Thursday, 13 November 2014

Healthcare Service Improvement

With a career spanning over 30 years in healthcare including front line work as an Occupational Therapist and more recently within Lead Service Improvement, Mary Duggan recalls the significance of mind mapping software within her role. Through her years of experience, Mary adapted her tools and approach in order to achieve a more productive and intuitive way of working. Recalling a particular moment in her career, Mary explains just how much mind mapping software revolutionised her role.

Every mind map tells a story 


Service improvement is generally seen as a systematic approach that walks people through the stages of assessment, diagnosis, problem definition and solution generation.  That's how we like to think about it anyway.  It is as comforting as the London Underground map - logical and straightforward to follow.  Many of us will recognise that it also bears as much relationship to the real world as the London Underground map does.  The process is a useful guide, but at some point you have to involve real people and real-life complex and messy situations.  Then the dissimilarities between the map and the territory begin to appear. 

Many years ago, I was working in a service for older people with mental health problems.  We were fairly sure that we could be using our resources more effectively.  As part of the initial assessment and diagnostic stage, I arranged to interview a group of men whose wives all had dementia and were receiving services from us.  I had a well-constructed question set all ready to go.  Within the first minute of the interview, it all started to fall apart.  I asked the first question.  One of the men replied "I'll tell you how it's been..." and began to tell the story of his experience.  I tried to draw him politely back to the question.  He ignored me equally politely and carried on with his story.  I bowed to the inevitable and listened carefully as he and his companions told me what it had been like to see their wives struggling more and more with everyday life and their experience of trying to get help.  As they ended their stories, I realised that they had answered all of my questions, naturally and eloquently.  Most importantly, they knew that their stories had been heard.

I wasn't using mind-mapping back then.  I had to spend a considerable length of time transcribing a tape recording of four men with very broad West Yorkshire accents.  Then I had to try to sort their answers into themes.  I got there eventually. 

Just a few weeks ago, I did some work with a team who were concerned about the end-to-end time that their referral to admission process took.  They provide a rehabilitation service for people who need longer-term support to regain their independence.  There was a general feeling that the process was lengthy and cumbersome.  The team had specifically requested support with some lean techniques.   

We had done some initial data exploration which seemed to be telling us that apart from a few outliers, the process generally took an acceptable length of time.  So what was the problem?  They wanted to map the process because there were aspects of it that they were still not happy about and wanted to find a way to articulate this.

I turned up to the next session, armed with huge sheets of paper and packs of sticky notes. They sat and regarded the blank paper thoughtfully.  Then they began to talk about the process and how they experienced it.  The conversation was free-flowing and divergent.  I already had my laptop connected to a projector, so I suggested that we used a mind-map rather than a process map.  This let them continue with their exploration of the issues with the added benefit of seeing the mind-map build up as they spoke.  They began to make some very interesting points about the underlying dynamics of the process of trying to find a good plan of care for individuals who may be quite chaotic and who certainly don't fit neatly into any pigeon-holes.  This can create significant levels of anxiety among the people who are trying to support them, and this anxiety easily rubs off onto processes.  The conversation moved away from “how can we speed up the process” to “how can we take some of the anxieties out of the process”.  This required a very different approach from eliminating waste and work-arounds from a process.  It helped the team realise that they needed to work on helping their stakeholders to understand the process, and that to do this they needed to use the right language to help people to understand the part they play in that process. 

Working with mind-maps is a great way to harness free-flowing conversations.  In my experience, this is usually the best place to start.  Then, having heard the underlying story, you are in a good position to select some more structured diagnostic tools.  You will be using your toolkit with precision and intentionality. 

It isn't difficult to create templates for many of your favourite diagnostic tools. If you check out the Problem Solving section in the built-in templates in MindGenius, you will find that there are some there already set up for you such as 5 whys, cause and effect and key questions.   

An added advantage of using a mind-map as your starting point for service improvement activities is that even at the earliest stage, you will find people identifying potential actions.  You are well aware of the dangers of leaping into solution generation before properly analysing the situation, but there is that natural human impulse to offer solutions.  Mind-mapping lets you have your cake and eat it.  You can create a dedicated branch in your map for actions.  After exploring the story of the situation and running some diagnostics, you will be able to see which of those actions are worth pursuing.  It's the work of seconds to then drop them into an action planning map.