1. PROCESS MAPPING - FLOWCHARTS OVERVIEW © 2008 – Jesse Whiddon – All rights reserved

2. Process Flowcharts Shows the basic work flow pathway drawn according to supplier/customer relationships. Provides a “snapshot” picture of the process which provides a clear understanding of inputs, pathways, action or decision points and ultimately completion. It can serve as an instruction manual or a tool for facilitating detailed analysis and optimization of workflow and service delivery.

3. Patient arrives with requisitions and is instructed to sign in. Patient is called into the drawing room. Review requisition for accurate patient demographics with patient Patient name, DOB, insurance okay and complete? Is requisition hand written or electronic? Make minor corrections on the handwritten requisitions Clinic corrects problem, patient comes back and must start process over Patient is sent back to the clinic for corrections on electronic requisitions Are hand-written tests legible? Call clinic office for verification of illegible tests that have been ordered Are you sure of specimen requirements? Go into outside lab database for specimen requirements Collect appropriate specimens PATIENT BLOODWORK PREPARATION FOR SURGERY PROCESS FLOWCHART N Y Y N N Y

4. Basic Flowchart Symbols Process Alternate Process Decision Terminator

5. Swim-lane Flowcharts A flowchart that focuses on the “who” in “who does what”. Shows who or what function is responsible for each step in the process…

6. Swim-lane Flowcharts Good at showing the handoffs between functions, groups, departments, etc. Especially good with administrative (service) processes. Very good at showing how delays, mistakes and cheating are most likely to occur.

7. SWIM-LANE FLOWCHART – COMPLAINT HANDLING CUSTOMER Submits Complaint (Samples?) to Quality Dept. at the Plant Investigates and Sends to Proc. Mgr. Writes Customer Response, Seeks Approval Investigates for Root Cause, Sends back to Quality Approval SALES QUALITY LABORATORY PROCESS MGR Yes No Sends to Sales, Distribute Copies Sends to Customer and Makes Phone Contact Yes Receives Response Contacts Sales STAFF MGR PLANT MGR Tests Samples, if needed

8. SWIM-LANE FLOWCHART – MAMMOGRAM PRIOR TO HOSPITAL ADMISSION General Practitioner Patient Radiology Surgeon Hospital Pathology Radiological Oncologist Medical Oncologist Appt Phys- ical Mamm ogram Phys- ical Appt Mamm ogram Dev- elop Send Recv Con- sult Appt Con- sult Sched Orders Con- sult

9. Transportation & Spaghetti Diagrams Diagrams that show the physical flow of work or material. Used to improve the physical layout of a work space.

10. Transportation & Spaghetti Diagrams Desk Test Station 1Test Station 2 Test Station 3 Door Hallway 1 2 3 4 5 6 1.Delivers Specimen 2.Picks up specimen 3.Returns and logs in base info 4.Carries specimen to test station 1, runs test 5.Carries specimen to test station 2, runs test 6.Carries specimen to test station 3, runs test & disposes. 7.Returns to enter test results. 7

11. Value Added Task It is an activity that is important to the patient so that the patient is willing to pay for it or it is absolutely essential to conduct business. People often confuse activity with value- added work. It changes what is being processed..

12. Value-added Task It is done right the first time with no waste or rework. It is value-added or it is waste (non-value added)

13. Value from the Patients Perspective Short or no wait time Timely reports Good and timely decisions Good outcomes Courtesy Reasonable costs Etc.

14. Value Process Flowcharts Similar to the basic process flowchart but incorporates symbols that identify value and non-value tasks. Are used to identify and then eliminate or reduce waste and to help improve value tasks.

15. To hospital Wait in waiting room (20 min) Admission by clerk (12 min) Wait (1 hour) To exam room (3 min) History & exam by nurse (20 min) To blood drawing room (2 min) Draw blood (5 min) To holding area (3 min) Blood to labChanges into gown (2 min) Test bloodWait (5 to 10 min) Blood work report to ORPrepping (5 to 25 min)Clean up & instrument removal (5 min) Hold blood work reportWait (10 min)To recovery room (PACU) (3 min) Surgery team pullsPremedication (15 min)Recovery (1 to 3 hours) To OR (2 min)To hospital room (5 min) Wait for blood work? (0 to 30 min) Nurse checks Id/ lab data (3 min) Anesthesiologist prep (10 min) Surgery (1 hour) Blood work flow Patient flow PRESENT STATE VALUE FLOWCHART

16. Value Flowchart Symbols Operation Transport Handle Inspect Delay Decide Store

17. To hospital Admission by clerk (3 min) History & exam by nurse (10 min) Draw blood (5 min) Changes into gown (2 min) Blood to labPrepping (5 to 25 min) Test bloodPremedication (15 min) Blood work report to ORNurse checks Id/ lab data (3 min) Anesthesiologist prep (10 min) Surgery (1 hour) Clean up & instrument removal (5 min) Recovery (1 to 2 hours) To hospital room (5 min) Blood work flow Patient flow IDEAL STATE VALUE FLOWCHART

18. To hospital Wait in waiting room (5 min) Admission by clerk (3 min) To blood drawing room (2 min) Draw blood (5 min) Wait (30 min) Blood to labTo exam room (3 min) Test bloodHistory & exam by nurse (10 min) Blood work report to ORTo holding area (3 min) Hold blood work reportChanges into gown (2 min) Pull when neededWait (5 to 10 min) Prepping (5 to 25 min)Clean up & instrument removal (5 min) Premedication (15 min)To recovery room (PACU) (3 min) To OR (2 min)Recovery (1 to 2 hours) Nurse checks Id/ lab data (3 min)To hospital room (5 min) Anesthesiologist prep (10 min) Surgery (1 hour) FUTURE STATE VALUE FLOWCHART # 1