1. Process Mapping A W5 Approach T. Rollefstad QI Consultant Oct 14, 2003 A W5 Approach T. Rollefstad QI Consultant Oct 14, 2003

2. Objectives A W5 approach to process mapping w What is ‘Flow charting’ ? w When would this tool be used? w Who should be doing flow charts? w Where to start? w Why did we do this again?

3. Flow Charts… What? w Step-by-Step schematic pictures of a process w Boxes show the steps in the procedure arrows indicate the logical flow w Symbols have specific meanings to help understand the process

5. Flow Charts… What? Flowcharts can document: w Flow of information w Movement of a patient w Delivery of a service w Any combination of the above

6. When to Use this Tool? w Provide a Common Understanding w Identifying Root Causes w Defining Projects w Designing Remedy w Implementing w Holding the Gains

7. Types of Flow Charts Macro Flow Chart w Sometimes called a top down chart w Documents major steps - usually no more that 6 steps w Below each major step, list the major sub-steps Micro Flow Chart w Describes most/all of the steps w Level of detail dependant on ability to see problems on a higher level w Use sparingly w A ‘Drill’ tool into problem area of a process

8. Macro Flow Chart w Promotes focus on essential steps w Represents only useful work w Helps Identify what should happen w Faster/more efficient that detailed flowcharting w Used as quick overview of a new process/project

13. Micro Flow Charting w Includes detailed information re: every stage in process w Includes loops caused by rework w Can get lost- so define the level of detail required w Ensure all the players of the process are involved w May need to validate - peer review, TIM Study

18. Who should be doing Flow charts? w EVERYONE :) “How can you possibly improve something unless you know how it works?” w Include all those intimately involved in the process w Often helps ID those who should be on the team

19. Flow Chart Symbols

21. Where to Start? Tips for Flow Charting 1. Decide on level of detail up front 2. Get basic process down first 3. Chart the process the way it is now 4. Define boundaries 5. Use standard symbols - keep it simple 6. Should be only one output arrow - if more may need decision box

22. Where to Start? w Discuss intended use of flow diagram w Decide on desired outcome - ›what do we want to find out ›how detailed do we need to get ›Use a macro chart first ›zero in on specific area using micro chart PRN

23. Where to Start? w Define the boundaries of process w Document each step in sequence w Ask questions like: ›Does a decision need to be made? ›How many times does this occur? ›Does the next step involve waiting for anyone/anything? ›Do we really know or are we supposing?

24. Where to Start? w Use appropriate symbols w Draw process from top to bottom or left to right w Decision points - complete arms sequentially w Review completed chart w If unsure - Verify ›observe process directly ›interview knowledgeable persons ›Peer review

25. How’s your Brain so far?

26. Why did we do this again? Analysis Step 1: Examine Each Decision symbol Step 2: Examine Each Rework Loop Step 3: Examine Each Activity Symbol Step 4: Examine Each Document/Data symbol

27. Why did we do this again? Ask these questions: w Can it be standardized? w Does every step add value? w Is there duplication of work? w Is it possible to simplify? - forms, procedures w Can the time required to complete be reduced? w Is there accidental bureaucracy?

28. Flow Chart Analysis Practice Macro flow charts Micro flow charts Macro flow charts Micro flow charts

32. Questions? “The journey of a1000 miles begins with just one step” Tao “The journey of a1000 miles begins with just one step” Tao