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Office for Aboriginal and Torres Strait Islander Health: Service Toolkit

Section4: Process mapping and service mapping

4.1 Process mapping and service mapping

This section explains process mapping and service mapping, and how to do them for your organisation.
Once your process and service mapping are done, youll have a list of things to change in the way you
work. This section also describes how to decide which changes to tackle first.

4.1.1 What is process mapping?

Process mapping is a description of how your organisation worksfor example, what happens to a
client when they come for treatment, where they wait, who they see first, and so on. After process
mapping, youll have an exact picture of the way your organisation delivers its services. This makes it
easier to see what works well and what doesnt, so you can think about how to improve things that arent Section
working well.
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Your first process map also gives you a starting point (a baseline), against which you can measure the

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Process mapping
effects of the changes you make. It also provides a very useful tool for orienting new staff.

Process mapping will:

provide a picture of what you do now


highlight where things arent working well
show everyone how things happen
help you to assess the flow of activity
help you to work out how your resources (money and staff) are used
help you to work out how many services you can deliver, and how well your organisation can
deliver them
provide the baseline data for improving your service and measuring how well your changes work.

Three sorts of process are mapped:

Organisational processes
These are the processes of governance and management, and are mapped between and within
organisations in entity relationship diagrams (see Figure4.1.1). Mapping the links between your
organisation and other service providers is known as service mapping (see Section4.1.2).

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Core business processes


These are the core business processes of the service model in general.

Support processes
These are processes that support the main things your organisation does, and the supporting health
system in general.

After activities and flows have been set out across these main areas, each of the processes can be
mapped on three levels.

Level 1 is the process chain map or entity relationship diagram. Its used to work out which people
and organisations work together, and how they work together for the whole system of care. In your
Healthy for Life program, this is called service mapping.

Level 2, the top level process map, shows the main areas of work that are done by the groups in the
Level1 process chain map. This level shows how the people and organisations do what they do.

Section
Each of these areas of work is then expanded and mapped to a Level 3 process map. This is the lowest
level of the process-mapping task, and shows physical work. Each box represents a group of activities, 4
which produce an outcome.

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Process mapping
Examples of processes that may be mapped through the Healthy for Life program include antenatal visits,
child health screening, adult health checks, chronic disease care and information management.

Figure4.1.1 Levels of process mapping


Level 1:
Community Visiting
Entity relationship GP Health centre
Council services
diagram

Level 2:
Medication
Identification of Screening Education Care planning
reviews
processes

Level 3:
Process map (for
Step Step Step Step
each process
identified)

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In the Healthy for Life program, youll be helping staff describe the work processes around what you are
planning to do with your Healthy for Life money. In most cases, about twohours will be needed to deliver
the processmapping tutorial (Section4.2) and conduct the processmapping exercise, including the
determination of priorities, so make sure you allow enough time.

For process mapping, youll need:

butchers paper;
three different coloured postit notepads (10cm 5cm stickers for main processes and smaller
ones for subprocesses);
pens and black textas;
a whiteboard to list and group problems identified; and
whiteboard pens.

People participating in the mapping exercises will need examples and instructions on how to do
the activity. A good way to start is to run through the process-mapping tutorial (Section4.2) to help
participants understand the exercise. Figure4.1.2 is a process map of the activities involved in getting
to work in the morning, and shows the macro-, mini- and microsteps involved in the process. Its Section

recommended that the group analyse the first two layers (macro and mini).
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Figure4.1.2 Process map of getting to work in the morning

Process mapping
Macro, Mini and Micro Diagram

Macro: Wake Up Take a shower Get dressed Have breakfast Drive to work

Make a pot Eat your


Mini: Put the jug on Clean up!
of tea coco pops

Take packet Pour milk over


Micro: Pour into bowl Get spoon Eat
from pantry coco pops

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Also included in the module is a process map showing the flow of chronic disease clients through
a primary health care service.

Before leading the process mapping exercise, the Healthy for Life staff will need to decide which
processes the group will be asked to map. Sometimes its useful to get all groups to map the same
processes to see if everyones understanding of workflows is the same.

Steps in the process mapping exercise are as follows:

1 Deliver the slide show tutorial on process mapping (Section4.2).


2 Explain that post-it notes are used because the order of workflows often changes during
discussions. Tell the group which colour post-it notes should be used for the main processes,
subprocesses and problems. Write this key on the whiteboard.
3 Ask people to break into groups. Four to six people is a good size for each group.
4 Ask the group to map the main processes and subprocesses first.
5 Once the work practices have been documented, ask participants to identify problems with
the processes. Section

6 Place the post-it note with the problem on it near the process that the problem affects.
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Process mapping
4.1.2 Service mapping

As part of the service stocktake, youll need to identify all the organisations available to the community
to support maternal and child health and chronic disease prevention and management services. It will be
necessary to identify where specialist and referral services are used, as this will be important for continuity
of care. Its also important to work out how all the organisations link together and whether there are any
gaps in service delivery or communication. The best way to do service mapping is to brainstorm with a
group of staff from the service about which organisations deliver which services.

Figure4.1.3 is a service map that links services providers to the types of service they deliver. In the
example in the diagram, treatment and care of the sick, aged and disbled is delivered by onsite health
workers and nurses with the support of visiting GPs and a visiting specialist paediatrician. To get access
to specialist services, a person has to be a patient of a hospital in the region. You can also see from the
map that very few screening and prevention services are offered.

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Figure4.1.3 Service providers map (very remote community, child health services)

Health Service Entities

Key Visiting RFDS


Service delivered on site _____ GP
Referral to off-site service - - - - On-site
Child health
Limited time to deliver services PHC team Visiting
Medivacs
(Ns and AHW) paediatrician

Hospital
Trauma care
Maternity care
Treatment and care Screening
Specialist paediatric care Tertiary and Health Community
of the sick, aged and illness Health education Advocacy
secondary care promotion development
and disabled prevention

Metro Hospital
Renal
Complex trauma
Complex maternity care
Complex surgery
Rehabilitation Dental services

Section

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4.1.3 Analysing and prioritising identified problems

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Process mapping
After the groups have finished mapping processes and problems, ask them to present the workflows
they have mapped. Discuss the maps to find out whether any key steps are missing, and whether there
were any differences of opinion about how workflow does occur.

As people are presenting their maps, the problems they identify should be listed on the whiteboard. When
all the processes have been discussed and all the problems listed, the problems should be grouped
(similar problems will often be expressed in different ways). Table4.1.1 is an example of this process.

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Table4.1.1 Clarifying core problems and contributing factorsan example

Core problems Contributing factors Likely cause/ next step

Long waiting time in clinic to see Cultural support and language


practitioner causes anger and problems
frustration for patients and staff.
Transport delays and problems cause
unpredictable patient flow through the
clinic and too many patients at once

Results missing from files at time of


consultation

Stores and pharmacy availability and


process

Practitioner inappropriately choosing


file from pile of files of patients waiting

Steps to prioritise problems are: Section

1 Advise all participants that they have $100 to spend on the three problems they think are the 4
most important.

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Process mapping
2 Give each participant three post-it notes, which will represent the money.
3 Ask each participant to indicate on the post-it notes, in whole dollars, how much they want to spend
on each problem. Participants may put all their money towards one priority or split it in any way
across any three priorities.
4 Ask participants to put their post-it notes on the whiteboard next to the problems they want to spend
their money on.
5 Add up the amount allocated to each problem. The problem with the most money allocated to it has
the highest priority.
6 Work out, from the total amount allocated, what percentage of total resources has been allocated
to the problem. The denominator is determined by multiplying the number of people participating by
100, which is the number of dollars each participant is allowed to allocate to the problems.

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