Transcript Flow Charting
Flow Charting MLC Grantee Meeting March 20, 2009
Jack Moran Senior Quality Advisor [email protected]
T: 202-218-4423
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PHF Mission: Improving public health infrastructure and performance through innovative solutions and measurable results.
http://www.phf.org
Innovative Solutions. Measurable Results.
Continuous Improvement
Act Check/ Study Plan
The continuous improvement phase of a process is how you Make a change in direction.
The change usually is because the process output is deteriorating Or customer needs have changed
Do
Quick Check Of Your Enthusiasm Level & Mathematical Skills
“If you can't describe what you are doing as a process, you don't know what you're doing.”
W. Edwards Deming
Flow Charting
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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
Flow Charting
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From this visual picture we can see a process and the elements comprising it Shows how interactions occur Makes the invisible visible
Flow Charting Is So Simple Even A Caveman Can Do It
We should write that spot down
Mapping
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MapQuest Takes directions and coverts them into a picture Shows various routes to a destination Shows communities you pass through to reach a destination
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Flow Chart Takes procedures and converts them into a visual Shows the routes inputs travel to become outputs Shows handoffs
Mapping
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MapQuest Shows connecting roads Shows faster and slower routes Provides alternative routes
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Flow Chart Shows connecting processes Highlights areas for improvement Triggers ideas to improve a process
Flow Chart Benefits
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Creates a common vision Establishes the “AS IS” baseline – Current State Baseline to measure improvements Identifies wasteful steps – activities/wait
Flow Chart Benefits
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Uncovers variations Shows where improvements could be made Show potential impacts of improvements Training tool
Types of Flow Charts
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As Is – current state - baseline
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Could Be – improved state – transition
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Should Be – optimal state
Flow Chart Exercises
Basic Flow Chart Symbols
Start/End Bookends Activity: Operation/Inspection Decision Wait/Delay Flow Lines
Flow Charting Construction
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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
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Complete the big picture first – macro view
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Fill in the details – micro view
Flow Charting Construction
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Gather information of how the process flows:
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Experience
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Observation
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Conversation Interviews Research Clearly define each step in the process
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Be accurate and honest
Flow Charting Steps
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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 though it in real time
Flow Charting Steps
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Circulate the flowchart to other people involved in the process to get their comments Make changes if necessary Identify time lags and non-value-adding steps.
Flow Chart Construction
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There is no one right way to develop a flowchart, but the following guidelines provide a general structure: Start with a simple one-line description or title of the process being flowcharted , e.g., "How to..." Using a top-down hierarchy, start with an oval symbol named Start.
Flow Chart Construction
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Connect each successive action step in the logical sequence of events. Reference detailed information through annotations or connectors. Follow the process through to completion, denoted by an oval symbol named End
Flow Chart Construction
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Use common symbols Use a form of Post-It Notes – easier to rearrange
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Realize everyone is not doing it the same way – there will be disagreements
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It will take multiple passes to get to the “As Is” State
Flow Chart Symbols
Start/End Bookends Manual Operation Data Base Activity: Operation/Inspection Wait/Delay Decision Storage Input/ Output Data Transport Document Input Forms Output A Flow Lines Connector Comment Collector Display Manual Input Preparation Unfamiliar/ Research
Olmsted County , MN – Performance Appraisal Process
Constructing a Flow Chart
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Asking questions is the key to flow charting a process.
For this process:
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Who is the customer(s)?
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Who is the supplier(s) ?
What is the first thing that happens? What is the next thing that happens?
Where does the input(s) to the process come from?
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How does the input(s) get to the process? Where does the output(s) of this operation go? Is their anything else that must be done at this point?
SIPOC + CM
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A High level Process Map Helps in developing the “As Is” State Defines knowns from unknowns Shows gaps in QI Team’s knowledge of a process
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Focuses data gathering activities
High Level S I P O C+ CM Collection Form A Form to identify all relevant elements of a process before starting a flow chart
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Suppliers - internal and external
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Inputs Process - activities Outputs – service provided Customers – internal and external + Constraints – facing the system or process + Measures - being used or to be used
S I P O C+CM Collection Form Project Title:____________________ Constraints: Begins With: Process/Activities: Ends With: Measures of Effectiveness : Inputs: Suppliers: : Outputs Customers:
S I P O C+ CM Collection Form Project Title: Effectively and efficiently disseminate information about public health needs and priorities to elected officials Ends With: Begins With: Tidbit of valid, valuable info on PH Constraints: Process/Activities: Funding, Priorities, Time Feedback of information effectively received Current methods and channels to disseminate public health information to elected officials Measures of Effectiveness: $$, support, outcomes, leadership, acknowledgement, recognition, policy or behavior change Inputs: Data, supporting documentation, policies and procedures, maps, health advisories, standards (filters for information), priority communications : Outputs Information, tangible mechanism of information format, data (who, what, when, where, why, how, etc), Policies and Procedures.
Customers: Suppliers: CDC, community partners, state, local hospitals, PHD functions Board of Advisors, residents, community, Mayor, community leaders
Cautions
In most processes:
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Few people have seen the total process and fully understand the process
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Departments are managed, processes are often unmanaged
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Those that designed the process are no longer there Work is being done that adds no value to customers Work the customer needs isn’t being done Rework is built into the process Inefficiencies are built into the process Workarounds have been developed that make the process appear to be working better than it really is
Flow Charting Forms
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Flow Process Chart Before and After Comparison Flow Chart Work Flow Analysis Form Others?
Before and After Comparison Flow Chart
Adding Time Lines
Could Be Flow Chart As Is Flow Chart Time Time Should Be Flow Chart
Flow Chart Quality Improvement
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Analyze the “As Is” flow chart Look for Critical Processes Look for Handoffs Analyze with a Cause and Effect Diagram Develop potential solutions Develop the “Should Be” state Communicate all changes Track implementation progress Document results Present results
Analyzing A Flow Chart
Examine each:
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Activity symbol – value/cost? Decision point – necessary/redundant?
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?
Improvement Opportunities
What to look for on a Flow Chart: – – – – – – – – – – Duplication of effort Unnecessary Activities/Steps/Tasks Delays/Waits Transports Storage Illogical Sequencing of Activities Unclear Lines of Responsibility Opportunities for Error Supplier Error Opportunities Disconnects
Improvement Opportunities
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Use a Cause and Effect Diagram to investigate areas identified on the “As Is” flow chart as areas that could be improved Can complete a micro level flow chart on specific process steps as required Fix the low hanging fruit first – quick success Involve customer/suppliers before any changes are made
How Improvements Are Made
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Standardizing – all the same Automating – if possible – Timing?
Eliminating – unnecessary steps/waste Combining/Rearranging – parts/steps Simplifying – reducing complexity Changing – people/place/sequence Reducing – storage/transports/rework
Continuous Improvement
Act Check/ Study Plan
The continuous improvement phase of a process is how you Make a change in direction.
The change usually is because the process output is deteriorating Or customer needs have changed
Do
Process Analysis Guide Detailed Flow Chart Identify Problem Areas Root Cause Analysis Pareto Critical Mass Recommended Opportunities
More Resources
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Online QI Training – access course through TRAIN by searching for course ID #1014545 www.train.org
Public Health Infrastructure Resource Center www.phf.org/infrastructure/ Public Health Memory Jogger II PHF QI Learning Series Catalog www.phf.org/pmqi/PHF_QI_Learning_Series_082008.
pdf Public Health Quality Improvement Handbook, Quality Press, American Society of Quality, Spring 2009
Gantt Chart
MLC Grantee Meeting March 20, 2009
History
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The first Gantt Chart was developed by Karol Adamiecki, who called it a
Harmonogram
Because Adamiecki did not publish his chart until 1931, this famous chart bears Henry Gantt's name (1861 –1919) designed his chart in 1910
Wikipedia, the free encyclopedia
Gantt Chart
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Henry L. Gantt – WWI
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Franklin Arsenal 1910 Progress Chart Work planned and accomplished are shown in the same space Emphasizes work movement through time Deals with plans and progress Helps identify and eliminate obstacles
Gantt Charts
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A Gantt chart is a matrix diagram The vertical axis lists all the tasks to be performed for a project Each row contains a single task identification The horizontal axis is headed by columns indicating estimated task duration in hours, days, weeks, months, etc.
Gantt Charts
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Some Examples
% Complete
Progress Bar
Milestone Chart - shows only important project events or milestones:
Task 1 Task 2 Task 3 Task 4 Task 5 Task 6 Task 7 Task 8 Task 9 4/5 4/12 4/19 4/26 5/3 5/10 5/17 5/24 5/31 6/7 6/14 6/21 6/28
Gantt Chart – Morning Routine
AM Time Ending Tasks Assign To: 6 6:10 6:20 6:30 6:40 6:50 7:00 Wake Up Make Coffee You Coffee Maker You Shower Dress Leave You You
Use Of Gantt Charts
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Establish order of tasks:
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Sequential and Parallel Identify resources requirements Timing of resource needs Identify the critical path Monitor the project “On-Time” Schedule Alerts where remedial action is required
Benefits Of Gantt Charts
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Overview of all the tasks Identifies major milestones Easy to review with top management Guidance – suppose to be here now Alerts to problem areas Measurement of progress Summary document when project is finished Training tools for future projects
Some Examples
Traffic Light Gantt Chart
Task: City of XYZ HD
Finalize assessment analysis Gain consensus on priorities Identify comm. with elected off.
Plan PHF consultant visit Set agenda and travel schedule City HD/PHF PI meeting On Schedule Watch Late or at Risk X X X 29-Feb X 7-Mar X X 14-Mar 21-Mar 28-Mar
2008 APHA Program
Integrating the Gantt Chart and the PDCA Cycle
Livingston County Department of Health – Accreditation Preparation Process
Livingston County Department of Health – Accreditation Preparation Process