SIPOC Matrix

Suppliers Input Process Output Customer

Who do the inputs to the process What "thing(s)" go into the Steps or tasks that utilize inputs What does the process Who receives the output of the
come from? process to generate the output? and generate output and are of generate? process?
value to the customer
Proper or personal noun (person, Noun (a "thing," which includes Should start with a verb Noun (a "thing," which includes Proper or personal noun (person,
group, or title) information). Should avoid verbs information). Should avoid verbs group, or title)
Patient ~ Vital signs Triage patients ~Early assessment Patient & Staff
~ Patient's story ~Vital signs
Patient ~ Questions about symptoms Assess patient (Nurse) ~ Symptoms Doctor
~ Possible causation ~ Family history
~ Family history ~ Vital signs
~ Vitals ~ What events may have triggered issue
according to patient

Patient, Insurance ~ Insurance card request Admit patient ~ Coverage for the patient Billing department &
~ Completed and signed admissions ~ Any signed liability & privacy documents Other staff that needs to communicate
paperwork ~ Any other critical information (billing with the patient at a later date
address, contact information, etc.)

Patient, Previous Nurses
~ Completed/signed admissions paperwork
~ verbal run-down of symptoms & vitals
~ symptoms & other important information
~ Doctor's specific questions and specific
follow-up questions
Assess patient (Doctor)
~ Nurses' detailed issue assessment Patient & Testing facility
~ Patient's detailed issue assessment
~ Doctor opinion
~ Additional paperwork
~ Patient answers to questions
~ Test request/orders & paperwork

Doctor, Patient ~ Test-request paperwork (fully complete) Run tests ~ Raw test results Doctor and patient
~ Test preparation instructions
~ Patient provides samples
Testing Facility Test Review test report ~ Diagnosis Doctor and patient
Doctor Test report Treat patient ~ Wellness for the patient Doctor and patient
Doctor, Patient Treatment Discharge patient ~ Discharge paperwork (complete with all Filing system clerk
information concerning visit and any Patient
followup needed)

726540523.xls
 SIPOC Matrix
Suppliers Input Defects Process Process Owner Output Defects Customer CTQ
Who do the inputs to the What goes into the process to What can be wrong with the inputs Steps or tasks that utilize inputs and generate Who is responsible for the What does the process generate? What can be wrong with the output? Who receives the output of What is important about the output to the
process come from? generate the output? going into the process? output and are of value to the customer process? the process? customer?
Proper or personal noun Noun (a "thing," which includes Should start with a verb (action Noun (a "thing," which includes Proper or personal noun
(person, group, or title) information). Should avoid verbs word) information) (person, group, or title)
Patient ~ Vital signs Wrong information Triage patients TBD ~Early assessment Missing or wrong information; test not ordered that Patient & Staff Assess the problem quickly. Keep in mind the
~ Patient's story ~Vital signs could have been ordered early in process to speed patient is feeling, " Be nice to me, I'm hurt or
up the process not feeling well."
Patient ~ Questions about symptoms ~ Unnecessary information Assess patient (Nurse) Head nurse ~ Symptoms ~ Patient explains symptoms poorly Doctor ~ Providing a proper diagnosis to the issue
~ Possible causation ~ Missing information ~ Family history ~ Patient leaving out important information in family ~ Limiting the amount of tests needed due to
~ Family history ~ Wrong information ~ Vital signs history due to improper questioning techniques complete understanding
~ Vitals ~ What events may have triggered ~ Vitals not taken properly ~ Not missing important tests
issue according to patient ~ Poorly described events leading to ~ Avoiding multiple visits or visits to other
misunderstanding by nurse(s) and/or doctor offices not needed

Patient, Insurance ~ Insurance card request ~ Patient does not have insurance
~ Completed and signed admissions card or information
paperwork ~ Insurance company is difficult to
work with
~ Patient does not have other critical
information
Admit patient Admitting supervisor ~ Coverage for the patient
~ Any signed liability & privacy
documents
~ Any other critical information (billing
address, contact information, etc.)
~ It is found that the patient's coverage has lapsed Billing department & ~ The customer is not billed for items that the
~ It is found that patient has a large deductable and Other staff that needs to insurance company should receive
must provide payment upfront and patient can't pay communicate with the ~ The insurance covers what should be
~ Incorrect billing information results in lost bills patient at a later date covered
~ Admitting cannot contact insurance company to ~ The customer is receives all important
confirm information communication in the future.

Patient, Previous Nurses ~ Completed/signed admissions paperwork
~ verbal run-down of symptoms & vitals
~ symptoms & other important information
~ Doctor's specific questions and specific
follow-up questions
~ Nurse passes incorrect information Assess patient (Doctor) Doctor in charge of ~ Nurses' detailed issue assessment ~ Paperwork filled out inproperly or incompletely Patient & Testing facility ~ Requested tests are the correct tests that
to the doctor department ~ Patient's detailed issue assessment ~ Incorrect assumptions made by previous nurses will determine core cause
~ Patient provides incorrect ~ Doctor opinion ~ POV of the patient negatively affects the doctor's ~ Avoiding unneeded tests
information or leaves out important ~ Additional paperwork ability to determine the core cause ~ Doctor providing a level of confidence to
information ~ Patient answers to questions the patient that the core cause is
~ Test request/orders & paperwork discoverable and treatable

Doctor, Patient ~ Test-request paperwork (fully ~ Test request is confusing or not Run tests Floor manager of testing ~ Raw test results ~Wrong data Doctor and patient ~ The test results are accurate
complete) specific enough facility ~ The proper tests were run
~ Test preparation instructions ~ Proper instructions are not given to ~ No tests are missing which would result in a
~ Patient provides samples the patient for preparation revisit or further waiting

Testing Facility Test ~Wrong results ~mixed Review test report Doctor ~ Diagnosis ~ Misdiagnosis Doctor and patient ~Diagnosis are accurate
up patient data ~Delay diagnosis ~Undiagnosis ~Patient symptoms diagnosed properly
~equipment failure ~Quickly get the result back to
Doctor Test report ~report sent to another facility Treat patient Doctor ~ Wellness for the patient ~Patient not given right treatment Doctor and patient patient
~The prescription filled out with label
~timeliness deadline not met ~Patient don't understand how to use treatment to information ~Doctor provide discuss
~result not ordered cure treatment with patient

Doctor, Patient Treatment ~wrong prescription Discharge patient Admitting supervisor ~ Discharge paperwork (complete with ~No follow up or treatment planning from Dr Filing system clerk ~Doctor explained follow up and discharge
~No consultation with Dr all information concerning visit and ~Patient don't understand discharge data Patient instructions
any followup needed) ~Thank patient for his/her visits and make
sure they are satisfied

726540523.xls