Examples Of Process Mapping In Hospital Path

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Process mapping the patient pathway

Introduction and principle of process mapping
Patient pathway has been described as a useful audit which looks at the patient journey in healthcare to identify problems faced by patients and therefore suggestions for improvements. ( BMJ 1 2 ). In essence it involves dividing the patient journey into small simple steps to assess and finds out what actually happens to the patient in this journey. It is a simple exercise which looks at what actually happens to the patient rather then what should happen (BMJ 4). These process maps can then be examined to look at the unnecessary and non-value adding steps with an aim to redesign the journey by improving the care provided to the
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In the literature there have been many published article of examples of mapping patient journey in hospital settings. There have been very few examples from primary care.
Some of the initial understanding of process mapping has been taken from taken from Japanese car maker Toyota ( BMJ 3) . Eight types of waste have been described in health care setting and many of these can be picked up by simple process mapping exercise and therefore corrected. As per Author ( BMj 18 ) ineffective steps can increase the effort of the process by about 9 times times as compared to value adding steps.
Process mapping can be divided into mainly 3 stages. First step is to map the journey to understand what where happens to the patient and who is involved. Second stage is to examine the journey of patient to elicit the problems faced by patients and to find out unnecessary and non-value adding steps. In the final step remedial actions are looked at and changes planned.
In the practice meeting we looked at few options to process map and decided that we will map walk in clinics. These clinics were done 3 mornings every
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Task time was fairly constant but the wait time could vary from few minutes to 5 hrs. Two types of bottleneck were seen, process bottleneck was the most common problem due to just one doctor doing the walk in clinic. Functional bottleneck were much less common happening particularly when doctors were pulled out for an emergency home visit, because of the delay caused by an unwell patient and nurse calling the doctor for reviewing an urgent situation. Batching was one of the major issues, patients were brought into the surgery in batches but seen individually causing a massive delay and a major problem which patients complained about all the time. Sometimes this wait could go up to 5 hrs which was inconvenient and unnecessary. Parents with small infants and older people also complained about waiting in the waiting room as inappropriate. Older people were concerned about sitting in the chair for long. Parents of school going children and people needing to attend work also complained about wait time. Workload markedly increased in winter months causing many patients to be turned back. There was no way of selecting the patients which actually needed to be certainly seen. Staff described a busy walk-in day stressful and

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