Process

Read here for an overview of Process, Process Mapping and Driver Diagrams. For a more detailed explanation please go to the Education Module.

Definitions

In order to implement improvement within a patient pathway or area of care, clinicians must understand the processes involved.
A process is a series of connected steps or actions to achieve a specific outcome.
It has several key characteristics:

  • A clear starting point and an end-point - “the scope”
  • A defined group of users e.g. a group of patients with similar characteristics or needs
  • Rules governing the standard or quality of inputs throughout the process
  • Points of linkage to other processes
  • Level of complexity - simple: phlebotomist taking blood, multifaceted: enhanced recovery following hip fracture

Here is a process mapping example on making a cup of tea:

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An oval shows the start of the process and the inputs required. It also marks the end of the process with the results or outputs. The symbol is the same for the start and the end to emphasise interdependency.

A box or rectangle indicates the tasks or activities of the process. A diamond indicates a stage in the process where a question is asked or a decision is required. Arrows show the direction or flow of the process.

This is a “HIGH LEVEL” map which is a starting point. It helps map out the scope of the process, any significant issues can be identified early, and it can form a FRAME for a more DETAILED map. The same can be said for processes encountered in clinical medicine.

The key message here is that by working through the process in its entirety, using a systematic approach, you remain focussed on the problem to be solved, rather than jumping ahead to implementing your perceived solution without fully understanding the process. Remember in healthcare any process has at least three versions:

  • What YOU think it is
  • What it ACTUALLY is
  • What it SHOULD be

Once areas of waste, error or inefficiency have been identified the next step is to improve the process in some way. If you have multiple points for improvement it is often useful to prioritise them, bottlenecks in a system may be a good place to start or those issues that at putting patient safety at risk or falling below a national standard of care.

It is important to be mindful that changes that suit staff or the department, may not necessarily be convenient or experienced as “adding value” or “quality” to the patient. During this time keep the patient and their experience at the centre of the decisions for action.

Driver Diagrams

These are another visual aid that can be used to help identify factors that are contributing to a specific healthcare outcome, and therefore can be used to form the basis of a QI project. Process Mapping is useful for patient journeys or pathways through hospitals, however Driver Diagrams are useful when the aim or QI project doesn’t “fit” this pathway model. It can be used to help devise an structured process to improve a more nebulous concept e.g. patient satisfaction or sepsis.

They are essentially a structured logic chart with four key features:

  • A clearly defined AIM or GOAL
  • The high-level factors that directly influence that goal that must be addressed or PRIMARY DRIVERS
  • The second-tier factors that act upon these factors, or SECONDARY DRIVERS
  • Specific PROJECTS and ACTIVITIES that act upon and are linked to these SECONDARY DRIVERS. There can be further tiers, depending on the complexity of the AIM or GOAL.

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