DEWITT ARMY HOSPITAL Fort Belvoir, VA

OUTLINE
Definition of Process Mapping Parts of Process Mapping Steps of Process Mapping Tools for Process Mapping Final Checking of Process Mapping Examples of Process Mapping How Process Mapping fits into the QSEs Common Mistakes in Process Mapping

Process Mapping
Is a graphical representation from start to finish. Flow chart

Oval: Show the input to start the process Arrows show direction or the flow of the process

Box or Rectangle: Show a task or activity performed in the process

T E M P L A T E Flow Chart

Diamond: Shows where a Yes/No question is asked or a decision is required

No Yes
Usually only one arrow out of an activity box. If more than one arrow, you may need a decision diamond. Make sure every feedback loop is closed, Every path takes you either back or forward to another step

Oval: Show the output at the end of the process

Tools for Process Mapping

Pen and paper Post-It notes
Software: PowerPoint, Visio, etc.

Start .End

Steps (Procedure)

Links to another process or flow chart

Questions ???

Arrow

Feedback loop

Quality System Essentials Organization

QUALITY SYSTEM ESSENTIAL Organization

Quality System Essentials Safety

NEEDLESTICK
Or other blood borne pathogen exposure
APPLY FIRST AID !!! OR REPORT TO ER IMMEDIATELY ATTENDING MD
NOTIFY SUPERVISOR Supervisor/ employee complete the assigned forms What is the status of the employee?

SUPERVISOR

SF 558 or progress notes. Give to injured employee Consent FORMS for HIV on both source & injured employee Order & draw lab tests STAT: NEEDLE SOURCE (order set name) Tubes: 1 red, 1 purple, & 1 HIV Tests: Rapid HIV-1; HIV; Hepatitis B Surface AG; Hepatitis C Antibody NEEDLE EMPLOYEE(order set name) Tubes: 2 red, 1 purple, & 1 HIV Tests: HIV, Hepatitis B Surface Antibody, Hepatitis C Antibody; CBC, CMP, HCG (female childbearing age) Decide on Tetanus shot If necessary, consult Community Health Nurse for psychological assistance

Military DA 4106 DD 689 FM 879

GS Civilian DA 4106, FM 879, DD 689 CA-1 & CA-17* *when applicable

Patient, Contract , Student, Volunteer, Visitor DA 4106

Report to ER for emergent care Report to ER for emergent care

Report to ER for emergent care

Ensure paperwork is properly filled out Forward Paperwork to designated area. REFER TO BACK PAGE. Report event to Infection Control

Decide on PEP (post exposure prophylaxis) therapy If YES, contact WRAMC Infectious Disease for follow up 202-782-1663

Report to Occupational Health within 72 hours of injury for follow-up care, (bring SF 558) CA-1 should be submitted to Safety Manager within 5 workdays of the injury

Report to your respective Contract Representative Office or Primary Provider for follow- up care

END

UPDATED 11-23-2004

Phone #s: ER (805-0518); Occ Health (805-0443); Infection Control (805-0044); Safety Manager (805-0157); Patient Safety (805-8048);CPAC (703-704-2743)

ACCIDENT/INJURY REPORTING
FIRST AID FIRST!!! IF UNCLEAR, REPORT TO ER IMMEDIATELY

DD 689 Individual Sick Slip Form Supervisor will give a signed form to injured employee to seek medical attention at ETR or Occupational Health DA4106 Quality Assurance/Risk Management Form On duty injuries must be reported to Patient Safety MEDDAC FM 879 DeWitt Army Hospital Supervisor Mishap Report Required to be submitted to Safety Management Office within 5 days of injury/accident. DA 285-A-B-R may be substituted to report POV incidents for military. CA1 Federal Employees Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation Supervisors are required to fill out form and bring it to Safety Management Office to be submitted to Department of Labor. Form is required to be submitted within 3 days of injury/accident. CA17 Duty Status Report Supervisor will fill out column A of form and give to injured employee if limited duty is applicable. Employee will provide form to provider and return to supervisor.

NOTIFY SUPERVISOR Supervisor/ employee complete the assigned forms What is the status of the employee?

SUPERVISOR Military DA 4106 DD 689 FM 879 (Both On and Off Duty accidents must be reported) GS/WG Civilian DA 4106, FM 879, DD 689 CA-1 & CA-17*
*when applicable

Contract , Student, Volunteer, Visitor DA 4106

Ensure paperwork is properly filled out Forward Paperwork to designated area. REFER TO BACK PAGE. Report event to Safety Management Office at 703805-0157

Report to ETR for emergent care and OH for first aid (DD 689 required)

Report to ETR for emergent care and OH for first aid (DD 689 required)

Report to ETR for emergent care

Report to Occupational Health within 72 hours of injury for follow-up care and bring DD 689 and ETR Report (SF558) if seen at DACH ETR. For GS/WG civilians, medical documentation is required.

Report to your respective Contract Representative Office or Primary Provider for follow- up care

END
Phone #s: Safety Manager (805-0157); Occupational Health (805-0443); Infection Control (805-0044); Patient Safety (805-8048);CPAC (703-704-2743)

UPDATED 02-04-2005

DA 4106
(Incident Report)

FM 879
(Dewitt Army Community Hospital Supervisors Mishap Report)

DD 689
(Individual Sick Slip)

CA-1
(Federal Employees Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation)

CA-17
(Duty Status Report)

SF 558
(Emergency Care and Treatment- Dewitt ACH)

SAFETY MANAGER OCCUP HEALTH PATIENT SAFETY *CPAC (Civilian only) EMPLOYEE FILE

COPY

ORIGINAL

COPY

COPY
(Electronically submitted)

COPY

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COPY

COPY

COPY

COPY

ORIGINAL

ORIGINAL

ORIGINAL

ORIGINAL

COPY

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LAB PI

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# OF COPIES

Quality System Essentials Occurrence Management

QSE: Purchasing and Inventory & Process Control

QUALITY SYSTEM ESSENTIALS PURCHASING AND INVENTORY

QSE: Process Improvement

Urine Collection Process in the Outpatient Phlebotomy Area

Start Print & Verify Labels No Label samples Log in CHCS Specimen transport to UA section Ship to reference lab? Yes

Patient Arrive

Patient Collect Sample Yes Patient turn in sample Give instructions to patient

Met Requirements ?

Transport to Shipping dept

No

INPUT (Adjustable, Specifications?)

STEPS

OUTPUT (Valuable, Measurable?)

BEGIN

END

IMPROVE CUSTOMER SERVICE IN THE PHLEBOTOMY ROOM INPUT (Adjustable, Specs?)

Greet patient with a smile Phlebotomist Available A

PROCESS Patient arrive

OUTPUT (Valuable, Measurable?)

Patient Satisfaction Survey Patient Waiting Time V,M V,M

Request for at least 2 IDs (DOB and name)

Log in CHCS

Patient Identification

Labels ; printer Labeled cups

Verify Labels
A A

Verification of the printed label Eliminate mislabeled sample

V V,M

Verbal instruction script Instruction sheet Sterile cups with wipes (not expired) Who will deliver ? Time to deliver (within 1hr) Back-up plan when busy A A A

Collect samples

Patient recall Repeat Testing

V,M

Transport to lab

Delivered in a timely manner

V,M

Example of Measurable Output CUSTOMER SERVICE ( Patient Satisfaction Survey 2007)

Example of Measurable Output CUSTOMER SERVICE

COMPLAINTS
25

20 1st Q 2nd Q 10 3rd Q 4th Q

15

0 Access Policy Staff Behavior Quality of Care Misc

QUALITY SYSTEM ESSENTIALS ASSESSMENTS PHLEBOTOMY WAITING TIME

Percent Served <= 15 Minutes (Threshold: 90%)
100% 95% 90% 85% 80% 75% 70% 65% 60% 1 2 3 4 5 6 7 8 9 10 11 12

2006

2007

QUALITY SYSTEM ESSENTIALS ASSESSMENTS

2007 PATIENT RECALL

(Threshold: < 1%)

# of patient seen 4500 4000 3500 3000 2500 2000 1500 1000 500 0 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT

% of pateint recalled 2.0% 1.8% 1.6% 1.4% 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0% NOV DEC

Example of Measurable OUTPUT

% Urine Contam ination 50% 40% 30% 20% 10% 0% previous current

peers
16%

Your lab

25% male female

male female 75%

84%

Steps of Process Mapping

First identify the PROCESS Provide OUTPUT variables for each step before the INPUT variables OUTPUT : Valuable or measurable INPUT: Controllable and enter specifications
P and 5 M (People, Machine, Materials, Method, Mother Nature, Measure)

Improve Customer Service In The Phlebotomy Room INPUT (Adjustable, Specs?)

Greet patient with a smile Phlebotomist Available A

PROCESS Patient arrive

OUTPUT (Valuable, Measurable?)

Patient Satisfaction Survey Patient Waiting Time V,M V,M

Request for at least 2 IDs (DOB and name)

Log in CHCS

Patient Identification

Labels ; printer Labeled cups

Verify Labels
A A

Verification of the printed label Eliminate mislabeled sample

V V,M

Verbal instruction script Instruction sheet Sterile cups with wipes (not expired) Who will deliver ? Time to deliver (within 1hr) Back-up plan when busy A A A

Collect samples

Patient recall Repeat Testing

V,M

Transport to lab

Delivered in a timely manner

V,M

Finalizing the Process Mapping

Review the process, by observing or asking the operator Are the operators following the process as charted? Do you have a consensus? Do you need to add or remove steps?

Process Mapping Mistakes

Map is too detailed, too much information and does not emphasize the importance.

Process Mapping Mistakes

Process is not focused on your main goal i.e. create value for your customer (customer satisfaction) Map the process without showing how the results will be measured

QUESTIONS