Professional Documents
Culture Documents
CTQs CTQs
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Inputs Process Outputs
X X
Process
Map
X
Common Detailed Process Mapping Symbols
– Delay (Red)
– Storage (Yellow)
– Decision (Blue)
Hidden
Factory
Step 2 Example: Identify All Process Steps
Pasta Process Map
Designate steps as value-added or non-value-
added
Rework
.01 DPU
No
.5 MINUTE 6 MINUTES .25 MINUTE 9 MINUTES
No
.5 MINUTE 6 MINUTES .25 MINUTE 9 MINUTES
CLINIC
DIET
PFT
ECHO/
TMT
Tracking Movements – Spaghetti Diagram
Educating Medication
Rounds
Discharge With
Process Doctor
Booking
Investigation
▪ A visual map of how patients and information flow from end-to-end of the
End Product chain and where is the flow interrupted by inefficiencies
Patient information flow analysis with key Delay due to other
teams / external issue
issues 2
Delay due to local
Very busy spot with ~130 team / internal issue
interactions per hour and people
queuing for information
1 6 9 10 11
Complexity of board and ▪ 60% doctors & nurses Variability in Waiting for Waiting for Waiting
notes management ▪ 15% patients how staff ‘TIS’ Technician or test results for A&E
currently requires senior ▪ 10% phone Majors and how tests doctor (e.g., (don’t know doctor
nurse, pulling scarce ▪ 15% other (tech, ▪ X-ray ~40% are launched to take blood) when ready)
capacity out of the team ambulance, student, porter) ▪ Bloods ~60%
▪ Referral ~25%
43%
Ambulance
Patient Board Nurse Allocation • Tests*
Take files, put
arrives in • 'Hello” • Chair Patient called TIS • Specialist A&E Doctor
card on board
Majors • Notes • Cubicle • Treatment
Reception 8-12 min 20–40 min
57%
3 ▪ Minors ▪ Minors
Slow PCs ▪ Resus ▪ Resus
▪ Walk In Centre 18–26 min
▪ Walk In Centre 25–35 min
▪ GP
18
Nurse often needed 4 5 7 8
Waiting for Multiple Changing Awaiting test results
to accompany Language barrier,
senior staff to checking by equipment Bloods: 70–110 min (chem), 60–80 min
patient to ward and waiting for health
handle transfer 17 TIS patients doctors and (ECG, (haem lab), 5–20 min (haem near-patient)
advocate
to bed No admin and slow writing wheelchair, from bleeding to results authorised
(10-10 service only)
photocopier of notes keys, etc.)
support at night
72%
Notes Home
photocopied Decision • Tests* • Tests*
discharge/ • Specialist Specialist • Specialist
admit • Treatment • Treatment
Get bed
Porter arrive Bed ready Request bed
allocation
28%
(from specialist
called to arrival)
60-80 min
16 50-80 min
Delays in porter arriving ~75 min 15 ~45 min 14
to transport patient to Delays when Delays from requesting
bed to identification of 12
bed or allocated beds are 13 Waiting for Specialist –
in finding and actually occupied ‘available’ bed Potential further Time from TIS to
copying notes cycle of tests – specialist arrival
~5% of cases 120–200 min
Golden rules for observing a PIFA
Do Don’t
Take the time to follow the whole process Neglect to explain objectives
to the staff member you followed
(observations do not focus on individual
performance!)
Let the staff members act naturally Interact with the employees during
observation
Write down all activities of the sequence Try to justify inefficiencies observed
observed
If
Verify bill If ok plain
Doctor advices Type of Appointment Patient arrives
at
CT scan scan scheduled at reception
reception
6 hrs
If contrast
Ask for:
Send to If not ok Doctor/tech - Blood values
respective
informed - Special
consultant
preparation
Handover
Correlate image Explain process If ok Verify details Verification and
datasheet and
with clinical Scanning and take and check blood report, registration at
consent form to
history consent form if contrast reception
Doctor/tech
If not ok
Check
report
Sent to Report enclosed If ok
despatch in respective Report signed
counter cover
PIFA process for X-ray
Patient reaches X-ray Patient is given a token and
Doctor advises X-ray Patient pays bill in op billing
reception asked to wait for his turn
Later arrival
Yes
Wet film Send for
received reporting Issue –
Inappropriate
clinical history
No
Accept- No
Or to
able Check Appropriate Write Doctor error Send to
check film Report Sign the
Stop for clinical report on to check despatch Stop
clarity and typing report
history presc. report counter
quality
Poor Not Error/
quality Appropriate modify
Issues – Typing
Send for errors & IT
Repeat Wait for interface
rectification/
X-ray patient
modification
Ultrasound process flow
Appointment
Reaches
Doctor advises Patient pays scheduled and Patient arrives
ultrasound
scan the bill patients at reception
reception
instructed
1
hour
Issues –
Waiting time
Patient to wait
If not
ok
If Check Verification,
ok patient pre- Handover Fill data sheet
Report written Procedure registration,
paration sheet to ultra- and paste
by doctor done and token no.
sound room sticker
given
If
Sent for system Patient Films and ok
Check
entry informed about report enclosed Send for typing Report signed
report
(pacs/print) despatch time in cover
If not ok