process mapping - final - aapm.org · a rough guide for creating process maps 4. ... check with...
TRANSCRIPT
![Page 1: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/1.jpg)
Process Mapping
Derek Brown, PhDUniversity of Calgary, Alberta
Eric Ford, PhDUniversity of Washington, Seattle
![Page 2: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/2.jpg)
Disclosures
• DB: Founding partner of TreatSafely, LLC.• EF: None
![Page 3: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/3.jpg)
Learning Objectives• To understand why process maps are
useful in the clinical environment.
• To become familiar with a few examples of process maps.
• To discuss several important tips for creating useful process maps.
![Page 4: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/4.jpg)
Process Mapping
Outline
1. What are the benefits of process mapping?
2. Brief look at different process map examples
3. A rough guide for creating process maps
4. Tips for creating useful process maps
5. Walkthrough example
4
![Page 5: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/5.jpg)
Process Maps – Why Bother?
Greg
5
Marsha
• Greg is an experienced therapist – Linac 1
• Marsha is a seasoned veteran therapist –Linac 2
![Page 6: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/6.jpg)
Process Maps – Why Bother?
6
Patient setup
Patient enters treatment
room
Beam on
…
…
…
…
![Page 7: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/7.jpg)
Process Maps – Why Bother?
7
Linac 1 – Patient Setup Procedure
Ready to Treat
![Page 8: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/8.jpg)
Process Maps – Why Bother?
8
Linac 2 – Patient Setup Procedure
Ready to Treat
![Page 9: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/9.jpg)
Process Maps – Why Bother?
9
Patient enters treatment
room
Beam on
…
…
…
…
Marsha is called away to answer an
urgent question from a relative of another patient
![Page 10: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/10.jpg)
Process Maps – Why Bother?• Marsha returns within a few minutes and asks Greg if
the patient has been setup correctly
• Greg, always glad to have done the job right, answers yes enthusiastically…
10
![Page 11: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/11.jpg)
Process Maps – Why Bother?
11
![Page 12: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/12.jpg)
What are the Benefits?
• Immediate benefits– Improving communication – everyone is on the
same page!– Harmonizing clinical practice and ensuring that
everyone operates with a shared model.– Improving efficiency. Workflow inefficiencies can
become obvious when mapped out visually
12
![Page 13: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/13.jpg)
Process Maps: Applications
• Failure Mode and Effects Analysis (FMEA)– Assemble team– Create process map– Identify failure modes– Score each for severity, occurrence and
detectability
13
Process maps
![Page 14: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/14.jpg)
14
CONSULT
SIMULATION
TREATMENTPLANNING
TREATMENT
High-RPN failure modes
Ford et al. Int J Rad Onc Biol Phys 74 (2009) 852 - 858
![Page 15: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/15.jpg)
Process Maps: Applications
• FMEA• Codifying events in incident learning
15
![Page 16: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/16.jpg)
Process Map
16
Sounds great.How do I make a process map?
![Page 17: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/17.jpg)
Types of Process Map
17
Consult Planning Imaging
Simulation Plan checks Treatment
Ishikawa Diagram or “Fishbone Diagram”
Kaoru Ishikawa, 1960’s, Mitsubishi Motors
![Page 18: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/18.jpg)
Types of Process Map
18
Ishikawa Diagram• Can be used to map process
• General use (outside rad onc) is as a cause-effect tool
nevron.com
![Page 19: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/19.jpg)
Types of Process Map
19
Process flow diagrams
Frank Gilbreth, 1920’s, ASME
![Page 20: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/20.jpg)
Types of Process Map
20
Process flow diagrams
A dictionary of process map symbolsSummer School Proceedings – Chapter 4
process
start / enddecision
Y
Ndatabase
document
flow arrow
![Page 21: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/21.jpg)
Process Maps - Examples
• The easiest way to become familiar with process mapping is look at some examples
• Immediately after this talk, we’re going to work through a process map together
21
![Page 22: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/22.jpg)
Process Maps - Examples
22
Luis Fong de Los Santos 2012in Consensus recommendations for incident learning database structures in radiation oncology
![Page 23: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/23.jpg)
Process Maps - Examples
23
Treatment Planning
Physician Consultation
Treatment Delivery
Simulation
Patient Follow Up
Patient Registration
![Page 24: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/24.jpg)
Process Maps - Examples
24
![Page 25: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/25.jpg)
Process Maps - Examples
25
TG-100 IMRT Process Tree
![Page 26: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/26.jpg)
Process Maps - Examples
26
Ford et al. Int J Rad Onc Biol Phys 74 (2009) 852 - 858
![Page 27: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/27.jpg)
The Rough Guide
• Step 1: Decide what process to map. The scale of the process is an important concern here. Don’t bite off more than you can chew!
• Step 2: Form a group and identify a team leader. It is vital that all professional groups are represented in this process. This may include administrators and managers as well as clinical staff.
27
![Page 28: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/28.jpg)
The Rough Guide
• Step 3: Create an initial process map. It is often useful to make a first draft that does not attempt to capture the entire process in detail but rather the workflow at a more general level.
• Step 4: Iterative mapping. The process map is refined with the input of all staff involved.
28
![Page 29: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/29.jpg)
The Rough Guide
• Step 5: Check with external resources to make sure that no steps have been missed.
• Step 6: Use the process map. Examples of this use can be found later in this chapter on FMEA analysis.
29
![Page 30: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/30.jpg)
Useful, Usable Maps and Diagrams
• What’s important in designing process maps?1. In our business it is customary to look at processes
from the patient’s perspective
2. For clinical processes a multidisciplinary team is necessary for the development of a valid map
3. The number of sub-processes identified should be the smallest number to meet the objective
30
![Page 31: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/31.jpg)
Useful, Usable Maps and Diagrams
• What’s important in designing process maps?4. The users of the map should have the same
understanding of the meaning of the sub-processes.
5. Choose the right level of detail. A map that is too general loses its utility, while one that is too detailed becomes unmanageable and staff lose the big picture.
6. Don’t get hung up on fancy graphics. There is value in the process of creating the map.
31
![Page 32: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/32.jpg)
Process Mapping
• Summary• We have looked at how process mapping can
be a useful tool in the clinical environment
• We have seen examples of process maps
• We have looked at tips for creating more useful process maps
• We have walked through the development of a process map
32
![Page 33: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/33.jpg)
• The goal of this exercise is to develop a process map for IMRT Treatment Planning, from the time the dosimetrist receives the final region‐of‐interest contours from the physician to the time the plan is ready to be treated.
33
Process Mapping Exercise
![Page 34: Process Mapping - Final - aapm.org · A rough guide for creating process maps 4. ... Check with external resources to make sure that no steps have been ... Process Mapping - Final](https://reader034.vdocuments.site/reader034/viewer/2022042801/5adea0ee7f8b9a213e8e5dfe/html5/thumbnails/34.jpg)
The Rough Guide• Step 1: Decide what process to map. The scale of the process is an important
concern here. Don’t bite off more than you can chew!
• Step 2: Form a group and identify a team leader. It is vital that all professional groups are represented in this process. This may include administrators and managers as well as clinical staff.
• Step 3: Create an initial process map. It is often useful to make a first draft that does not attempt to capture the entire process in detail but rather the workflow at a more general level.
• Step 4: Iterative mapping. The process map is refined with the input of all staff involved.
• Step 5: Check with external resources to make sure that no steps have been missed.
• Step 6: Use the process map. Examples of this use can be found later in this chapter on FMEA analysis.
34