Transcript Flowcharting Presentation

Using Flowcharting
to Improve
Inefficiencies
Marsha Moxley, RN, BSN, MA, CPHQ
February 10, 2010
10:15-11:45 AM
Learning Objectives
By the end of this session, participants will be able to:
1.
2.
3.
Identify the three most common shapes
used to develop a flowchart.
List three different types of flowcharts.
Describe the reason for utilizing
flowcharting to understand the basic
concept of process management.
When Should you Use
Flowcharting?

To gain knowledge & understanding of how the
actual system works versus
ideal system

To identify redundant steps in a system
to improve performance

To reduce variation and eliminate waste
to improve the quality & cost of care
delivery
Purpose of Flowchart
A flowchart is a picture of the steps
(processes) within a system.
Flowcharts are utilized to examine the
relation and sequence of steps: to identify
redundancy, unnecessary complexity,
inefficiencies and to create a common
understanding of the flow of a system
"Flow Chart" is a Snap Shot of
your Business Processes.

You can tell a lot about the complexity (and often
over-complexity) of many business processes
just by looking at an as-is flow chart of them without even reading the text in the symbols.

You can easily see the flow of information and
materials, branches in the process, opportunities
for infinite loops, the number of process steps,
inter-departmental operations, and more.
What is the Difference between a
Process and a System?

Process: a series of actions that lead toward a
particular result

System: regularly interacting or interdependent
group of items forming a unified whole.
Methodical in procedural of plan
Definitions from Webster’s New Collegiate Dictionary
Usefulness of Flowcharts
In process improvement, flowcharts are
often used to clarify how a process/system
is being performed or to agree how it should
be performed.
Assists in standardization of systems as a
graphical format for procedures and to assist
in training of procedures.
Flowcharting Symbols
Oval: Represents Start or Stop
of process/system. The ovals are
the boundaries.
Rectangle: Activity Step (s) of
a process.
Diamond: Decision Points in
process flow. Form a question.
Each decision should have a “yes”
or “no path.
Flowcharting Symbols
2
Small Circle: Represents connections
in process flow. More than one column
or more than one page.
Triangle: A step where there is waiting
or storage occurs.
Example: Admission/discharge waits
Arrow: A step where product (or a patient)
is being transported.
Example: To Therapy or Dialysis
If you don’t involve the user,
you will develop the wrong
system.
Brian Joiner
Steps to Develop a Flowchart
1.
Decide on the system to flowchart.
2.
Define the beginning and ending steps
of the system.
(These are known as the boundaries)
Steps to Develop a Flowchart…
continued
3. Describe the beginning of the system
with an oval.
(When developing a flowchart, steps can be written on Post-it
notes so that the actions can be reordered easily)
4.
Ask “What Happens Next”?, each
subsequent process step will be in a
rectangle shape.
Steps to Develop a Flowchart…
Continued
5. When a decision step occurs, use a diamond shape for
the questions. Write yes / no and develop a path for
each.
( Make sure each decision loop reenters the system or is
pursued to a conclusion)
6. Describe the ending step in an oval.
Sometimes, due to the branching at decision points,
a system may have more than one ending boundary,
especially when it is a complex “super’ system.
Things are the way they
are simply because that
got that way….
It’s always been done that way….
Examples of the
Various Types of
Flowcharts
Common Names for Flowcharts:
Process Flow Chart
 Process Map
 Process Chart
 Business Process Model
 Process Model
 Process Flow Diagram
 Work Flow Diagram
 Business Flow Diagram

Top Down Flowchart
Step 1: Plan
To Write AHCA
Application
1.1
1.2
1.3
1.4
Assess if eligible to apply
Review AHCA Application
Attend Workshop
ETC……
Step 2: Organize
/assign Roles &
set deadlines
2.1 Copy of application to team
2.2 Assign sections for content
experts
2.3 Set deadlines for completion
2.4 Review data, decide improvements
2.5 Assign graphs – review options
2.6 Assign 1 writer
2.7 Assign reviewer for English,
sentence structure and grammar
2.8 ETC…….
Step 3: Submit
the darn
3.1 Get Final clean copy
from writer
3.2 Credit card approval
3.3 Submit on-line
3.4 Go out and celebrate!
Workflow Diagrams - Before
Workflow Diagrams - After
Alarm
Goes
Off
Go back to Sleep
A
Can I hit
the snooze
button?
Blow Dry Hair
Get OOB & turn off alarm
Let the Dog Out
Decide what to wear
Any
special
meeting?
Take A Shower
Start Coffee
Get dressed & put on jewelry
Turn on TV & listen to News
Apply makeup
A
1
Change would
be easy if it
weren’t for all
the people
Risk Identification/Prevention
New Admission/Re-admission
YES
Complete 24hr Admission Assessment
1. Skin assessment to be 1st section completed
2. Compare assessment findings to risk factors on IPOC.
Is pressure ulcer present?
YES
NO
NO
Assess change in risk status by weekly skin
assessments, change of condition, etc.
*See below change of condition criteria
Pressure Ulcer Flow Diagram
1. Discuss risks with resident and
family/Risk brochures
2. Implement immediate
interventions.
3. Develop individualized care
plan.
Pressure ulcer identified from admission skin
assessment/weekly skin assessment/observation.
Implement resident specific interventions immediately:
•
Specialty mattress/pressure reduction mattress
on bed
•
Pressure reduction cushion in wheelchair
•
Treatment as ordered
•
Individualized repositioning
*See Pressure Ulcer Guideline and IPOC
Plan of Care/Communication
Treatment: Actions/Steps
Initiate IPOC – BE565 and place individual resident interventions
and mark problems/risk factors
Notify physician and document notification
Notify family and document notification
Print new treatment order and place on Treatment Administration
Record (TAR)
Notify:
Initiate BE598C – Pressure Ulcer Report and document initial
assessment of pressure area including:
• Location and staging
• Size (length x width/depth) presence and location of
undermining and tunneling
• Edudate/if present” type, color, odor, and approximate amounts
•Pain/if present: nature and frequency
•Wound bed: color & type of tissue/character including/character
including evidence of healing (granulation) or necrosis (slough
and eschar).
•Description of would edges and surrounding tissue
• Dietary
• Activities
• Social Services
*Change of Condition criteria: May include the following:
•Bed Mobility Problem
•Bedfast
•Bowel incontinence
•Previous Ulcer
•Skin desensitized to pain or pressure
•Daily Restraint
Input MD order/treatment into Vista Keane system
Reassess, re-evalute and revise interventions when progress is not
note within 14 days.
Flowchart Resolution
National Patient Safety
Foundation’s (NPSF) Philosophy
Most errors are a result from faulty
Systems rather than human error, e.g.,
poorly designed processes that put people
in situations where errors are more likely to
Be made. Those people are in essence
“set up” to make errors for which they are
not truly responsible”.
Let’s Give It A Try!
Developing Flowchart Tips

Use post-its & sharpies /markers (Visible)

Doesn’t have to be in a meeting room go to Nursing Station and put each process
on a post-it note

Use flipchart paper / ability to switch steps easily

Ask those that work in the system to validate the
flowchart is accurate versus ideal
Common Questions to ask the
User of the System?

“What do you do first?”

“What happens next?”

“Is it always that way?” “Does it ALWAYS work
this way?”

“Do you sometimes do something else?”

“Is there ever any problems you experience
because of lack of training or supplies or
equipment?”
Case Study / Group Exercise
Instructions:
•
Flowchart a Falls
System
2.
Decide Who Will
Debrief To All
3.
Have Some Fun!
Flowcharting Software
Word /PowerPoint/Excel draw function
 www.Smart.draw.com
 www.breezetree.com
 www.edrawsoft.com
 www.springcape.com

“Google” Flowcharting and you will be
amazed!
References
www.Smart.draw.com
 www.breezetree.com
 Webster’s New Collegiate Dictionary
 The Team Handbook, Joiner, 5th Ed.,
2001
 Root Cause Analysis: Simplified Tools and
Techniques, Bjorn Anderson, Tom
Iagerhaug, Milwaukee, WS, ASQ Quality
Press, 2000.

Questions?
Thank you!
Marsha Moxley
Cell: 407-247-8814