Implementing Surgical Process Maps to Improve Patient Safety

Erin Sherer, Ed.D, PA-C, RD

AASPA President Elect

Article originally printed in Sutureline: Nov/Dec 2017 pg. 11

Surgery is often performed to save a patient’s life or improve the quality of that patient’s life. And, while these goals seem straightforward, there are many factors that impact whether or not they will be achieved. For example, surgeons and surgical physician assistants (PAs) are constantly concerned about reducing complications of the surgery, reducing infection rates, and getting the patient in and out of the operating room in a timely manner. These are concerns because all of these factors can impact patient safety and patient care outcomes.

To improve patient safety in surgery, process maps have been created. A process map can be explained as “a workflow diagram to bring forth a clearer understanding of a process or series of parallel processes” (Ahoy, 1999). Process maps are frequently used in business and management settings to help “help characterize the functional relationships between various inputs and outputs” and can “reveal areas where a process should be improved” (Lucidchart, 2017). These process maps often involve quantitative analysis to better understand the activities involved. In the surgical setting, process maps have been created to reduce infection rates and to reduce operating room delays, thus improving safety, and efficiency.


 A study published in 2010 focused on improving efficiency in the surgical suite (Cima et al., 2013). The authors applied Lean and Six Sigma methodologies to increase efficiency by creating a process map of the entire surgical process from the decision to operate to patient discharge. The study found that the use of process maps increased operating room efficiency and financial performance across an entire operating suite.

Another study that supported the use of process maps in the surgical setting was published in 2014 (Simon and Canacari). The authors of this study sought to improve operating room efficiency in a large academic hospital. A team of leaders within the hospital worked on creating process maps. Their goals included, “developing a safe, effective, patient-centered, timely, efficient, and accurate orthopedic scheduling process; smoothing the schedule so that block time was allocated more evenly; and ensuring correct site/side” (p. 147). The authors found that the process maps “reduced the occurrence of site/side discrepancies to zero, reduced instances of changing the sequence of orthopedic procedures by 70%, and increased patient satisfaction” (p. 147).

Most recently, a study focused on reducing surgical infections in low and middle income countries applied the concept of process mapping. Forrester et al, 2017, developed “Clean Cut” which is a checklist that aims to improve compliance with perioperative infection prevention standards, to decrease surgical infectious complications. The Clean Cut process map included the following infection prevention standards: hand and surgical site decontamination; maintenance of a sterile field (integrity of gowns, drapes, and gloves); confirmation of instrument sterility; prophylactic antibiotic administration; surgical gauze tracking; and checklist compliance. The study was conducted at a pilot site in Ethiopia and the authors found that the process map significantly improved hand-washing rates and the timing of prophylactic antibiotics. The authors concluded that “simplifying these process maps into an adaptable tool could be a powerful means for improving safe surgery delivery in low and middle income countries” (p. S101).

As technology continues to improve our ability to perform basic tasks, it is no secret that surgical processes will be evaluated and improved. Process mapping is just one way in which surgical procedures and systems can be streamlined. As clinicians, we must continue to support research in this area as it can lead to improvements in patient safety.



  1. Ahoy, C. (1999). Process mapping. Facilities News. Retrieved from
  2. Cima, R., Dankbar, E., Lovely, J., Pendlimari, R., Aronhalt, K., Nehring, S., ... & Team, C. S. S. I. R. (2013). Colorectal surgery surgical site infection reduction program: a national surgical quality improvement program–driven multidisciplinary single-institution experience. Journal of the American College of Surgeons, 216(1), 23-33.
  3. Forrester, J., Koritsanszky, L. A., Hailu, M. M., Amenu, D., Haynes, A. B., Berry, W., ... & Weiser, T. G. (2017). Developing Operating System Process Maps for Surgical Infection Prevention: A Tool to Improve Perioperative Standards in Low-and Middle-Income Countries. Journal of the American College of Surgeons, 225(4), S101.
  4. Lucidchart (2017). What is process mapping? Retrieved from
  5. Simon, R. W., & Canacari, E. G. (2014). Surgical scheduling: a lean approach to process improvement. AORN journal, 99(1), 147-159.