Flow ChartingMLC Grantee Meeting March 20, 2009

…PHF Mission: Improving public health infrastructureand performance through innovative solutions and measurable results. 

Innovative Solutions. Measurable Results.

http://www.phf.org

Jack MoranSenior Quality Advisorjmoran@phf.orgT: 202-218-4423

Continuous Improvement

Act

DoCheck/Study

PlanThe continuous improvement phase of a process is how youMake a change in direction.The change usually is because the process output is deterioratingOr customer needs have changed

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

We should write that spot down

Flow Charting Is So Simple Even A Caveman Can Do It

Mapping

MapQuest• Takes directions and

coverts them into a picture

• Shows various routes to a destination

• Shows communities you pass through to reach a destination

Flow Chart• Takes procedures and

converts them into a visual

• Shows the routes inputs travel to become outputs

• Shows handoffs

Mapping

MapQuest• Shows connecting

roads• Shows faster and

slower routes• Provides alternative

routes

Flow Chart• Shows connecting

processes• Highlights areas for

improvement• Triggers ideas to

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

Activity:Operation/Inspection

Decision

Start/EndBookends

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 Chart Symbols

Activity:Operation/Inspection

Decision

Start/EndBookends

Document

Wait/Delay

Storage

Data Base

Transport

Input

Output

Flow Lines

A Connector

Forms

CommentCollector

Input/OutputData

ManualOperation

Preparation

ManualInput

Display

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

Process/Activities:

Begins With:

Ends With:

Inputs:

Suppliers:

Outputs:

Customers:

Constraints:

S I P O C+CM Collection FormProject Title:____________________

Measures of Effectiveness:

Process/Activities:

Begins With:

Ends With:

Inputs:

Suppliers:

Outputs:

Customers:

Constraints:

Tidbit of valid, valuable info on PH

Funding, Priorities, Time Feedback of information effectively received

Measures of Effectiveness:$$, support, outcomes, leadership, acknowledgement, recognition, policy or behavior change

Current methods and channels to disseminate public health information to elected officials

Data, supporting documentation, policies and procedures, maps, health advisories, standards (filters for information), priority communications

CDC, community partners, state, local hospitals, PHD functions

Information, tangible mechanism of information format, data (who, what, when, where, why, how, etc), Policies and Procedures.

Board of Advisors, residents, community, Mayor, community leaders

S I P O C+ CM Collection FormProject Title: Effectively and efficiently disseminate information about public health needs and priorities to elected officials

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 LinesAs 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 ChartExamine 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 OpportunitiesWhat 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

DoCheck/Study

PlanThe continuous improvement phase of a process is how youMake a change in direction.The change usually is because the process output is deterioratingOr customer needs have changed

Process Analysis Guide

Detailed Flow Chart

Identify Problem

Areas

Root Cause

Analysis

Pareto Critical

Mass

Recommended Opportunities

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

Make Coffee

Shower

Dress

Leave

You

Coffee Maker

You

You

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 APHAProgram

Integrating the Gantt Chart and the PDCA Cycle

Livingston County Department of Health – Accreditation Preparation Process

Livingston County Department of Health – Accreditation Preparation Process