Process MappingRebecca S. (Suzie) Miltner, PhD, RNAssociate Professor, School of Nursing

Learning Objectives

Practice use of common and useful quality improvement tools:Process Maps

2

Rationale for Process LiteracyCommon understanding, shared model

for an improvement team Identify parts of the system to measureHelps generate hypotheses for changeContext is critical

Process Arrogance & Complex Systems“Exaggerated sense of knowing how

things work” – Ogrinc et al, 2012

-4-

Describe an elephant

Rationale for Process LiteracyCommon understanding, shared

model for an improvement team Identify parts of the system to measureHelps generate hypotheses for changeContext is critical

Gathering Data to Understand the Problem: Suggested Steps

Appreciate culture and contextObserve processes Interview key personnelGet ideas down in writingFeedback from key stakeholdersCreate symbolic representation

-7-

Understanding a ProcessCommon tools to help organize your

thoughts: Brainstorming and use of affinity diagrams Cause and effect diagrams (“fishbone” or

“Ishikawa”) Process flow maps (in Lean = “value stream

map”) Deployment flowchart Workflow (“spaghetti”) diagram

Create a conceptual map of the process you use to get ready to come to work in the morning.

Use the labels provided.There are blanks ones for other

steps you may use.

11

Skill Exercise

What is your process?

12

Alarm goes off

Drive to work

???

Developing a Process MapWhy? Provides a common picture of a process

for the whole team. Helps identify which parts of the system

are important to measure. Helps generate ideas for change. (Define,

standardize or find areas for improvement in a process.)

13

Visual representation of a process: IKEA style

Developing a Process MapHow? Use symbols to represent steps in the

process Start with big picture and develop detail

later Need to have people who do the process

involved

15

Process Map Symbols16

Rectangle: Denotes a step in the process or

instructions

Oval: Denotes the Start or Stop point in

the process

Diamond:Denotes a decision

point in the process

Arrow: Denotes directionTriangle:

Measurement point

Simple Process Map

Preheat Oven

Carve and serve meat

Cook Meat

Prepare Turkey

Let meat rest

Done?

Yes

No

Simple Process Map

Preheat Oven

Carve and serve meat

Cook Meat

Prepare Turkey

Let meat rest

Done?

Yes

NoIndicator 1: Time to preheat Indicator 2: Time at rest

Step 1. Heat 2 TBSP oil in large wok or pan

Step 2. Add the vegetables in order of how long they will take to cook 

Step 3. Add the cooked meat

Step 4. Crack two eggs into the middle stir to scramble them until they are almost cooked through

Step 5. Add the rice

Step 6. Stir swiftly around the wok until the rice is heated through

Step 1. Heat 2 TBSP oil in large wok or pan

Step 2. Add the vegetables in order of how long they will take to cook 

Step 3. Add the cooked meat

Step 4. Crack two eggs into the middle stir to scramble them until they are almost cooked through

Step 5. Add the rice

Step 6. Stir swiftly around the wok until the rice is heated through

“Looks good. But the six "easy" steps follow the less-easy and more messy - buy, wash, chop veggies; buy, cook rice; buy, chop, cook meat(s). The cooks in the back of the kitchen make the chef appear awesomely efficient.” (Kris Miltner)

Developing a Process Map*When? When you need to clarify the process When you need to identify places to

measure key steps of the process. When you need to help others understand

the process. Procedure manuals?

21

Not So Simple Process Map

Yes

Current IAD Process Map

Ideal IAD Process Map

TipsBegin with the global aim statement

Where the process begins and ends Boundaries should be aligned with the aim

statement and improvement theme.Do not mix reality with wishful thinking.

Always map the CURRENT process Helps to understand where you can improve

the process

-25-

Ideally!We haven’t done this

yet!

TipsAsk what happens first, next, and then

what happens next. If DEPENDS, then pick the most common next

step and follow what happens after, and then go back to follow the other one.

Keep it simpleTurn the list of steps into a flow chart

using symbols

-26-

Who is a puzzler?

Breakout: Process MapWe are going to break out into 5 groups.One group is our puzzle experts.

They are going to create an ideal process map for a puzzle based on their knowledge of the process.

The other 4 groups will put a puzzle together.

28

Breakout: Process MapPuzzle teams:Each team will get a set of puzzles.Put together the puzzle marked by a

circle on the back.Write down all the steps in the

process of solving the puzzle.Map the process on the

board/paper.

29

Discussion: Process MapPuzzle experts will share the IDEAL

process map.Compare your team’s actual

process to the ideal. Are they the same? If not, where is the variation?

What did you learn about the process of putting a puzzle together?

30