© 2009 public health informatics institute multi-state learning collaborative september 17, 2009

© 2009 Public Health Informatics Institute

Multi-State Learning Collaborative

September 17, 2009


Today’s Presenters

• Claudia W. Brogan, MS Ed– Associate Director, Training

• Deb Bara, M A– Associate Director, Programs


The Institute & Improvement

• Part of our Mission

• Embedded in previous work

• Others are applying the methodology to quality improvement in public health


Fundamental Questions for Improvement

• What are we trying to accomplish?

• How will we know that a change is an improvement?

• What changes can we make that will result in an improvement?

• Who will participate in the improvement process?


Collaborative Requirements Development Methodology



Business Process Analysis

thinkthinkHow do we do How do we do our work now?our work now?

•Define goals and objectives

•Model context of work

•Identify business rules

•Describe tasks and workflow

•Identify common task sets



Business Process

Redesign

rethinkrethinkHow should we How should we

do our work?do our work?

•Examine tasks and workflow

•Identify inefficiencies

•Identify efficiencies with repeatable processes

•Refine business processes and business rules

•Remodel context of work

•Restructure tasks and workflow



Requirements Definition

Requirements Definition

describedescribeHow can an information How can an information

system support our work?system support our work?

•Define specific tasks to be performed for optimized business processes

•Describe the implementation of business rules

•Describe in words and graphics how an information system must be structured

•Determine scope of next phase activities


What is a Business Process?


Sally’s Sandwich Shop


Business Process Matrix

• A table that helps keep track of all the business processes you are mapping

• Includes, for each business process:– Goal– Objective– Business Rules– Trigger(s)– Task Set– Inputs– Outputs– (Measurable) Outcomes


Business Process MatrixDefinitions

GoalGoal

The major goal in terms of benefits to population health that is supported by the business process.

ObjectiveObjective

A concrete statement describing what the business process seeks to achieve, pointing to quantifiable measures of performance.

Business Business RulesRules

A set of criteria that defines or constrains some aspect of the business process.

TriggerTrigger

Event, action, or state that initiates the first course of action in a business process.

Task SetTask Set

The set of required activities or steps that are carried out in a business process.

InputsInputs

Information received by the business process from sources outside of the process.

OutputsOutputs

Information transferred out of a business process.

OutcomeOutcomess

The result of performing a business process, which indicates the objective has or has not been met.


Example: Order Fulfillment

Goals Objective Business Rules

Trigger Task Set Inputs Outputs Outcomes

Timely provision of food and service to the customer at the best value

Accurately process food order for and receive payment from customers in a minimal amount of time

FDA standards for food handling; cashier does not handle food; cashier provides greeting and acts as point of contact for all food stations

Customer arrives at drive-through station or counter

Greet customer; take order; process order; bill customer and receive payment; receive and deliver food to customer

Food and beverage inventory; inventory of paper goods (bags, straws, napkins)

Inventory orders; sales activity reports; deposits; incident reports

Payments received, timeliness of order fulfillment; number of customer complaints; incident reports


Sally’s Sandwich Shop


Context Diagrams

Entity Entity


Sally’s: Order Fulfillment

Paym

entB

illO

rder detailG

reeting

Change

Sandwic

h

Drink

Side salad

Customer

Sandwic

h ord

er

Sandwichstation

Drink order

Side order

Sidestation

Drinkstation

Order taker


Task Flow Diagrams

Task A

Task D Task E Task F

Task Series 2

Task

Decision

Choice B

Choice A

Information Flow


Sally’s Task FlowOrder Fulfillment Sally’s

Lunch Stop

Provide Payment

Provide Bill

Amount

Complete Transaction

Receive Food End

Give FoodYes

No

Food Ready?

Start Arrive

Greeting

Provide Order Detail

Record Order

Receive Order

Prepare Food

Deliver Food to Cashier


Questions so far?

Q A&


Stakeholder Analysis:Influence / Interest Matrix

LowLowLowLow HighHighHighHigh

Lo

wL

ow

Hig

hH

igh

HIGH InterestHIGH InterestLOW InfluenceLOW Influence

LOW InterestLOW InterestLOW InfluenceLOW Influence

STRATEGY: Passive relationship management

STRATEGY: Provide information, status updates

LOW Interest LOW Interest HIGH InfluenceHIGH Influence

HIGH InterestHIGH InterestHIGH InfluenceHIGH Influence

STRATEGY: High levels of communication and

attention, goal alignment

STRATEGY: Active engagement, targeted communication, goal alignment, leverage influence


Choose

Measure

Examine

Redesign

Test

Business Process Redesign Steps


Choosing a Process to Redesign

• Is it inconsistent?

• Antiquated?

• Inefficient or redundant?

• High volume?

• High risk?


2 x 2 Table

LowLowLowLow

Lo

wL

ow

HighHighHighHigh

Hig

hH

igh


Building a Home in Mahoning County


Why Measures Are Critical

• Provides objective, quantifiable way to see if new, redesigned process is really better than the old one


Public Health Application


ExamineSymptoms of Inefficiency

• Duplication of effort

• Unnecessary tasks

• Long cycle times

• Processes unclear to staff

• Lots of activity for an unimportant task

• Quality checks too distant from the process


Principles of Redesign

• • Eliminate unnecessary tasks Eliminate unnecessary tasks • • Streamline tasksStreamline tasks

• • Group administrative tasks Group administrative tasks • • Perform steps in parallel Perform steps in parallel

• • Use multiple versions of the process Use multiple versions of the process •• Minimize handoffs Minimize handoffs

• • Find and remove bottlenecks Find and remove bottlenecks •• Smooth work flow Smooth work flow

•• Avoid cumbersome translations and interfaces Avoid cumbersome translations and interfaces

• • Use automation Use automation •• Help all process participants feel ownershipHelp all process participants feel ownership

•• Measure outcomes, not tasks or handoffs Measure outcomes, not tasks or handoffs


Pilot Testing

• Test before invest

• Start on small scale

• Gather feedback


The PDSA Cycle

SOURCE: Institute for Healthcare Improvement, Improvement Guide, P 10


Questions and Discussion

Q A&


Thanks for attending!

For more information about the Public Health

Informatics Institute, visit us on the web at

© 2009 public health informatics institute multi-state learning collaborative september 17, 2009

Documents

public health slide

improvement process

institute improvement

optimized business processes

population health

workflow slide

common task sets slide

previous work