general mess that builds up over time. Excess space required due to inefficient process flow. Complexity: Complex process flows. Confusing product and service choices. Organization boundaries, which introduce inefficiencies and frustrate any sense of accomplishment. Strategies for Reducing Waste: Ideas for reducing waste in processes (ideas should not be limited to those on this list) Simplify and standardize processes Identify and eliminate work-arounds, loop-backs Decrease Total Steps Rearrange Steps Combine Steps Decrease Total Queues Decrease Total Handoffs Decrease Total Checks Decrease Total Forks Smooth out for Continuous Flow (work is processed and moved immediately to the next step) Questions to think about when creating your TO BE process Can any steps be eliminated? As unnecessary By new equipment? By changing the place where it is done or kept? By changing the order of work? By changing the product design? By changing the specification of the incoming supply? Can any steps be combined with another? By changing the specification of supplies? By changing the design of the product? By changing the order of the steps? By changing the equipment used? Mapping out the improved TO BE Process Count the number of: - Steps - Queues - Handoffs - Checks - Forks In Partnership with: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of Health and Human Services grant 90RC0004/01. IA-HITREC-09/ Page 3 of 6

4 Patient Check-in Scheduled Patient Patient Arrives Patient Arrival Type Signs in at Front Desk Patient Completes Forms Walk-in Marks Patient Arrival New Patient? Give Pt Forms to fill out, collect & copy insurance card Enter Info into the EMR Does Pt Info updated? Record updates in EMR, collect & copy insurance card if needed Collect Payment & generate record of payment for billing department Does co-pay collected? Generate Flowsheet Put chart & flowsheet in bin indicating patient is ready for rooming Page 4 of 6

5 Office Visit Workflow Template Provider Nurse/MA Patient Arrives & checks in Opens patient s schedule & recognizes patient arrived status Performs EMR review before entering exam room Enters the room, greets patient Greets patient and escorts to clinic area Provider sends alert with directions to front desk Consults with patient and records HPI Front Desk Obtains patient s weight, height, blood pressure, temp., etc. Sends completed information to the provider and leaves room Performs physical exam How to provide info to patient Record History: past medical, social, family, substance (smoking history), etc. Documents review of systems & physical exam into Assigns Level of Service (LOS) Enters vitals & chief complaint. Verify & record allergies & current medications Updates problem list & triggers CDS rules if needed Places orders as necessary (see Orders workflow) MU Objective: Record and chart changes in vital signs MU Objectives: Maintain active medication & medication allergy list MU Objective: Record smoking status for patients 13 years old or older MU Objectives: Maintain problem list of current and active diagnoses & Implement relevant CDS rules Provider Closes the encounter in Provider hands information to the patient Office Visit Workflow Template Patient returns to front desk comments to front desk Question or comments to front desk Check-out Front desk responds to questions or comments Information given to patient Patient request copy of EMR Preps EMR Hands over info to the patient End of visit Referral Preps referral Hands over info to the patient Page 5 of 6

6 Front Desk Receptionist Patient Patient Check-in Process is Fully Integrated/Interfaced with Practice Management System (PMS) Patient Arrives Signs in at Front Desk Patient Completes Forms Marks Patient Arrival on New Patient? Give Pt. Forms to fill out, collect & scan insurance card Select Patient from Collect and enter information into Does Pt Info updated? Record updates in, collect & scan insurance card if needed MU Objective: Record Pt Demographics as Structured Data Collect Payment & record into Does co-pay collected? Mark pt is ready for rooming into This document is provided by NJ-HITEC in Partnership with: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of Health and Human Services grant 90RC0037/01. Page 6 of 6