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Root Cause Analysis: Using flow charts to understand complex processes

Root Cause Analysis: Using flow charts to understand complex processes. Why flowchart?. A flowchart is a visual aid to help map complex workflows. Flowcharts help to: Understand actual work processes, as compared to policies or “official” workflows

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Root Cause Analysis: Using flow charts to understand complex processes

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  1. Root Cause Analysis: Using flow charts to understand complex processes

  2. Why flowchart? A flowchart is a visual aid to help map complex workflows. Flowcharts help to: Understand actual work processes, as compared to policies or “official” workflows Identify conflicting perspectives on workflows, especially where processes are handed off from one stakeholder to another Identify inefficiencies, redundancies, gaps, and likely breakdowns in the processes or system

  3. Order is received from health facility Flowchart Basics Warehouse staff pick items to fill the order Start and end points Are the requested supplies available? Each step in the process Three basic shapes are used to plot a flow chart: • Decision point yes Order is packed at the warehouse no Order status recorded in warehouse log

  4. Incorporating Multiple Perspectives For complex processes, like a national supply chain system, one person will probably not know the whole system from the beginning to the end, and never would one single person be involved at all steps of the process. Finding all the involved parties in order to understand every step in detail can be difficult and time consuming.

  5. Using Flowcharts in Project Planning In supply chain management, understanding both inbound (request/ordering) and outbound (delivery) logistics is crucial to the project. The following simple steps provide a guide for using flowcharts to formulate a project work plan, using the Tanzanian medical supply chain as an example.

  6. Step 1. Understand the overall work flow Each of these organizations has its own workflow Start by identifying the organizational structure or departments involved in the process. For example, in Tanzania, medication was going from the central Medical Stores Department (MSD), to District Medical Offices (DMO) and to health facilities. MSD Zonal Warehouse DMO Hospital Health center Dispensary

  7. Every 3 months Compare ledgers in all departments Step 2: Map the detailed work process Determine stock on hand Determine consumption in past 3 months Estimate order Complete ILS Order Form After identifying the involved departments or organizations, map the detailed work process of each of these groups. For example, this is a flow chart for the medication ordering process at a health center. Review the details of each step, and the documents and personnel involved. Also make sure the end of one step links up with the beginning of the next step for a reliable handoff. Adjust order according to budget Deliver to DMO pharmacist DMO approval Submit order to MSD for processing

  8. Every 3 months Step 3: What can a flow chart tell you? Compare ledgers in all departments Determine stock on hand What about supplies needed during a stockout? Determine consumption in past 3 months Estimate order A well-plotted flowchart enables you to see if redundancy or inadequacy exist in the process. Complete ILS Order Form What is the method for determining what gets cut? Adjust order according to budget Deliver to DMO pharmacist These gaps and questions suggest avenues for possible interventions. DMO approval Submit order to MSD for processing

  9. Every 3 months Compare ledgers in all departments Step 4: What is NOT evident in a flow chart? Determine the discrepancy between the actual need and the amount consumed Determine stock on hand Determine consumption in past 3 months Estimate order The flowchart may highlight the breakdown, but it does not indicate severity or frequency. Next step: formulate your work plan to continue to fill in gaps in your root cause analysis. Complete ILS Order Form Determine the discrepancy between the amount ordered and what the budget allowed Adjust order according to budget Deliver to DMO pharmacist DMO approval Submit order to MSD for processing

  10. In summary, flowcharts can… Help you understand complex processes Bring together perspectives across units or departments Identify breakdowns and redundancies Highlight possible interventions Shape further questioning during the root cause analysis

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