[Ryan Kaufman] Quality improvement is the goal of every family medicine office. We all work to improve the care we give patients each day however in the hectic office environment is hard to make much progress if we do not have good tools in place to make these changes.

Hello i'm Ryan Kaufman today i will guide you through using process mapping to understand how your practice team is currently providing care then use this information to improve the quality of care that you provide to your patients.
In order to determine how you best make change in your practice you need to understand how you are doing things now. To be most effective you should involve representatives for all team members. If you have a small practice like mine you should probably include the entire practice team in the process. If you have a large practice or a multi-site practice you should have representatives from each of the roles within the practice.
This process will allow your practice to see all the resources that you have available to improve the care you provide to patients. When you are finished with this you will be able to understand how your practice is currently functioning.

By involving other team members in this process you will see how they play a critical role in the delivery of excellent care to your patients. This process will allow you to discover opportunities to share patient care responsibilities with other members of your team.

When you give team members ownership in the care of patients you can increase the buy-in for all staff members increase job satisfaction for your employees and improve the care your patients receive without creating more work for you.
This process also creates low risk opportunity to have your entire team develop ideas of how to improve patient care. Again every practice will have different people involved but you should have broad representation from your practice team involved in the process mapping.

This should include non-clinical staff members including front office staff billing staff and office managers. You should also include nurses medical assistants any mid-level providers and physicians. If you have other staff such as case managers laboratory staff dietitians mental health providers or patient educators you should include them in this process as well.Every practice situation is different there is no right or wrong way to do this process. While this process works best when the teams are acting face to face it is possible to do this over a virtual platform.

When working as a team on process mapping it is important to consider the power dynamic that takes place in the office. Even in an employed situations physicians opinion carry significant weight. In private practice situations where the physician is also the employer this can magnify this power differential. As physicians make sure that you are listening to the opinions of staff members before you give your opinion. Because your staff can see things that you do not see hearing the things that they say can give you new insights into how you can improve the care your patients receive. Make sure that you create a safe environment where your staff feels free to share their insights into how you as a team can better care for your patients. You will learn a lot of useful ideas and skills from this process that may change the way you approach it the next time. Well we will use the example of patient education. This process can be applied to many different clinical situations including preventative health screening vaccination chronic disease management and acute care.

To do this you will need a surface to create your map. Generally this process uses a large paper but can work with whiteboard or even a table. You will need two colors of sticky notes and markers to write on them. Ideally you should capture the results on a phone or camera so you can refer back to this process map later. The first part of developing a process map is to determine the lanes or the individuals or groups that affect patient care within your practice. This will be different for each practice depending on the resources available to you. For this example we will include front office nursing physician and patient.

Your practice may have other individuals that you can involve in the care of your patients. Depending on the process that you're evaluating you may want to include outside resources such as specialists and community organizations.
Once you've defined your lanes you will start putting the care process in chronological order. As you go through this process you can add additional lanes if you discover others that are contributing to the care of your patient.
As you work through this process you may decide to change the starting point of your process which may create other opportunities to improve the care of your patients. At this point you're documenting the process as it is currently done. While you will realize changes you may want to make to the system and should make note of them you should record things as they currently exist.

We'll start with the patient calling to schedule an appointment. Front desk will find a time that is open on the physician's schedule and schedule the patient for that appointment. When it is time for that appointment the patient arrives the practice. The patient is greeted by the front office staff is checked in and their insurance information is updated. Next the patient is taken to room by the nurse. Vital signs are taken and the reason for their visit is discussed. Then the physician sees the patient takes a history and examines the patient. The physician then makes treatment recommendations. What happens next is done differently by different physicians in the practice. The way that this is shown on the process map is using a different colored sticky note that contains the word fork. There are times that the front office prints patient information while at other times the nurse does patient education. Regardless of who has educated the patient the patient is given information about online educational materials to support their management of their condition.

Finally the nurse will check with the patient in a few weeks after the visit to address any questions and encourage the patient to follow the treatment plan. What is nice about using sticky notes is that when you realize you missed something it is easy to make changes to your process map at any point in this process. As you can see this process can quickly help you determine how you are currently doing things in your practice. Remember that the rest your team brings valuable insights into how your practice can improve the care of your patients. Make sure that you hear what other team members have to say. Now that you are finished with your process map make sure that as a team you discuss what you've learned. Feel free to keep adjusting the map until everyone on the team is satisfied with it then take a picture of the final process map so you can refer back to it later if needed. If you have representatives from your practice team involved in the development of your process map rather than the entire team make sure you share what you've learned with the rest of the team. Once you've completed your process mapping there are a number of questions that you need to consider as a team. First of all you need to consider is the process that you currently have the most effective process that could be used for the task at hand.

Next you need to consider if they're members of the care team who contribute in other ways to this process. It's important to consider whether you have the right information at the right time to provide the care patient needs.
Sometimes this could be as simple as assigning a team member to pull information so that is available at the time the patient is seen. Other times this may require technological changes such as enabling an interface in your electronic health record to get information from outside sources. It's also important to consider whether the workflow can be simplified. Sometimes things are more complicated than is necessary and that offers more opportunities for things to fail.
As your team evaluates the map you want to consider what you've learned whether this can be applied to other processes within the office.

Now that you've completed mapping your process you'll be able to figure out how you want to change your patient care system. Make sure you empower the other members of your team to implement the changes to the system and improve the care your patients receive. Once you've completed this cycle of practice improvement you should evaluate the results and then start the next cycle of practice improvement. Whenever you make changes in your practice it is always important to make sure that you consider how these changes will affect health equity. You should consider if the changes you're making are appropriate for all subgroups within your practice. Are there individuals in your practice where these interventions might not work because of language barriers technology barriers cost barriers or issues with access. Are the interventions you've identified culturally appropriate for the patients you serve. You also need to consider how you can apply population health principles to improve the care your patients receive. What processes extend beyond your practice. How can you partner with other organizations in your community to get resources that will improve the care of your patients.

Using process mapping has changed the way that my practice approaches quality improvement. It's given all members of my team a new appreciation for the contribution each person can bring to the care of our patients.
It's allowed us to understand the challenges we face in our current system has allowed us to change our system so we can provide better care to our patients.
I hope you will find this to be as useful in your practice as we have in ours. You