Process Flow Diagram Tutorial: High Level, Detailed & Swim Lane

OPQC Fall Learning Session QI Skills Lab

Map Your Process Moira Crowley, MD and Susan Ford, RN

Objective: Dr. Myron Tribus, an American organizational theorist has said, “You don’t learn to Process Map, you Process Map to learn.” In order to improve a process, you need to have a clear understanding of how it actually works. This session will examine the skills necessary to drill down into the steps of a process in order to improve

Process Flow Diagrams

• “ A flow diagram is one of the basic tools for improvement that gives a visual picture of a process being studied.” p. 410 *

* Langley, Gerald J., et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. San Francisco: Jossey-Bass, 2009. Print.

Process Maps are used to:

• Document processes – Provide a reference to discuss how things get done. – Describe and understand the work we do.

• Analyze and improve on processes.

– Identify of areas of complexity and re-work. – To generate ideas for improvement. – Illustrate process improvements.

Source: National Network of Public Health Institutes; http://nnphi.org/CMSuploads/MI-ProcessMappingOverview.pdf

Key Points A process is a series of steps or actions performed to

achieve a specific purpose.

A process can describe the way things get done. Process Map in the manner it currently is, not what you

would like the process to be.

Process Mapping is dynamic. Use Post-it notes, dry erase markers, pencil, etc.

All Process Maps must have start and stop points.


Usage for Process Maps

• There is no single right way to Process Map. It is a tool to learn about your organization and work.

• Process Maps can be used in a variety of settings outside Quality

Improvement, such as: – Orienting new employees – In-service presentations – Brainstorming possible process changes – Creating or revising policies and procedures that support the process – Creating measures – Identifying logical outcomes of a process


Steps to creating a flow map

1. Set boundaries on the process – Where does the process

start and stop?

2. Map the process – Who does the work?

• Who does what? • When? Where?

Why? How? – What type of process map

is most useful? • High level • Detailed • Swim lane

3. Check results – Get reactions of others – View the process in action

and compare to the process map

4. Take action – Are there obvious changes

that would improve the process?

– Fix obvious problems immediately

– Monitor any solutions to be certain they work

– Watch for side effects and unintended consequences

Commonly Used Shapes

Process Map for making a morning cup

of coffee • Let’s take a moment now to construct a

Process Map of the method that is used to make your morning cup of coffee…

Snapshot of Flow Diagram Tools

Step or Activity

Start/End points in the

process

Cloudy or Unclear Step or Activity

High-level flow diagrams. These are simple and facilitate understanding of the basic process. Three fundamental symbols work in any type of flow diagram: oval, cloud, and rectangle (see meaning below).They are joined using connectors, to illustrate the flow of activities through the process.

High Level Process Flow Diagrams

• Include: – 4-5 major “boxes” that summarize the main steps, inputs and

outputs. • Very Useful for:

– Understanding the process and determining team membership. Gaining quick group consensus about the process.

– Developing areas or indicators to be monitored for process information.

• Often Useful for: – Identifying who provides what to whom.

• Sometimes Useful for: – Searching for specific problem areas or steps that must often be

redone. – Redundant or unclear steps in a process.

Example: High Level Process Flow Diagram

Sometimes, the easiest way to get familiar with using a new tool is to practice with a process that is very common in your daily life. This simple, high level, diagram was created in about 1 minute, using “getting to work” as the process. This is a birds-eye-view of the major steps taken from wake up to arrival at the office.

Detailed Flow Diagrams are more time consuming and offer a more complex and comprehensive look at a process. In addition to the three fundamental shapes (ovals, clouds, rectangles), you can use the following to further organize steps:

Decision or

Branch point

Yes

No

Information into

Database

Wait or Bottleneck

Connector to another process

Detailed Process Flow Diagrams

• Include: – Decision points, waiting periods, tasks that must

be redone (rework), and feedback loops. • Very Useful for:

– Gaining group consensus about the process. – Finding areas where efficiencies can be gained. – Searching for specific problem areas or steps

that must often be redone. • Often Useful for:

– Developing areas or indicators to monitor for process information.

– Identifying who provides what to whom.

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Example: Detailed Process Flow Diagram Using the familiar process of “getting to work”, this

diagram details the more specific steps and

decisions that make up the process.

High Level Process Map

• Process map (high level) of how to obtain approval for a conference at a certain institution


Detailed Process Map

• Process map (detailed) of how to obtain approval for a conference at a certain institution


Swim Lane Process Flow Diagrams

• Include: – Steps, inputs and outputs, persons involved.

• Very Useful for – Gaining group consensus about the process. – Identifying who provides what to whom. – Allocating tasks. – Clarifying roles and responsibilities.

• Often Useful for – Understanding process and determining team membership. – Finding areas where efficiencies can be gained. – Searching for specific problem areas or steps that must

often be redone.

Example: Swim Lane Process Flow Diagram

Pre-visit Planning and Communication Process Flowchart –

PVP

Team

PVP

Co-o

rdPr

ovid

erFe

llow

IDs JIA patients

from schedule

Presents and treatment plan is determined

Review PVP prior to visit consider changes in plan;

initial

Request eye exam

PRNStarts PVP

Form

Completes assigned PVP Form using EHR data

Eye exam updated?

Return PVP Form to PVP

Coordinator

Completes eye exam request

form

Give PVP Form to Fellow

PGA > 4?

Complete second level review and

return PVP form to Coordinator

Take PVP form to weekly division

meeting

Give PVP form to provider

NO

YES

File PVP form making ready for

clinic dayNO

YES

Place PVP form in folder on clinic

day

Give PVP form to PVP Coord for filing

Questions to think about… • Are these the right Start/Stop steps?

• Based on this process map, could a new

person successfully perform this process?

• Where should more detail be included?

• What happens if this this person is gone or step is not successfully conducted ….? (anticipate variation)

• Is any “position” missing?

Once the process is mapped out… • Observe the process and edits map as necessary.

• Quickly get every position’s input until the map is

sufficiently accurate for improvement work .

• Use the process map to identify improvement opportunities (load leveling, gaps, redundancies, rework loops, waste, excess variation).

• Use final version of process map to support sustainment.

Time to map out YOUR process • Using a process would you like to improve in your

workplace, select one type of flow map.

• Write out EACH step of the process - as it currently exists - on the Post-It Notes.

• Arrange the steps in the correct order.

• Where are the areas where improvement could be made?

Thank you! Break from 2:15 – 2:25pm Snacks available in the Atrium Please return to the Ballroom for OB and Neonatal Specific Presentations starting at 2:25pm

Process Flow Diagram Tutorial: High Level, Detailed & Swim Lane

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