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Workflow Analysis

Case Studies

Learn how Qualis Health's workflow consulting has helped primary care providers streamline their systems:

Sea Mar Community Health Centers (located throughout Washington's I-5 corridor)

Terry Reilly Health Services (southwestern Idaho)

University of Washington Medical Center - Roosevelt (Seattle)

University of Washington Neighborhood Clinics (greater Seattle)

Washington Park Medical Center (Centralia, WA)

Lean methodology calls inefficiencies “waste.” Process mapping is a powerful tool to analyze workflows, expose waste, and guide more efficient design.

Process Mapping

Any process can be mapped—but it  is important to have staff that actually do the work participate, as they know the details best.

Most process mapping is done in a workshop setting, where team members spend a block of several hours to work through the activity. At the workshop, team members:

  • Map the current workflow of a selected process
  • Identify waste and other concerns
  • Discuss possible improvements
  • Build a future-state workflow

While this does require a time investment, the pay-off can be substantial. Benefits of a process-mapping exercise include:

  • Developing a complete, shared understanding of the selected process, including a visual representation of its complexities and inter-relationships
  • Creating a forum to challenge assumptions about how the process is currently completed, and for staff to express their views about the process
  • Providing opportunities for team bonding
  • Clarifying responsibilities and ownership
  • Helping staff understand their value and how they contribute to the process
  • Determining how resources are used and where there are gaps
  • Identifying inefficiencies and wastes, and developing solutions to eliminate them
  • Generating baseline data for measuring the impact of change
  • And ultimately—designing a more efficient, reliable, and satisfying workflow

It is highly likely that problems and barriers not directly related to the selected process may come to awareness during the team's discussion. To prevent the team from being sidetracked, record these on a “parking lot” flipchart page for future action planning.

Current-State Mapping

To map the current state, the team identifies all the steps of the process between the agreed-upon beginning and endpoints. During this exercise, participants are often surprised to discover the variability between staff performing the same work, and the redundancies in work performed.

Handwritten sticky notes are convenient to document each step so that everyone can view the entirety. These may later be transferred to a computer program such as Visio. It is desirable to preserve the current-state process map for comparison to the future map(s).

Example Process Map, Created with Handwritten Sticky Notes
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Photograph of example process map


Example Process Map, Created in a Software Program
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Example process map, created in software program


Future-State Mapping

After the current-state map is completed, team members can build the desired future-state map, again using discussion and sticky notes. The team's goal is to identify—and attempt to eliminate—as much waste as practical.

In the example lab workflow, the current-state map included 18 steps and was trimmed to just five steps in the future-state version.

Example Future-State Map
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Example process map, created in software program


The illustrations shown on this page were prepared by Qualis Health as part of our work as the Washington & Idaho Regional Extension Center, under grant #90RC0033/01 from the Office of the National Coordinator for Health Information Technology, Department of Health and Human Services. 2011