Acknowledgements For further information see

1 improvement Leaders Guide to process mapping , analysis and redesignFor further information development of this guide forImprovement Leaders has been a trulycollaborative process . We would like tothank everyone who has contributed bysharing his or her experiences, knowledgeand case team: Liz Allan, Kim Ashall, Sue Beckman, Helen Bevan, Kevin Cottrell,Jim Easton, Cathy Green, Richard Green,Judy Hargadon, Sally Howard, Jeanette Hucey, Kam Kalirai, Ruth Kennedy,Libby McManus, Steve O Neill, Mike McBride, Jean Penny, Helen Pye, Neil Riley, Sarah Shuttlewood. Our thanks to Darent Valley Hospital andGravesend Medical Centre, Kent for theircooperation with the photography. 2002 Crown CopyrightDesigned by Redhouse Lane, 020 7291 4646 Published by Ancient House Printing Group,Ipswich, 01473 232777new A/W 4/2/02 5:48 PM Page 1 process mapping , analysis and redesignI am pleased to present this guide one of a series forImprovement Leaders in the key objective for all of us in the NHS, whatever our role, is to continually look for ways to improve the experience and care of patients.

2 Manyimprovements have been achieved already, whether as part of a large nationalprogramme, or on a much smaller scale, through the commitment of a smallteam of healthcare staff. Everyone involved in such projects has gained so muchknowledge about initiating and sustaining these aim of this set of guides is to gather this knowledge into a summary ofcurrent thinking. We ve put them together in response to a huge demand fortools and techniques to support improvement in patient care. All the guidesinclude useful, practical advice that can be applied in healthcare by experienced healthcare staff, they are aimed at allImprovementLeaders in the NHS by which we mean everyone who wants to improve thecare and experience of patients, whether a manager of a small team in generalpractice, a director of modernisation for a large Trust, or the clinical leader of ateam of doctors, nurses or I said, the guides are based on current learning and thinking but this isconstantly changing.

3 If you ve found this printed version useful, keep checkingthe website on the guides will be regularly updated as we learn more and have new thingsto and modernisation is really just beginning. It s an exciting time,and a great opportunity to develop and share new skills and understanding sowe can truly make things better for our Fillingham, Director NHS Modernisation AgencyApril 1new A/W 4/2/02 5:48 PM Page 3 process mapping , analysis and redesignThe improvement Leaders GuidesCollectively the improvement Leaders Guides form a set of principles for creating the best conditions for improvement in healthcare. The greatest benefit is when they are used to support a programme of training inimprovement should I start?The seven guides are not sequential and ideally you should read them all at anearly stage in your improvement project, to be aware of the tools andtechniques in all the guides.

4 However there are some things we would suggestyou should do first, as you develop your plan based on local needs andexperience. Each guide includes some background information on the topic some activities which you, as an improvement Leader, may find useful to helpthe teams you work with understand the basic principles questions that are frequently asked about the topic and suggested ways toanswer them guidance on where to go for more information . Sources include the excellenttoolkits that have been produced to support improvement programmes inspecific services, such as Cancer, Critical Care, Mental Health and ClinicalGovernance. Useful books, papers and websites are also listednew A/W 4/2/02 5:48 PM Page 2 process mapping , analysis and mapping , analysis and redesignWhat s in each guide?What the guide has to offer an improvement LeaderThis is definitely the place to start. This guide offers help in the use of the Model for improvement .

5 This is a framework for setting aims, identifying thepossible changes and beginning to think about measures that will show that yourchanges have made an improvement . Then there is the vital first stage of mappingyour chosen patient process and analysing it to really understand what : how do we know a change is an improvement ? Answer: by measuringthe impact of the changes. This guide should also be considered very early on in an improvement project and gives valuable advice on what and how to measurefor improvement and how to present the data to interested parties. In our experience the process of truly matching capacity and demand has led tosome of the most exciting changes in a healthcare process . This guide explains themost effective ways to understand the capacity and demand of a service and the bottlenecks in the system which often cause patients to wait. It goes on tosuggest ideas to reduce or eliminate these queues and waiting lists for patients.

6 It is vital that process mapping and analysis is done prior to using this we do should be focused on patients and their carers. They must be involved in our improvement programmes and projects from the very beginning. We are able to offer advice based on current thinking and experience of how to involve patients and carers in the most effective way, with warnings ofpossible of us take to the idea of change more easily than others. Some like todevelop ideas through activities and discussions, while others prefer to have time to think by themselves. We are all different and need to be valued for ourdifferences. This guide gives ideas of how to ensure the best possible outcomewhen working with different is fundamentally important that after making improvements they are sustainedand built upon. This is a real challenge to anyone involved in improvement is also important that we share our learning and ideas with other areas ofhealthcare so that the maximum number of patients can benefit.

7 This guidesuggests methods and principles based on experience from healthcare both inEngland and beyond for sustaining and spreading improvement has shown that working collaboratively produces the best environmentfor creating and sharing improvement ideas. Use this guide when a group ofhealthcare staff want to work in a different way, to innovate and test new modelsof delivering care, to dramatically improve the service for a group of patients and to create learning for their own organisation and the whole of the NHS. improvement Leaders Guide mapping , analysis and for capacity and demand patients and carers* the human dimensions of change* and spread* up a collaborative programme* * Available July 5new A/W 4/2/02 5:48 PM Page 4 process mapping , analysis and the thinking website will be a dynamicmedium. Please contribute to thediscussion if you can. We wouldwelcome and value your have said that leading animprovement project has been one ofthe most enjoyable and fulfilling rolesof their careers!

8 Let us know what you think of want your comments andthoughts about the ImprovementLeaders Guides. Our aim is to keepimproving them so let us know whatyou think. how can we improve the guides? Isthere anything we have left out? have you found them useful? If sowhich guide in particular and whichsection? how have you used them? Can youtell us any stories? if there were to be other guides,what topics should they be on? have you visited the website? Howcan we improve it? is there anything else you would liketo tell us about the ImprovementLeaders Guides? Email us now few additional thoughts:The guides are based on currentthinking and aware that this is constantlychanging. Check updates on theImprovement Leaders Guides website, will be updated often aswe test out and learn from newtechniques. Be aware of your own this field is totally new to you, planhow you can find out more throughfurther reading or developmentcourses.

9 If you are familiar withleading service improvements, can you share your experiences andknowledge with others in yourhealthcare community and the wider NHS?Make contact with others who haveimprovement people in healthcare have hadtraining in the improvement skillscontained in these guides. Theirtraining will most likely have been fora particular service such as primarycare, dermatology or cancer. Makecontact with them to form a healthcommunity improvement network tosupport and learn from each other. Try it for guides don t represent the onlyway to do things, but they provide agood starting point. Create your owncase studies and then share yourexperiences with us. improvement Leaders Guideto process mapping , analysis and redesignnew A/W 4/2/02 5:48 PM Page 6 process mapping , analysis and 9 process mapping , analysis and redesignContents1 Introduction2 Model for Improvement3 What is a process ?

10 4 The benefits of mapping and analysing a patient s journey5 mapping a patient s journey6 Analysing a patient s journey7 Redesigning a patient s journey8 Activities to support process mapping9 Frequently asked questions and answers10 Useful reading for more information and ideas11 Glossary of terms1. IntroductionProcess mappingis a simple exercise. It helps a team toknow where to start making improvements that will havethe biggest impact for patients and staff. The Model forImprovement helps a team to set aims, targets andmeasures, and introduces a way of testing ideas beforeimplementing them. So it s logical to consider the twotogether. Every system is perfectly designed to get the results it achieves. Don BerwickA plan for improvement could include the following 1define the aim for the project including: the group of patients you are considering your targets Step 2consider how you are going to know if a change is an improvement : what measures you are going to use how are you going to report progress to all the interestedpartiesStep 3involve the staff in mapping and analysing the process : to really understand the problems for the patients, their carers and the staff to start to measure and create the baselines for your improvements.