To quickly recap, there are two types of process maps:
1. Sequential flow
2. Hierarchical task analysis
The sequential flow diagram organizes tasks with arrows indicating order of completion. The hierarchical task analysis diagram organizes tasks with arrows associating relevance to an outcome.
There appears to be uncertainty over which approach is more appropriate for healthcare quality improvement projects. I suspect it depends on the nature of the project, and ultimately the process in question. For complicated, multi-faceted processes with many outcomes of interest, it seems likely that the hierarchical task analysis diagram would provide a clear representation. But for single-track processes with minimal stratification, the sequential flow diagram seems a simpler, faster option.
What are some examples of healthcare processes conducive to mapping?
1. Single-track processes, for example, could include things like documenting patient encounters, performing physical exams, or even USMLE preparation (medical students, meet quality improvement).
2. Complex processes, on the other hand, could include rehabilitation regimes, cancer therapy, or new patient intake.
What are some practical implications of using process maps?
1. Construction: the marker-and-whiteboard method was demonstrated today, but technology is more advanced than that. What software exists to ease construction of process maps? Hey, Apple...is there an app for that?
2. Convention: complicated chemistry has rules for diagrams (bonds, elements, reactions, etc.); process maps need rules too. Dashed lines, dashed boxes, block arrows, solid arrows--the graphics need definitions. Do process maps already have standards? Or should healthcare users attempt to establish them as the tool becomes more widespread?
3. What else?
-Brian Blaugrund
To your ? regarding Construction: Visio has been the classic software for generating process maps. Being windows based software, it is cumbersome to use on the move. Why separate walking the process from mapping the process? Perhaps an app for a mobile device would allow process notes to be taken while investigating the process. Then, when the user returns to their desk, a rough process map awaits.
ReplyDeleteI poked around in the Android marketplace, and while I didn't find any apps that were specifically geared toward process maps, there is a free app called Thinking Space that might work. It allows you to create mind maps on your Android mobile device, which can then be uploaded to your computer and used with Xmind (also free). Mind maps might be a little difficult to use when creating sequential process maps, but they seem like they would be pretty effective for HTA maps.
ReplyDeleteWhat concerns me more right now is how we’re going to promote these strategies amongst both our peers and predecessors. HTAs and sequential step diagrams might be unwelcome and daunting to the many that already fear paperwork overload and administrative interference. Furthermore, will we encourage those programs that are already actively working on quality improvement projects to adopt these techniques? Understandably, one of the goals of this program and IHI as a whole is to train students and professionals in seminars like this so that we can implement these techniques in our own practices once we become part of the medical community. It seems important, though, to consider how we can successfully introduce and initiate thought processes like these diagrams into the purview of current professionals. Granted, some like Dr. Doshi find and promote Six Sigma methods on their own prerogative, but this seems more of an exception than the rule (correct me if I’m wrong here!). Is it feasible for medical teams to hire someone with this analysis as his/her career description, or would it be more of a matter of reframing intradepartmental meetings to consider these diagrams as regular discussion points? I guess that would depend on the department’s preference. These may be premature questions- just thinking.
ReplyDeleteI agree with Meghan, and also add the fear that many risk losing their jobs because of the thrust of quality improvement into the medical workplace. The goal of the process map is to identify and eliminate weaknesses in the series of steps designed to achieve a goal. Anything or anyone that is considered wasteful should be cut out. The system must be lean to be efficient. It reminds me of the movie “Office Space”, where the character Tom Smykowksi (had to look up his name) is being interviewed by the two Bobs about what he does for the company. After some casual investigation, they all realize that Tom doesn’t actually do anything, serving as a useless intermediary between the engineers and the customer.
ReplyDeleteSimilarly, some individuals see process development as a threat to their livelihood. Most healthcare workers see no incentive for working smarter, as the elimination of duties eliminates the necessary number of jobs. This can be exacerbated by budget cuts at the hospital such as those we are experiencing currently. While hospital administrators love to make their businesses run more efficiently, the individuals that see the changes that need to be made on the front lines fear such discoveries.
@Meghan: I'm not sure of the value of this book, Managing Up, but its title has certainly entered business parlance.
ReplyDelete@Zane: This is an important question. It's one I've found people have trouble answering, much as a death penalty supporter would hesitate to throw the switch. Quality Improvement makes all attempts to retrain people for value-add jobs within their organization, rather than give them the axe.