JCI Quality & Safety Training

Program

Flowcharts and Process Maps

© Copyright, Joint Commission International

2018
 Objective
• Learn the value of mapping the current state
process
• Acquire knowledge and skill at constructing a
process map
• Gain skills in creating a detailed flowchart
• Understand the different variations of the
flowchart

© Copyright, Joint Commission International

2
 From Systems to Process Maps
Business Business
Development
Process
(“Strategic”)

Business
Sales Underwriting Contracting Customer Service
Processes

SIPOC S Terms Docs Neg Close C

Underwriters (ext.) Customers
(int.) Cust. Service Dept.

© Copyright, Joint Commission International

Detailed
Subprocess
Map
Tasks Procedures

Process Map
3
82
 Process Definitions

© Copyright, Joint Commission International

Definition of a Process
• A chain of interrelated activities with
specific inputs and tasks that constitute
a procedure, which has specific outputs

© Copyright, Joint Commission International

From www.ASQ.org

5
Definition of a Process
• A set of action steps:
➢ Each must be performed properly
– In the proper sequence
– on time
– Accurate
• Performed by owner of the process
• Actions that directly impact next customer in the
flow

© Copyright, Joint Commission International

• Two types of Customers of a process
➢ Primary: serves the patient in the flow
➢ Secondary: serves the staff in the flow

6
Types of Processes
➢ Value added processes are those that
actually deliver a service or product in way
that meets customer requirements (5-10%)

➢ Support processes are those that are

needed to enable the primary value-added
processes to run, but are not directly involved
in satisfying customers ( 35%)

© Copyright, Joint Commission International

➢ Non-value added processes are those which
do not add value to customer and are not
required by primary processes (55-60%)
7
Process Mapping

“The benefit of process mapping is

that it provides a shared
understanding among those
involved in the process of the
steps in the process, its

© Copyright, Joint Commission International

nature, and what it is
intended to produce”
8
WHAT is a Process Map?
• A visual description or diagram of the steps and
flows of a process

• A picture of the separate steps of a process in

sequential order.
• Use of common, recognized symbols to illustrate
the actual path of a process or what the ideal

© Copyright, Joint Commission International

path should be

9
Definitions and terminology

• Process Chart: first used in 1921

• Flowchart
• Process Map

© Copyright, Joint Commission International

10
WHAT is a Process Map?
• Elements that may be included in a map
are:
➢sequence of actions
➢materials or services entering or leaving
(inputs and outputs),
➢decisions

© Copyright, Joint Commission International

➢people involved
➢time at each step
➢process measurements.
11
Quality Toolbox, 2nd Ed
WHY do Process Mapping?
• Increase the overall awareness of individual roles,
responsibilities, and effort

• Evaluate the overall efficiency and appropriateness of

the process

• Improve the understanding and communication about

the process

© Copyright, Joint Commission International

• Capture the knowledge of staff who do the work

• Generate ideas for improvement

12
WHEN to do Process Mapping?
A process map should be done to:
• Identify a complete picture of the total process

• Train new employees on specific procedures

• Plan a project
➢ Redesign a flawed process

© Copyright, Joint Commission International

➢ Design a new system and processes

13
WHEN to do Process Mapping?
A process map should be done to:
• Identify time constraints

• Define relationships with various stakeholders

• Understand the movement of patients or staff

throughout a process

© Copyright, Joint Commission International

14
All Start with a High Level Map

Flow Chart

High
Level Process
Horizontal Map
Map
Value

© Copyright, Joint Commission International

Stream
Map

15
Steps in Creating a High Level Map
Step 1: Identify the process
Step 2: Scope the process. Where does a process
begin? End?
Step 3: Describe process tasks, inputs and
outputs.
Step 4: Draw sequential steps in process with
directional flow arrows.

© Copyright, Joint Commission International

Step 5: Check for Completeness.
Step 6: Finalize the map

16
Group Exercise
• Going to Work

• Start: Waking Up
• End: Entering Building

• Identify:

© Copyright, Joint Commission International

➢Steps? Decisions?

17
From Systems to Process Maps
Step 1: Identify the Process

Systems

MACRO
Processes Processes Processes PROCESS

© Copyright, Joint Commission International

MICRO
Process 1 Process 2 Process 3 PROCESS
Tasks
Tasks

Tasks 18
 From Systems to Process Maps
Step 1: Identify the Process
Business Business
Development
Process
(“Strategic”)

Business
Sales Underwriting Contracting Customer Service
Processes

SIPOC S Terms Docs Neg Close C

Underwriters (ext.) Customers

© Copyright, Joint Commission International

(int.) Cust. Service Dept.

Value Stream Map

Detailed
Subprocess
Map
Tasks Procedures

Process Map 19
82
Scope the Process
Step 2
• First, define the purpose or problem that
needs to be solved or improved

• Identify the process directly related to the

problem

© Copyright, Joint Commission International

• Identify where the process begins and ends

20
 Scope a Process
In and Out Selection

18
21

© Copyright, Joint Commission International

Identify Steps in Process
Step 3
• Always collect the information by walking the
entire pathway to get a sense of flow and
sequence of processes
“WALKING THE GEMBA”
• Begin at the point of providing the service to
the customer and walk up steam

© Copyright, Joint Commission International

• Document each step and related tasks, the
input for each step and the handoff or
output of each step

22
Draw the Process Map
Step 4
• Map while you walk; observe and
document.

• As you draw think of other information

to gather.

© Copyright, Joint Commission International

• The point of mapping is not the map, but
understanding the process and related
flow
23
Remember!

The shared experience of a group

working to create a map is equally
if not more important than the final
map itself.

© Copyright, Joint Commission International

24
Check for Completeness
Step 5
• Draw the final map on flip chart paper
and post on wall

• Have the team review for accuracy and

completeness

© Copyright, Joint Commission International

• Ensure input from frontline staff who
are the process owners

25
Tools for Drawing a Map

• Flip Chart
• Mapping Symbols
• Process Analysis Tool
• Software Application (optional)

© Copyright, Joint Commission International

26
A High Level Macro Process Map -

Horizontal Flowchart

COM
TRA
ORDER MUN VERIF ADMINI
ICAT REVIEW PREP NSP
MED ORT Y STER
E

© Copyright, Joint Commission International

Remember!! Use Nouns to Describe Process Steps

27
High Level Sedation Map
JCI ASC.3 – 3.2
#1 Pre- #2 Intra- #3 Post-
Procedure Procedure Procedure
Care Care Care

© Copyright, Joint Commission International

#5
#4 Staff Performance #6 Policy
Qualifications Adverse Procedure
Event (locations)
Monitoring

MACRO PROCESSES 28
 High Level –
Medication Administration Map
#3
#1 Order #2 Storage, Preparation
Dispensing

© Copyright, Joint Commission International

#6
#5 #4
Monitoring
Monitoring Administration
Errors
Patient

MACRO PROCESSES 29
High Level – Hospital Care Map
Patient Patient
registered with Dx
Patient
Receive Diagnose Treat patient
referred to
patient patient medically
Hospital

Patient Patient
treated discharged
Discharge Follow-up Patient
patient patient Treatment

© Copyright, Joint Commission International

completed

MACRO PROCESSES

30
High Level – Hospital Care Map
Patient Patient
registered with Dx
Patient
referred to Receive Diagnose Treat patient
Hospital patient patient medically
Register/
Interview
update
pt
data

Take Update
initial med TOP DOWN
samples record
TASKS DESCRIPTIONS
Give pt
relevant Inform
tour patient

© Copyright, Joint Commission International

Patient Patient
treated discharged Patient
Discharge Follow-up
Treatment
patient patient completed

MACRO PROCESSES 31
Process Statistics
• Addition of statistics to the mapping exercise
helps focus the improvement efforts
• Statistics provide important information about
the actual flow through the process and about
the efficiency at different points in the process
➢ Cycle time of a process step
➢ Waiting time between process steps

© Copyright, Joint Commission International

➢ Utilization and TAKT time
➢ Throughput yield
However, do not overload mapping with
statistics so that the map is still readable.
32
 Detailed Flowchart

33

© Copyright, Joint Commission International

Detailed Flowcharts
• This is a popular tool for those working
in quality management

• This is a simple map depicting the

relationship between activities in an
individual process

© Copyright, Joint Commission International

• Directional flow is determined by
decision points in the process
3437
Detailed Flowcharts
• Start by drawing a high-level map from the beginning to
the end, identifying each of the process steps

• Brainstorm the process steps between the starting and

ending process steps

• Have a discussion on the specific tasks related to each

process step

© Copyright, Joint Commission International

• Discuss the critical decision points that altered the flow
of the basic flowchart

35
Detailed Flow Charts
• Design the flowchart, placing:
➢Each activity in a box (square or rectangle)
➢Each decision in a diamond
➢Ovals or circles for the start and stop points
➢Connecting arrows indicating the flow
➢If there is more than one "output" arrow

© Copyright, Joint Commission International

from an activity box, it probably requires a
decision diamond

36
Symbols Used in Flowcharts
Start / End

Process Step

No
Decision

© Copyright, Joint Commission International

Yes

Connector A

37
Symbols Used in Flowcharts
Direction of
Flow

Delay, Wait

Input,

© Copyright, Joint Commission International

Output

38
Define the Start and End Points

Pharmacy
Receives
Order

Physician order
Transported to
pharmacy
Patient receives
Medications

© Copyright, Joint Commission International

in pharmacy

Patient
Receives
medications
39
Define the Processes Between the
Start and End Points
Physician Order Pharmacy Patient
Orders Sent to Reviews, Administered
medications pharmacy Prepares, medication
dispenses

© Copyright, Joint Commission International

40
Define the Processes Between the
Start and End Points
Order Pharmacy
Physician Nurse
Sent to Reviews,
Orders Transcribes
pharmacy Prepares,
medications Order
dispenses
to Mar

Nurse
Administers Nurse
medications Verifies

© Copyright, Joint Commission International

medication
With order
and patient
Patient identification
Administered
medications
41
 Levels of Flowcharts
MACRO MINI MICRO
Turn on
Start Start computer

Start word
proc. apply.
Draft Get rough
POD draft of POD
Is
rough in No
word proc.
Type
rough POD
Type apply.
POD Is it No ?
Get
approved approval Yes
?
Edit POD
Distribute
POD Yes

© Copyright, Joint Commission International

Are
Type there any Yes Make
smooth corrections corrections
End ?
No
End
Print POD

42
Flowchart Analysis
• Analyze the flowchart, looking for process
"glitches": inefficiencies, omissions/gaps,
redundancies, barriers, etc.

• Also look for the smooth parts of the process

to use as models or "best practices" for
improvement

© Copyright, Joint Commission International

• Decide whether to correct steps within the
current process, design a new process, or do
corrections first, then redesign in the future
43
Flowchart Analysis
• Examine each process step
Bottlenecks? Poorly defined steps?
Ineffective sequence? Delays? Weak links
• Examine each decision symbol
Can this step be eliminated?
• Examine each rework loop

© Copyright, Joint Commission International

Can it be shortened or eliminated
• Examine each activity symbol
Does the step add value for the end-user?

44
Why are Decision Points Important

• They clarify different processes and

roles in the journey

• They often delay, interrupt, and change

flow

© Copyright, Joint Commission International

• They identify duplication of effort

45
Other Types of Process Maps

➢Top-down flowchart
➢Swim lane Diagram
(deployment flowchart)
➢Value Stream Mapping
➢Spaghetti diagram (workflow

© Copyright, Joint Commission International

diagram)

46
 Top-down flowchart

47

© Copyright, Joint Commission International

 Swim
Lanes

48

© Copyright, Joint Commission International

Process Mapping
Final Recommendations
• Organizations should select one or two types of
process maps and train staff to effectively use
these techniques

• Each map should have a clearly identifiable start

and end points and a series of logical sequenced
processes that flow from start to the end

© Copyright, Joint Commission International

• There are a number of processes in real life that
are inherently complex and often do not have a
straightforward sequential activities
49
 Group Exercises

50

© Copyright, Joint Commission International

 Questions

51

© Copyright, Joint Commission International

 ‫شكرا‬

52

© Copyright, Joint Commission International