Treatment mapping--a systematic methodology to assess quality, efficiency and variability in the hemodialysis delivery process.

Background/Aims: Radical thinking about the design of industrial processes has greatly improved the quality and efficiency of manufacturing and services. Applying similar methods in healthcare to deliver quality care at lower costs would be valuable. Methods: We have developed and validated a methodology – Treatment Mapping – to analyze the hemodialysis (HD) delivery as an operational process. Results: The methodology was well applicable in the 26 Gambro Healthcare clinics studied (Europe, Taiwan, USA). Monitor process, patient process and dialysis treatment times (mean ± SD) were 324.4 ± 46.0, 272.2 ± 34.5 and 221.6 ± 28.8 min, respectively. In general, significant variability in process cycle times was found in the clinics studied. Conclusion: HD delivery is a complex process influenced by patient characteristics, monitor/disposables design, staff skills and clinic practices and physical layout. The Treatment Mapping methodology is a useful tool to analyze the HD delivery from a process quality and process operational perspective.