Process Mapping With Times, Process Measures, and Labor Costs

We are aware of the story of Japan’s quality revolution after the postwar teachings of Dr W. Edwards Deming. But what motivated the Japanese business leaders and engineers to embrace his teaching and eventually create many products superior to those made in the United States? At every lecture in Japan, Dr Deming would draw on the board a diagram titled “Production as a System” (Fig 1). Later, he would tell his audience, “The flow diagram shown was the spark that in 1950 and onward turned Japan around. It displayed to top management and to engineers a system of production. The Japanese had knowledge, great knowledge, but it was in bits and pieces, uncoordinated. This flow diagram directed their knowledge and efforts into a system of production, geared to the market—namely, prediction of needs of customers.” In health care, we seem to lack an understanding of the processes as part of the “systemof care,” and lack a clear definition of the role of clinicians for improvement, a framework to align the work of clinicians, metrics needed for reporting, and the ability to hear the voice of our patients. This article aims to describe a framework of health care as a system, tools that can help understand the processes that make up that system, a method to identify the roles each member of the health-care system plays in process improvement, and, finally, a means of providing labor cost. MD Anderson Cancer Center has a diagram called “Cancer Care as a System” to guide the improvement work (Fig 2). This emulates the diagram Dr Deming used in Japan. Based on this diagram, the core process of care is the target of an endeavor called “Clinical Process Analysis,” in which a clinical team helps each center create its own process flowcharts.