Process mapping in screening mammography

Process Mapping Occupational Therapy Activity within a Medical Admissions Unit

There are increasing demands on professionals within health care to provide a service that meets the needs and expectations of patients. This requires the patient to be placed at the centre of the care pathway. Occupational therapy is well placed to contribute to this change in emphasis because of its fundamental client-centred philosophy. Experience has shown, however, that the realisation of these aims has been a challenge for all health care professionals. Increasingly, the National Health Service is drawing upon expertise from outside and, in particular, the quality improvement tools that are used within industry.

This article explores the use of the traditional quality tool of process mapping in the evaluation and review of occupational therapy processes. The use of this tool is explained in relation to a clinical audit within a medical admissions unit.

The results of the process mapping exercise, and the associated audit that was undertaken, demonstrated the value of the approach. In particular, process mapping enabled the occupational therapy service to evaluate systematically the service being provided and to visualise the optimum pathway of care.

Integrating cancer survivors' experiences into UK cancer registries: design and development of the ePOCS system (electronic Patient-reported Outcomes from Cancer Survivors)

Background:

Understanding the psychosocial challenges of cancer survivorship, and identifying which patients experience ongoing difficulties, is a key priority. The ePOCS (electronic patient-reported outcomes from cancer survivors) project aims to develop and evaluate a cost-efficient, UK-scalable electronic system for collecting patient-reported outcome measures (PROMs), at regular post-diagnostic timepoints, and linking these with clinical data in cancer registries.

Methods:

A multidisciplinary team developed the system using agile methods. Design entailed process mapping the system's constituent parts, data flows and involved human activities, and undertaking usability testing. Informatics specialists built new technical components, including a web-based questionnaire tool and tracking database, and established component-connecting data flows. Development challenges were overcome, including patient usability and data linkage and security.

Results:

We have developed a system in which PROMs are completed online, using a secure questionnaire administration tool, accessed via a public-facing website, and the responses are linked and stored with clinical registry data. Patient monitoring and communications are semiautomated via a tracker database, and patient correspondence is primarily Email-based. The system is currently honed for clinician-led hospital-based patient recruitment.

Conclusions:

A feasibility test study is underway. Although there are possible challenges to sustaining and scaling up ePOCS, the system has potential to support UK epidemiological PROMs collection and clinical data linkage.

Process maps in clinical trial quality assurance

BACKGROUND

A process map is a diagram showing the sequential steps and decisions used to accomplish a procedure from start to finish. Process maps are a standard tool in continuous improvement efforts. They have not been used routinely in clinical trials although they are well suited to display trial processes.

PURPOSE

We present the use of process maps as a tool to visualize and to monitor the correctness of trial work flows. We show that process maps can be used to assure that trial processes are conducted according to the SOP.

METHODS

We describe how a process map is made. We then derive process maps from two sources: the SOP and trial procedures as currently implemented. We compare these maps to each other, using the SOP maps as the gold standard, to check that work is done according to the written procedures.

RESULTS

Eight process maps were produced from each source. 172 differences were found between the SOP maps and the walkthrough maps. Differences included the addition of extra steps, order errors, step mistakes, and ambiguities.

LIMITATIONS

These process maps focused only on clinic procedures, so interactions with other trial components were not considered. The maps were made after the trial started, which may have biased their content and use.

CONCLUSION

Process maps are a simple tool to check if clinical trial processes are operating as designed and offer an effective means to identify and correct such divergences. Further research should focus on using process maps in the design phase of trials, analyzing the cost to benefit ratio for process maps, and linking the analysis of the process map to monitor queries to quantify the improvement gained from using this technique.