Process Mapping Template: A Guide for Healthcare Improvement

Why Process Mapping Matters in Healthcare

Healthcare processes are often complex, involving multiple disciplines, handovers, and decision points. Without a clear understanding of these pathways, it's difficult to pinpoint inefficiencies, bottlenecks, safety risks, or areas where patient experience could be improved. Process mapping offers:

• Clarity and Shared Understanding: It creates a common visual language for all stakeholders, revealing how a process actually works versus how it's believed to work.
• Identification of Waste: It helps identify non-value-added steps, delays, re-work, and unnecessary movement.
• Risk Mitigation: By visualising pathways, potential points of failure, communication gaps, and safety hazards can be highlighted.
• Foundation for Improvement: Once the current state (current process) is mapped, it becomes easier to design and implement a more efficient and effective future state (improved process).
• Engagement: Involving staff directly performing the work in mapping exercises fosters ownership and buy-in for subsequent changes.

Practical Explanation: What is Process Mapping?

Process mapping involves creating a flowchart or diagram that illustrates the sequence of steps in a process. It uses standardised symbols to represent different types of activities, decisions, and flows. While various symbols can be used, a few key ones are commonly understood and sufficient for most healthcare applications:

• Oval/Rounded Rectangle (Start/End): Denotes the beginning or end of a process.
• Rectangle (Process Step/Activity): Represents a single action or task performed.
• Diamond (Decision Point): Indicates a point where a decision must be made, leading to different paths (e.g., 'Yes/No', 'If X then Y').
• Arrow (Direction of Flow): Shows the sequence and direction of steps.
• Cylinder (Database/Information Store): Represents where data or records are stored or accessed.
• Parallelogram (Input/Output): Indicates materials or information entering or leaving the process.

Types of Process Maps

While this template focuses on a basic flowchart, it's good to be aware of common variations:

• Basic Flowchart: Simple, sequential representation of steps.
• Swimlane Diagram (Cross-functional Flowchart): Organises steps by the team or individual responsible for them, showing handovers and responsibilities clearly. This is often highly effective in healthcare.
• Value Stream Map (VSM): A more advanced Lean tool that focuses on identifying value-adding steps versus non-value-adding (waste) and measuring lead times. Useful for complex, end-to-end patient pathways.

Common Pitfalls

When undertaking process mapping, teams can often encounter challenges that diminish the exercise's effectiveness:

• Mapping 'Should Do' vs 'Actually Do': Teams often map the ideal process as per policy, rather than the reality on the ground. It's crucial to map the current state accurately, including workarounds and informal steps.
• Limited Stakeholder Involvement: Only involving senior staff or a small subset of the team will miss critical operational details and hinder buy-in. Involve individuals who perform the work daily.
• Excessive Detail or Too Little Detail: Striving for an unreasonable level of granularity can make the map overwhelming and time-consuming. Conversely, too little detail can render it unhelpful. Aim for sufficient detail to identify bottlenecks and key decision points.
• Lack of Clear Scope: Without defining clear start and end points for the process, the mapping exercise can become unfocused and unwieldy.
• Forgetting the 'Why': Process mapping is a tool, not an end in itself. Always keep the improvement objective in mind to maintain focus and drive meaningful change.

Step-by-Step Approach: Using the Process Mapping Template

Our downloadable template provides a structured frame to guide your mapping session. Before you begin, clearly define the scope of the process you intend to map.

Phase 1: Preparation

1. Define the Process: Clearly articulate the process you want to map. What is its name? What specifically triggers its start? What marks its end? (e.g., 'Referral to Community Mental Health Services', 'Discharge from Acute Medical Unit', 'Prescribing and Dispensing of take-home medications').
2. Assemble the Team: Gather a multidisciplinary group who are directly involved in the process. This should include staff from different roles and levels (e.g., nurses, doctors, pharmacists, administrators, allied health professionals). Aim for 4-8 people.
3. Gather Materials: You'll need a large whiteboard or flip chart, sticky notes (various colours are helpful), markers, and the downloaded Lazomis Process Mapping Template.

Phase 2: Mapping the 'Current State' Process

1. Start and End: On your map, clearly mark the very first step and the very last step. Use oval symbols.
2. Brainstorm All Steps: Ask the team, "What happens next?" for each step. Write each step on a separate sticky note. Encourage everyone to contribute their perspectives on what actually happens, including any workarounds or inefficiencies.
3. Sequence the Steps: Arrange the sticky notes in sequential order, connecting them with arrows. If using a swimlane diagram, place notes in the lane of the responsible person/department.
4. Identify Decision Points: Use diamond shapes for points where a choice is made, and ensure all possible paths from that decision are accounted for.
5. Review and Refine: Once a preliminary map is complete, walk through the entire process with the team. Ask:
   • Are there any missing steps?
   • Are any steps in the wrong order?
   • Are there any steps that shouldn't be there?
   • Where are the handovers? Are they clear?
   • Where are patients waiting or experiencing delays?
   • Where are the points of frustration?
6. Add Detail (Optional but Recommended): Once the basic flow is established, consider adding details such as:
   • Time taken for each step.
   • Who is responsible for each step.
   • Key resources or information required.
   • Problems or pain points identified for each step.

Phase 3: Analysis and Improvement

1. Identify Bottlenecks and Waste: Look for areas where flow stops, where there's unnecessary waiting, duplication, movement, or errors. Use different coloured sticky notes to highlight these.
2. Root Cause Analysis: For identified problems, explore their underlying causes. (e.g., Use '5 Whys' or Fishbone Diagram – see Lazomis resources on these topics).
3. Brainstorm Solutions: For each identified problem or area of waste, brainstorm potential solutions. Focus on improvements that are feasible, impactful, and sustainable.
4. Design the 'Future State' Process: Create a new process map incorporating the agreed-upon improvements. This visual representation of the desired state helps solidify changes.
5. Plan for Implementation: Develop an action plan for implementing the changes, assigning responsibilities and timelines. (e.g., use a PDSA cycle – see Lazomis resources on PDSA).

Example in Clinical Practice: Improving Discharge from a Medical Ward

A QI team on a medical ward embarked on a project to reduce delays in patient discharge. They assembled a multidisciplinary group including junior doctors, ward nurses, pharmacists, discharge coordinators, and administrative staff.

They used a large whiteboard and sticky notes to map the entire discharge process, from the consultant decision-to-discharge to the patient leaving the ward. They quickly identified several key issues:

• Delay in obtaining take-home medications: Often, medication charts were not written until late morning, leading to the pharmacy needing to dispense many medications simultaneously in the afternoon.
• Lack of clarity on transport arrangements: Sometimes, patients were medically fit but had to wait hours for family or ambulance transport that hadn't been pre-booked or clearly communicated.
• Inconsistent communication with family/carers: Families were sometimes not informed of discharge plans until the last minute, causing delays or difficulty arranging collection.
• Waiting for discharge summaries: Junior doctors often prioritised ward rounds, leading to summaries being handwritten or typed late in the day.

By mapping these steps and identifying the decision points, the team could visually grasp the 'why' behind their delayed discharges. They then redesigned the process, implementing changes such as:

• Electronic prescribing for discharge medications by specific morning deadlines.
• A daily discharge huddle to proactively plan transport and family communication.
• Standardised communication protocols with families.
• A dedicated 'Discharge Hub' on the ward to coordinate tasks and support junior doctors.

This led to a measurable reduction in discharge delays, better patient flow, and improved patient and staff satisfaction. The process map served as their foundational tool for understanding and transforming their pathway.

How Lazomis Can Help

Lazomis provides a suite of tools that complement process mapping efforts. Our QI Project Setup module guides you through defining your project scope, aims, and measures, which are essential precursors to effective process mapping. Our secure, collaborative environment facilitates team-based work, allowing you to share and refine your process maps digitally once the initial sticky-note exercise is complete.

The Lazomis Document Editor can host your finalised process maps, linking them directly to your data collection tools, run charts, and action plans within the platform. This ensures your improvement activities are integrated and easily accessible, moving your insights from mapping to measurable impact. While Lazomis doesn't replace the initial physical mapping session with your team, it provides the digital infrastructure to manage, track, and sustain the improvements identified.

This resource supports, but does not replace, clinical judgement. Local policy, formulary and specialist advice should be followed.

Download the Lazomis Process Mapping Template here.