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Process mapping

A process map is a visual representation of the transactions that occur for the patient through a process of care.

Process mapping is useful within PFCC as it enables teams to define the care experience they want to look at – marking clearly where it begins and ends. For example, the team might want to look at the admissions process or the discharge process from the same service. These might be separate projects within PFCC. (See PFCC sample process map)

It also provides clinical staff with an overview of the entire care experience that is seldom visible to everyone involved with the same patient. It shows how the different parts fit together. For staff, this alone shows how complex and interrelated their work is, in ways they may not have realised or intended. Often, staff are unaware of how their part of the process impacts on others. For example, the process for making scan appointments may delay the way teams have to work elsewhere in the hospital. You can use the process mapping format to identify patient and staff perspectives at each stage of the process.

To start mapping a care process, stick large sheets of paper on the wall and draw a horizontal timeline across the sheets. Then ask participants to note on Post-its specific events within the care process (such as booking an appointment), and any thoughts about that event. They then stick the Post-its in the relevant place along the timeline. Gradually, discrepancies will start to emerge between what should happen and what actually does happen, revealing glitches such as bottlenecks. These will inform the focus of your improvement work.

Preparing a process mapping exercise

  • Time – Minimum of two hours, maximum of four hours so think about refreshments.
  • Space – Room with plain, long, open wall where people can stand or sit.
  • Materials – Background paper (either large sheets or a roll of paper like wallpaper) and a means of attaching it to the wall. Post-it notes in three or four colours; marker pens; sticky tape (to stick post-its in place at the end of the session).

Key points

  • Process mapping can bring together people who do not necessarily operate as a team, to focus on the patient’s journey. It is part of building the team, so it is important that this stage includes a wide variety of staff, senior and junior, each seeing different aspects of the care experience.
  • You would expect to include doctors, administrative and clerical staff, therapists, nurses, managers – and wherever possible patients.
  • Who you involve depends on how much detail you want to go into within the care experience in question. For example, the event featured on the timeline could be making an appointment, receiving a letter, or attending a clinic.
  • Use a variety of sources of data and points of view.
  • Encourage the whole working group to carry out the process together, talking about what happens and different perspectives.
  • It is worth taking the time to understand the overall experience from different perspectives, so make sure you set aside enough time (two to four hours).
  • Process mapping doesn’t need to be too complex. Be really clear about what you want to work on. If your scope is too broad, the scale of the work will be unmanageable.
  • The areas where there are obvious problems, or the greatest discrepancy between the ideal and current situations, will help you identify your smaller improvement projects within this work.
  • It can be useful to mirror a process map drawn from the patient’s point of view with one drawn from the staff’s point of view. Often, this reveals glitches that are as frustrating for staff as they are for patients.
  • Try to create a sense of energy, urgency and ownership among the staff so they feel they have been listened to and their concerns taken on board.
  • During the process mapping session, ideas for improving the experience may well come up. Record these separately to avoid confusing the purpose of this session, which is to map the current state. These ideas may form projects or tests of change in the future.