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Scott D. Duncan, MD, MHA, FAAP. Science of Safety. We cannot improve quality and safety of healthcare until we view the everyday delivery of healthcare as a science. Flow Charts. “If you can’t describe what your doing as a process, you don’t know what you’re doing” W. Edwards Deming
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Science of Safety We cannot improve quality and safety of healthcare until we view the everyday delivery of healthcare as a science
Flow Charts “If you can’t describe what your doing as a process, you don’t know what you’re doing” W. Edwards Deming • A written description of a process requires a common definition of terms, fluency with the concepts, and the absence of an agenda by the author and reader.
"Draw a flowchart for whatever you are doing. Until you do, you do not fully understand what you are doing. You just have a job.“ "The first step in any organization is to draw a flow diagram to show how each component depends on others. Then everyone may understand what their job is. If people do not see the process, they cannot improve it."
SIPOC+CM SIPOC is a data collection form that is used before we start to construct a flow chart since it helps us to gather relevant information about the process. Assists in gathering information about Suppliers, Inputs, Process, Outputs, and Customer of the process. SIPOC is high level view of the “As Is” state of a process under investigation.
SIPOC+CM When to use it: When first starting to investigate a process and a team needs to understand the basics that make up the process. When a team needs a way to get the collective knowledge of the team members about a process recorded in an easy to view format. When we need to make a concise communication to others about a process and the parameters that it encompasses.
SIPOC+CM Collection Form Constraints: Ends With: Begins With: Process/Activities: Measures Outputs: Inputs: Customers: Suppliers:
Flow Charting Flow charting is the first step we take in understanding a process Organized combination of shapes, lines, and text Flow charts provide a visual illustration, a picture of the steps the process undergoes to complete it's assigned task From this graphic picture we can see a process and the elements comprising it Shows how interactions occur Makes the invisible visible
Flow Chart Benefits • Problem Identification • Generating Solutions • Test • Disseminate
Flow Chart Benefits • Puts a spotlight on waste • Streamlines work processes • Defines and standardizes the steps and sequence • Promotes deep understanding • Builds consensus • Key tool for continuous quality improvement
Flow Charting Construction Clearly define the process boundaries to be studied Define the first and last steps – start and end points Get the right people in the room Decide on the level of detail Complete the big picture first – macro view Fill in the details – micro view
Flow Charting Construction Gather information of how the process flows: Experience Observation Conversation Interviews Research Clearly define each step in the process Be accurate and honest
Flow Charting Steps Use the simplest symbols possible – Post-Its Make sure every loop has an escape There is usually only one output arrow out of a process box. Otherwise, it may require a decision diamond. Trial process flow – walk through people involved in the process to get their comments Make changes if necessary Identify time lags and non-value-adding steps.
Adding Time Lines Could Be Flow Chart Should Be Flow Chart As Is Flow Chart Time Time
Flow Chart Symbols Manual Operation Start/End Bookends A Connector Data Base Comment Collector Activity: Operation/Inspection Wait/Delay Decision Display Storage Input/ Output Data Manual Input Transport Document Input Preparation Forms Output Unfamiliar/ Research
Process Flow Chart Yes No Yes No Yes No
Analyzing A Flow Chart • Assessing the current process map with the goal of improving patient flow by looking for steps that: • Definitely add value • Add no value, but are unavoidable • Add no value, but are avoidable • Once completing a process map, return to the site and discuss it with employees to ensure its accuracy. Together, consider how the map could be used to make improvements to the system.
Analyzing A Flow Chart Examine each: Activity symbol – value/cost? Decision point – necessary/redundant? Choke Points – bottlenecks? Rework loop – time/cost? Handoff – is it seamless? Document or data point – useful? Wait or delay symbol – why?/reduce/eliminate Transport Symbol – time/cost/location? Data Input Symbol – right format/timely? Document/Form Symbol – needed/cost/value?
