Process Mapping in Healthcare: A Systematic Review

Abstract

Introduction Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare.Methods We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC–Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analyzed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach.Results The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward.PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N=105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterizing healthcare improvement interventions.Conclusion The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM.Prospero ID : CRD42017082140.

The use of process mapping in healthcare quality improvement projects

“…Although the informed and systematic use of PM in healthcare is advocated by researchers and practitioners, 29–32 it is not routinely used in improvement approaches within healthcare organizations. 31–34 Early findings from our systematic literature review 21 show that, despite the number of studies reporting on the use of PM in healthcare increasing during the last 10 years, there are still few examples of documented use of this tool in the healthcare sector.…”

“…Previous literature describes only isolated empirical implementations of PM in healthcare and the analysis of articles reviewed in our systematic literature review 21 shows that in most of these studies, the way in which PM exercises are conducted is poorly documented. 42,43 A few papers in the healthcare literature provide suggestions on how to conduct a PM exercise.…”

Improving the standardisation, timeliness and efficiency of the occupational therapy admission process in an older adult inpatient service

“…As well as being a systematic and robust tool, it helped us enhance engagement and teamwork by supporting a shared insight into OTY process in a logical way understood by the OTY team and wider stakeholders such the matron, heads of nursing and area service manager. [20][21][22] In this sense, it provided an opportunity for a multidisciplinary team to openly discuss the status of the process and coalesce around what needed to be done. The benefits of this tool and our approach meant that we were able to systematically understand the different contexts for the two wards described and all have a shared sense of what needed to be done and a shared purpose.…”