NURS 6421 Week 3 process map example

From Fax to First Appointment: A Current-State Process Map of an Outside Referral Through a Composite Sleep Medicine Clinic, Three Loops Left In

Student Name

College of Nursing, Walden University

NURS 6421: Supporting Workflow in Healthcare Systems

Instructor Name

Month Day, Year

From Fax to First Appointment: A Current-State Process Map of an Outside Referral Through a Composite Sleep Medicine Clinic, Three Loops Left In

Scope and Method

This map traces one kind of work: an outside referral to a composite four-provider sleep medicine clinic, from the moment a referral arrives to the moment the patient has a scheduled first appointment. It does not follow the visit itself. The map was built from two mornings of observation at the front desk and nurse triage station and from interviews with the scheduler, the triage nurse and the front desk lead. Process mapping is widely used in health care improvement, but reviews note that maps are often drawn from assumptions rather than observation and that their value depends on how the information behind them was gathered (Antonacci et al., 2018). For that reason, each step below is marked as observed or described. The clinic, its queue and its volumes are composites.

Legend

Rectangles are actions, each beginning with a verb and naming the role that performs it. Diamonds are decisions with two exits. A loop is a path that returns to an earlier step. Elapsed ranges are shown only under the four steps slow enough to shape the patient's wait. In the drawing, the process runs left to right across one wide page; Table 1 lists the same steps in order, with shapes and exits, so it can be read without the drawing.

The Map, Step by Step

Table 1

Referral Process Steps, Shapes, Roles and Evidence

The table contains 22 steps, 18 actions and 4 decisions. A fifth decision, whether a patient who declines should be closed or kept, is made informally by the scheduler and appears in the notes below rather than as a drawn diamond.

The Three Loops

Loop A, incomplete referrals, returns work to the referring office and restarts the process at step 1 when new pages arrive. The front desk lead estimated that about one referral in four is incomplete on arrival, most often missing clinical notes. Because returned pages arrive as new faxes, they are sometimes logged as new referrals, creating duplicates that the scheduler later removes by hand.

Loop B, authorization requests for more records, is the longest delay in the map and is described rather than observed, since the authorization coordinator works from another building. It depends on the payer's response and the referring office's willingness to send more.

Loop C, reaching the patient, is the loop most often mistaken for inefficiency. The scheduler follows a rule of three attempts over about two weeks before sending a closing letter. The loop is drawn as a loop because that is how the work happens; straightening it into a single step would hide the part of the wait that the patient controls.

How the Map Was Checked

A current-state map is only useful if the people who do the work recognize it. The draft was shown to the scheduler, the triage nurse and the front desk lead in one fifteen-minute huddle, and each was asked to trace one recent referral through it and say where the drawing departed from what happened. Two corrections followed. The front desk lead pointed out that returned pages were sometimes attached to the original referral and sometimes logged as new, which is why the duplicate note now appears under Loop A. The scheduler added the three-day interval in Loop C, which the draft had shown as a single retry. The triage nurse confirmed the study-first branch but noted that providers sometimes changed the pathway after reading the referral themselves, a variation left for the next round of observation.

Notes on the Map

The informal decision about patients who decline is worth naming. When a patient says they no longer want the visit, the scheduler sometimes closes the referral and sometimes leaves it open in case they call back, and the choice is not recorded. This means the queue count overstates active referrals. The distinction between observed and described steps matters because steps 8, 9, 11 through 14 and 21 rest on staff accounts. Workflow research recommends combining observation and interviews and checking one against the other where possible (Unertl et al., 2010), and the next stage of this work will observe the authorization coordinator for one morning. Finally, the map shows that the clinic's process involves at least five roles and two outside organizations. Human factors frameworks describe this kind of process as work shaped by the interaction of people, tasks, tools and organization across boundaries (Holden et al., 2013), which is why improvements aimed at one role alone tend to move the delay somewhere else.

References

Antonacci, G., Reed, J. E., Lennox, L., & Barlow, J. (2018). The use of process mapping in healthcare quality improvement projects. Health Services Management Research, 31(2), 74-84. https://doi.org/10.1177/0951484818770411

Holden, R. J., Carayon, P., Gurses, A. P., Hoonakker, P., Hundt, A. S., Ozok, A. A., & Rivera-Rodriguez, A. J. (2013). SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics, 56(11), 1669-1686. https://doi.org/10.1080/00140139.2013.838643

Unertl, K. M., Novak, L. L., Johnson, K. B., & Lorenzi, N. M. (2010). Traversing the many paths of workflow research: Developing a conceptual framework of workflow terminology through a systematic literature review. Journal of the American Medical Informatics Association, 17(3), 265-273. https://doi.org/10.1136/jamia.2010.004333