Developing a High-Level Process Map and Swim-Lane Diagram

Project RED (Re-Engineered Discharge) Training Program

Provides a four-module training program to help hospitals implement Project RED.

Developing a High-Level Process Map and Swim-Lane Diagram

Process mapping is a technique for making work visible. A process map shows who is doing what, with whom, when, and for how long.

It also shows:

  • Decisions.
  • Event sequences.
  • Inherent wait times or delays.

Process maps are good for streamlining work activities and telling new people, as well as internal and external audiences, what the organization does. The maps also can help prevent errors, reduce cycle time, avoid rework, and eliminate some inspections or quality control steps.

The process map is a horizontally aligned flow chart that maps a process from start to finish. A variety of shapes can be used in flow charting, but the most common ones are:

Graphic of a box

Boxes – Indicate activities, tasks, or steps.

Graphic of a diamond

Diamonds – Indicate decisions.

Graphic of an oval

Circles – Indicate start and end steps.

Graphic of an arrow

Arrows -- Connect activities, decisions, or start and end steps.

Steps in Creating a Process Map

  1. Assemble a team of no more than 12 employees who are very familiar with the process being mapped.
  2. Ensure at least one team member is not familiar with the process. This individual's questions will challenge the group to think through the rationale for why things are the way they are.
  3. Identify a facilitator who is neutral to the process and will facilitate discussion (as opposed to participating in the discussion).
  4. Agree as a group on the five to six high-level steps that occur within the process 80 percent of the time. For example, a doctor admits the patient and writes orders, care and treatment is provided, the discharge order is written, and the patient is discharged.
  5. Use basic flow chart symbols to map the process on a flip chart or on paper. Beginning and end steps are written inside circles, process steps are written inside squares, and decisions are written inside diamonds. Avoid using a computer to map processes because this medium can impede team members from seeing the process globally.
  6. Connect each activity with an arrow.
  7. Ask each discipline to discuss the subprocesses that occur in each step.
  8. Analyze the process map once it is complete.

Once the first draft of the process map is created, it will be important for the team to verify the map by “going and seeing” what actually happens; that is, they will “walk the walk.” Invariably, what team members think is happening in the process is inconsistent with what they will see during their walk. After the walk, the team will gather again to discuss the findings and refine the process map.

Creating a Swim Lanes Diagram

A Swim Lanes Diagram (or Cross-Functional Flow Map) is used to map work processes as they occur within an organization's functions, disciplines, or departments. The process improvement team discusses high-level process steps first, and then each team member is asked to document his or her own individual work steps within a swim lane.

As the performance improvement team compiles these detailed work steps, team members can begin to understand each others' work requirements and can see the process from patient's perspective. For example, using a Swim Lanes Diagram of the discharge process, it may become apparent that both a nurse and a physician assess the patient right after each another. The patient may become worried if he or she has to answer the same questions multiple times and may reasonably assume that the nurse and doctor are not communicating with one another.

To create a Swim Lanes Diagram:

  1. Assemble a team of no more than 12 employees who are who are very familiar with the process.
  2. Ensure at least one team member is not familiar with the process. This individual's questions will challenge the group to think through the rationale for why things are the way they are.
  3. Identify a facilitator who is neutral to the process and will facilitate discussion (as opposed to participating in the discussion).
  4. Think about the five to six high-level steps that occur within each individual's process 80 percent of the time. Each staff member focuses on his or her own work process and swim lane. For example, the physician may write that he or she admits the patient, writes orders, provides care and treatment, writes the discharge order, and discharges the patient.
  5. Use basic flow charting symbols to outline the process steps. Beginning and end steps are written inside circles, process steps are written inside squares, and decisions are written inside diamonds. Avoid using a computer for mapping swim lanes because this medium can impede team members from seeing the process globally.
  6. Connect each activity with an arrow, even if they cross swim lanes.
  7. Ask each discipline to discuss the subprocesses that occur in each step.
  8. Analyze the Swim Lane Diagram once it is completed.

Map and Diagram Analysis

The steps listed below will help you analyze your Process Map and Swim Lanes Diagram.

Look at each process step for:

  • Bottlenecks.
  • Sources of delay.
  • Errors that are being fixed instead of prevented (i.e., rework).
  • Role ambiguity.
  • Duplications.
  • Unnecessary steps.
  • Cycle time (i.e., the total time that it takes to start and end a process).

Look at each decision for:

  • Authority ambiguity (i.e., two or more people get to make a decision).
  • Relevance (i.e., if decisions are needed at that point).

Look at each rework loop to determine if steps can be eliminated, can be done in less time, or can be prevented.

Use the customer's point of view to determine value-added versus non-value-added steps.

Summary

Process mapping is a technique for making work visible. There is no right or wrong way to build a process map. The team exercise of building the map and seeing the process globally are the factors that are critical for success rather than what the actual map looks like in the end.

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Current as of August 2011
Internet Citation: Developing a High-Level Process Map and Swim-Lane Diagram: Project RED (Re-Engineered Discharge) Training Program. August 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/red/swimlane.html