Operation Charting Forms

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					Flow Charting
MLC Grantee Meeting
March 20, 2009
 Jack Moran
 Senior Quality Advisor
 jmoran@phf.org
 T: 202-218-4423

…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     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
   Check/
            Do
   Study
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
  • 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
  • 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
         MapQuest               Flow Chart
 • Takes directions and   • Takes procedures and
   coverts them into a      converts them into a
   picture                  visual
 • Shows various routes   • Shows the routes
   to a destination         inputs travel to
 • Shows communities        become outputs
   you pass through to    • Shows handoffs
   reach a destination
Mapping
        MapQuest                 Flow Chart
 • Shows connecting       • Shows connecting
   roads                    processes
 • Shows faster and       • Highlights areas for
   slower routes            improvement
 • Provides alternative   • Triggers ideas to
   routes                   improve a process
Flow Chart Benefits
 • Creates a common vision
 • Establishes the “AS IS” baseline – Current
   State
 • Baseline to measure improvements
 • Identifies wasteful steps – activities/wait
Flow Chart Benefits
 •   Uncovers variations
 •   Shows where improvements could be made
 •   Show potential impacts of improvements
 •   Training tool
Types of Flow Charts

  • As Is – current state - baseline

   • Could Be – improved state –
                  transition

  • 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
 • 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 though it in real time
Flow Charting Steps

 • 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
 • 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
 • 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
 • Use common symbols
 • Use a form of Post-It Notes – easier
   to rearrange
 • Realize everyone is not doing it the
   same way – there will be
   disagreements
 • It will take multiple passes to get to
   the “As Is” State
                                             Flow Lines
Flow Chart Symbols
     Start/End              Manual
                                         A   Connector
     Bookends               Operation
                            Data Base
     Activity:                               Comment
     Operation/Inspection                    Collector
                            Wait/Delay
     Decision
                                             Display
                            Storage
      Input/
      Output                Transport         Manual
      Data                                    Input

     Document                Input
                                             Preparation

     Forms                   Output           Unfamiliar/
                                              Research
Olmsted County , MN – Performance Appraisal Process
Constructing a Flow Chart
  • Asking questions is the key to flow
    charting a process.
  • For this process:
    – Who is the customer(s)?
    – 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?
    – 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

 • 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
 • 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
    –   Suppliers - internal and external
    –   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:____________________
                                                     Ends With:

                  Constraints:
Begins With:



                 Process/Activities:
                                                       Measures of Effectiveness:




   Inputs:                              Outputs
                                        :




                                        Customers:
   Suppliers:
                                   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:

                               Constraints:         Funding, Priorities, Time                       Feedback of
Begins With:                                                                                        information
                                                                                                    effectively received
Tidbit of valid,
valuable info on
PH                            Process/Activities:
                                                                                                      Measures of Effectiveness:
                                                                                                      $$, support, outcomes,
                                 Current methods and channels to disseminate                          leadership,
                                 public health information to elected officials                       acknowledgement,
                                                                                                      recognition, policy or
                                                                                                      behavior change


   Inputs:                                                              Outputs      Information, tangible mechanism of
                                                                        :            information format, data (who, what,
                Data, supporting documentation,                                      when, where, why, how, etc), Policies
                policies and procedures, maps, health                                and Procedures.
                advisories, standards (filters for
                information), priority communications

                                                                        Customers:
   Suppliers:                                                                               Board of Advisors, residents,
                     CDC, community partners, state,                                        community, Mayor, community
                     local hospitals, PHD functions                                         leaders
Cautions
 In most processes:
   – Few people have seen the total process and fully
     understand the process
   – Departments are managed, processes are often
     unmanaged
   – 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

 • Flow Process Chart
 • Before and After Comparison Flow
   Chart
 • Work Flow Analysis Form
 • Others?
Before and After Comparison Flow Chart
Adding Time Lines
As Is Flow Chart          Could Be Flow Chart          Should Be Flow Chart

                   Time                         Time
Flow Chart Quality Improvement
  •   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:
  – 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
 • 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
 • 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     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
   Check/
            Do
   Study
Process Analysis Guide



                                                Recommended
                                     Pareto     Opportunities
                                     Critical
                           Root       Mass
                           Cause
               Identify   Analysis
    Detailed   Problem
     Flow       Areas
     Chart
More Resources
• 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

  • 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
  • Henry L. Gantt – WWI
    – 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

 • 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

 • Some Examples
% Complete
Progress Bar
Milestone Chart - shows only important project events or milestones:
         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




Task 1

Task 2

Task 3

Task 4

Task 5

Task 6

Task 7

Task 8

Task 9
Gantt Chart – Morning Routine
    Tasks                       AM Time Ending     Assign To:

                 6 6:10 6:20 6:30 6:40 6:50 7:00


    Wake Up                                         You

   Make Coffee                                       Coffee Maker

    Shower                                           You

    Dress                                             You

    Leave                                             You
Use Of Gantt Charts

• Establish order of tasks:
    – 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
•   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                     29-Feb       7-Mar       14-Mar   21-Mar   28-Mar



Finalize assessment analysis         X



Gain consensus on priorities         X



Identify comm. with elected off.     X



Plan PHF consultant visit                         X



Set agenda and travel schedule                                X



City HD/PHF PI meeting                                        X



                    On Schedule



        Watch



         Late or at Risk
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

				
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