Flowcharting

Flowcharting is the method used to determine how a process works by requiring an intense look at the current process, breaking down each step, and asking whether or not this step can be improved or deleted.

When a flowchart is created and a process is improved, the flowchart may be used to teach new staff members, many of whom are visual learners, how the process should be carried out. Posting the flowchart in areas where process steps occur allows for frequent visualization and reduces the possibility that variation will occur.

1. Define the boundaries of the process, where you will start and where you will end, and then begin to map the process. Mapping requires you to identify the big steps within a process, thereby directing you to the individuals needed to help create the more detailed version. This is the aerial view. For example, flowchart illustrating the triage process from the time a patient enters the ED until the patient's initial ECG may look like this:

   

   These are the "big" steps in the triage process. Many steps occur in each big step and this is where the flowcharting begins.

2. Gather together the right people. The people who work with the process are essential to help define the process. By interviewing the different people involved, you may find that the process is done differently by different staff members and during different shifts, weekends, and after hours. Variations in carrying out each task will be important to know going forth when process improvements are to be implemented.

   Remember, a flowchart is a graphic representation of a process from beginning to end. Certain symbols are used to designate the steps of the process as they occur sequentially. For the purpose of accreditation, only eight basic symbols are necessary:

3. Use flowcharting symbols to represent each step within the flowchart by building off of the block diagram.

   	Rectangle, designating an activity or activities
   	Diamond, designating a decision that must be made
   	Circle, designating an on-page reference
   	Five-sided "home plate," designating an off-page reference
   	Oval, designating the start or end of a process
   	Arrow, connects symbols and indicates directionality
   	Delay, designating a delay in the process
   	Document, designating a document created in the process

   The following illustration is an example of a flowchart of the process of EMS responding to a 911 call through delivery of the patient to the ED , using many of the symbols listed above.

   

4. 4.When completed, the flowchart should reviewed by others involved in the process who may not have been part of its creation. Observe the process while comparing what you see with what is on paper. When you are sure the flowchart is accurate and the process itself is being done in a consistent manner, you can begin to think about ways to improve the flow. Always keep in mind that if flowcharting properly, there will be many drafts before a final product is reached. Additionally, in the true spirit of process improvement, even when completed the process itself should be continually critiqued for better and more efficient ways to perform the task. This will, of course, result in continual flowcharting changes.