Visual process maps to support implementation efforts: a case example
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(2020) 1:105
Implementation Science Communications
SHORT REPORT
Open Access
Visual process maps to support implementation efforts: a case example Jennifer Kononowech1* , Zach Landis-Lewis2, Joan Carpenter3,4, Mary Ersek3,4, Robert Hogikyan5, Cari Levy6,7, Ciaran Phibbs8,9, Winifred Scott8 and Anne E. Sales1,2
Abstract Background: Process mapping is often used in quality improvement work to examine current processes and workflow and to identify areas to intervene to improve quality. Our objective in this paper is to describe process maps as a visual means of understanding modifiable behaviors and activities, in this case example to ensure that goals of care conversations are part of admitting a veteran in long-term care settings. Methods: We completed site visits to 6 VA nursing homes and reviewed their current admission processes. We conducted interviews to document behaviors and activities that occur when a veteran is referred to a long-term care setting, during admission, and during mandatory VA reassessments. We created visualizations of the data using process mapping approaches. Process maps for each site were created to document the admission activities for each VA nursing home and were reviewed by the research team to identify consistencies across sites and to identify potential opportunities for implementing goals of care conversations. Results: We identified five consistent behaviors that take place when a veteran is referred and admitted in longterm care. These behaviors are assessing, discussing, decision-making, documenting, and re-assessing. Conclusions: Based on the process maps, it seems feasible that the LST note and order template could be completed along with other routine assessment processes. However, this will require more robust multi-disciplinary collaboration among both prescribing and non-prescribing health care providers. Completing the LST template during the current admission process would increase the likelihood that the template is completed in a timely manner, potentially alleviate the perceived time burden, and help with the provision of veteran-centered care. Keywords: Long-term care, Goals of Care conversations, Process maps
Background Process mapping or visualization is an important approach to understanding how behaviors and activities need to change to support implementation of new practices [1–3]. We provide a brief case study illustrating approaches to making visual process maps to support implementation efforts. Our case example focuses on the implementation of goals of care conversations in * Correspondence: [email protected] 1 Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA Full list of author information is available at the end of the article
long-term care settings in the Veterans Health Administration in the USA. More detail on the case example is given in Additional file 1, including the background of the initiative as well as the context of the implementation work. We also described the
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