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Practice Facilitation Handbook
Module 5 Appendix
Table of Contents
A Guide on Workflow Mapping
Contents
Slide 1. A Guide on Workflow Mapping
Slide 2. Learning Objectives
Slide 3. Workflow Mapping
Slide 4. Use for Workflow Maps
Slide 5. Types of Flowcharts
Slide 6. Common Symbols
Slide 7. What it Looks Like. Example: The Process of Buying a Box of Cereal.
Slide 8. What it Looks Like. Example: The Process of Buying a Box of Cereal
Slide 9. What it Looks Like. Example: The Process of Buying a Box of Cereal
Slide 10. Flowchart of Previsit Work and Appointment Scrubbing
Slide 11. Who is Involved?
Slide 12. The 6-Step Process
Slide 13. Know Your Process Template
Slide 14. Impact and Complexity Grid
Slide 15. Scheduling PCP Follow-up Appointments for Patients Prior to Hospital Discharge
Slide 16. How To Analyze My Map
Slide 17. Tips on Mapping
Slide 18. Workflow Mapping Exercise
Slide 19. Questions to Ask
Slide 20. In Conclusion
Slide 21. Remember
Slide 22. Thank You!
Slide 1. A Guide on Workflow Mapping
LA Net Community Health Resource Network
A Practice-Based Resource Network
Slide 2. Learning Objectives
- Identify the three types of flowcharts.
- Explain the use for flowcharts.
- Apply the six steps used to produce a flowchart.
- Evaluate an organizational process using your flowchart.
Slide 3. Workflow Mapping
- Workflow maps are also referred to as flowcharts, flow maps, flow diagrams, flow sheets, and process maps.
- A workflow map is defined as a visual representation of a process.
- A process considers a sequence of operations with a start and end point.
Image of a hand drawing a flowchart.
Slide 4. Use for Workflow Maps
- To map current practice flow.
- Are we really doing what we say we do?
- Begin to identify areas for process improvement.
- Visual aid and representation of roles and responsibilities.
- Add on to an organization’s policies and procedures.
- Process maintenance.
Slide 5. Types of Flowcharts
- High-level flowchart: is a diagram that provides a brief overview of a process only highlighting major events in the process.
- Detailed flowchart: is a map that marks every step in a process, which includes decision points, waiting periods, and feedback loops.
- Swimlane flowchart: is a map that displays processes carried out for multiple roles across multiple stages.
Slide 6. Common Symbols
Oval → Start/End
Rectangle→ Operation
Diamond → Decision
Pentagon → Delay
Arrow → Direction
Oblong → Connection
Slide 7. What it Looks Like.
Example: The Process of Buying a Box of Cereal
High-Level Flowchart
Diagram of steps to buy cereal: Arrive at the grocery store, walk to the cereal aisle, pick up a box of cereal, walk to cashier with cereal, pay for the box of cereal.
Detailed Flowchart
Diagram of steps to buy cereal: Arrive at the grocery store, walk to the cereal aisle, decide on cereal (Corn Flakes or Honey Oats), pick up a box, walk to cashier with cereal (if Honey Oats, give cashier coupon), pay for the box of cereal.
Slide 8. What it Looks Like.
Example: The Process of Buying a Box of Cereal
Swimlane Map
Detailed flowchart showing the activities of the customer and cashier. Customer arrives at the grocery store, walks to the cereal aisle, decides on cereal (Corn Flakes or Honey Oats, picks up a box of the chosen cereal, walks to the cashier with the cereal, and places the box on the belt. For Honey Oats, the customer gives the cashier a coupon and cash. For Corn Flakes, the customer gives the cashier cash.
Slide 9. What it Looks Like.
Example: The Process of Buying a Box of Cereal
Swimlane Map
The cashier’s process starts when the customer places the box on the belt. The cashier takes the box from the belt, scans the box code, states the final price, receives cash and coupon, and gives customer change. The “swimlanes” link the customer placing the box on the belt to the cashier taking the box and link the customer giving the cashier cash to the cashier receiving cash.
Slide 10. Flowchart of Previsit Work and Appointment Scrubbing
Detailed flowchart of Previsit Work and Appointment Scrubbing.
This is an example of what is referred to as a “swim lane map.” A swim lane map displays processes that are carried out for multiple roles across multiple stages. Each swim lane is representative of a role, in this case: PCP, Clerk, LVN. The stretch of each lane is marked by the stages in the process. Here they are marked in the following order: 1) Appointment list review, 2) Appointment status, 3) Scrubbing.
Slide 11. Who is Involved?
Involve all those who play a part in the process.
Tips:
- Start with a small group if it’s a challenge to start with the entire group.
- Pick a champion for this group.
- Be sure to have all materials on-hand.
- Provide the team with an overview of what the mapping process looks like.
- Clearly state the objective and process selected for this exercise.
Slide 12. The 6-Step Process
Step 1: Identify a process to map (use the Know Your Process template).
Step 2: Begin with a high-level flowchart.
Step 3: Move into a detailed flowchart.
Step 4: Walk through the process once or twice.
Step 5: Validate the maps to ensure they truly reflect the current process.
Step 6: Identify quick fixes and distinguish them from larger fixes (use LA Net’s Impact & Complexity Grid).
(REMEMBER: A flowchart captures the process AS IS, not how it is supposed to be)
Slide 13. Know Your Process Template
Worksheet to rate core and supporting processes. The first column of this table lists Processes (e.g., Answering phones, Messaging, Billing/Coding). The rest of the columns are for staff to rate the processes (works well, not a problem, small problem, real problem, totally broken, cannot rate, we’re working on it, source of patient complaint). This worksheet should be used to identify areas for improvement. Each process should be flowcharted and possible improvements explored.
Slide 14. Impact and Complexity Grid
- Build Complexity:
- Low Complexity/High Impact.
- Low Complexity/Low Impact.
- Next Stage:
- High Complexity/High Impact.
- Avoid Option #4:
- High Complexity/Low Impact.
| Low Impact | High Impact | |
|---|---|---|
| High Complexity | High Complexity/Low Impact (Option #4) |
High Complexity/High Impact (Option #3) |
| Low Complexity | Low Complexity/Low Impact (Option #2) |
Low Complexity/High Impact (Option #1) |
Slide 15. Scheduling PCP Follow-up Appointments for Patients Prior to Hospital Discharge
Detailed flowchart moving from resident writing discharge note through resident getting information about follow-up appointment. If no appointment info, patient given discharge instructions without follow-up appointment. If follow-up appointment info, patient given discharge instructions with follow-up appointment. The chart notes various steps and decision points, such as whether the attending wrote a note with follow-up appointment in it.
Slide 16. How To Analyze My Map
You can use your process map to assess problem areas or potential areas for improvement by examining some of the following:
- Bottlenecks and other sources of delay.
- Rework due to errors.
- Role ambiguity.
- Duplicated efforts.
- Unnecessary steps.
- Sources of waste.
- Variation.
- Hand-offs.
Slide 17. Tips on Mapping
- Be sure to map current process.
- Get key players involved and their input.
- Recognize that any flowchart will take multiple attempts to complete.
- Leverage existing experts and experiences.
Slide 18. Workflow Mapping Exercise
- Break into groups of 5 to 6
- Be sure to have:
- Poster board paper.
- Post-its (or 5x6 index cards).
- Marker.
- Pick a leader and a scribe
- Ground rules:
- State process: Making coffee.
- Define beginning and end points.
- Assumptions: you already have coffee, a coffee pot, and you do not have a Keurig.
Slide 19. Questions To Ask
- Who knows what a workflow map is?
- Who has experience in workflow mapping?
- Did you consider your start and end points? What were they and how did your team come to this conclusion?
- How did you deal with process agreements/disagreements?
- Did everyone have input? If not, why?
Slide 20. In Conclusion
- The 3 types of flowcharts include: High-level, Detailed, and Swimlane flowcharts.
- Flowcharts are used to map current processes, identify barriers and opportunities to increase efficiency, and to train newly hired staff of a process.
- There are 6 major steps in mapping a flowchart.
- There are a series of questions that need to be discussed after you develop your map that ask about repetition, role maximization, and decision points.
Slide 21. Remember
Workflow maps serve as a tool to improve care for patients, improve efficiency in practice, and redistribute work and job responsibilities.
Cartoon of a complicated flowchart of workflow design. Two women are looking at it and one points to the bottom box and says, "And this is where our ED workflow redesign team went insane."
Slide 22. Thank You!
LA Net Community Health Resource Network
3940-B East Broadway, Long Beach, CA 90803
Phone: 562.434.2000
www.lanetpbrn.net
Page originally created June 2013