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RCGP Quick guide: Process and Value Stream Mapping

This RCGP Quick guide introduces process and value stream mapping, techniques that creates a visual representation of all the steps in a process.
Download RCGP Quick guide: Process and Value Stream Mapping
Day-to-day general practice work involves very many processes to ensure safe, effective delivery of care for patients. These processes include the management of repeat prescriptions, the referral process, managing the post and clinical information and handling results.
Each includes many steps, involving many people, including our patients. There is a possibility of error at every stage, and errors can lead to harm to patients, though more often, they lead to inefficiencies and wasted time. Process mapping creates a visual representation of all the steps in a process.
Changing processes, especially those that may be well-established, but inefficient, can be complex and difficult. For effective improvement the first step is for all people involved to fully understand the existing process.
Process mapping can help everyone to:

  • Understand the stages of a process they are not directly involved in.
  • Quickly identify bottlenecks
  • Identify steps that appear to be a waste of time
  • Co-design revisions to a process
  • Engage in change
  • Contribute to improvements
  • Take ownership of the new or revised process – which will help with buy-in.

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How to
Preparation Stage:

  • Step 1: Decide which process is to be mapped.
  • Step 2: Arrange a date to meet that all can make. Invite anyone involved in the process to participate in the mapping exercise, including patient representatives where relevant.
  • Step 3: Choose a facilitator. This person needs to be able to explain the exercise to the rest of the team. They do not need to have a detailed understanding of the process that is to be mapped.
  • Step 4: Collect the materials. You will need post-it pads of different colours and pens.

During the Session:

  • Step 5: The facilitator explains process mapping to the participants, making it clear that each step needs to be broken down. The more detailed the better because this will identify waste.
  • Step 6: Define the start and end point of the process. For repeat prescribing, the start point could be the patient requesting a repeat prescription. The end point could be the patient collecting the prescription.

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  • Step 7: If one step can be done in several ways, this is added vertically e.g. in the repeat prescribing process the patient may request a script in different ways.

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  • Step 8: Once the map is created, the facilitator asks the group where the problems arise. The participants then note the problems on a different coloured post-it note and attach these at the appropriate point on the map.
  • Step 9: Participants are then asked to identify solutions. These are noted on another different coloured post-it note. They are stuck over the problems that were identified.
  • Step 10: This process will then have identified areas for improvement and generated new ideas to try out. The group should decide if they will try out the changes one at a time or several and what measurements they will use to identify if there is an improvement over time. Using run charts is one way you might measure and track change to identify those which improve the process and should be sustained.
  • Step 11: A further process map is then created by the group to illustrate the agreed new process.

After the Session:
By the end you will have created a visual display of an improvement to an existing process. The exercise often highlights the more steps there are a process, the more likely it is there is inefficiency. It is a good idea to leave the map on display for a few weeks so that any issues that arise during implementation can be more easily discussed.
Value Stream Mapping
This is a visual map of a process or system. It has similarities to process mapping, but includes more detail including the length of time between steps in the process and how long each stage usually takes.
Its purpose is to identify waste to help streamline processes. The objective is to reduce or eliminate activities that don’t appear to be adding any value to the whole process or to the patient.
How to

  • Follow Steps 1-7 of the process-mapping guidance.
  • On this map, record the time it takes to complete each step and the time taken between steps. Once all the steps have been identified, decide which are: value-added, value-enabling (activities do not add direct value, but are necessary to the process) or non-value added
  • Once the Value Stream map has been created the group will generate ideas about how to eliminate steps in the process that are neither value-adding nor value-enabling, or reduce the time it takes to complete each step, or interval between steps.