Process Improvement Toolbox

How to Flowchart

Flowcharts force an organizational focus on process.

Flowcharting is useful for:

  • Providing a starting point/baseline view
  • Understanding the process
  • Identifying key problems/bottlenecks
  • Showing where to test ideas for most impact
  • Stimulating thinking - results in brilliant ideas
  • Adding interactivity and fun - gets the team together
  • Creating a simple and succinct visual process overview

Creating a simple flowchart for access

  • Flowchart the steps that a typical client follows from initial contact (phone, walk-in, or referral) to the first clinical treatment session or admission to a bed. At this point, try to avoid any special circumstances that occur infrequently.
  • Draw the flowchart from top to bottom and number each box – this makes it easier to talk about the flow and refer to specific steps. To provide guidance, we have included a sample flowchart Add to portal with 27 numbered boxes on two pages. This is the most we expect – 20 to 30 steps and two to three pages. (Resist getting into more detail.) Note that the attached flowchart was drawn using textboxes and arrows in Microsoft Word – see tip below.
  • On the attached template, list any data collection forms that are used in your process. Identify where on the flowchart the form is used (refer to corresponding box number) and record what is done with it.

Tip: If you choose to use MS Word to create your flowchart, before adding any textboxes, hit "enter" multiple times until the cursor has moved down two or three pages. The pages will remain blank. If you don't do this initially, it is more difficult to add boxes later.

Group Flowcharting

To begin the flowcharting process, the organization should schedule a “flowcharting event” or often referred to as group flowcharting. Table 1 outlines steps for successful group flowcharting. The first step in planning a flowchart event is to define the objectives (e.g. see all clients within 24 hours). This step is best accomplished by meeting with clinical and managerial leaders to discuss objectives, identify participants, etc.; be sure to include opinion leaders.

Flowcharting Steps
Step 1 Define objective (e.g., see all clients within 24 hours)
Step 2 Define process (e.g., admission process)
Step 3 Define first and last steps
Step 4
Quiet Time 1		 Have each person write down process steps on yellow Post-it notes
Step 5 Have everyone place their yellow Post-it notes on wall paper to create a flowchart. Encourage those who finish this step quickly to read what others are placing on the wall paper.
Step 6 Review flowchart
Step 7
Quiet Time 2		 Have each person use red Post-its to identify and record bottlenecks and blue Post-its to describe suggestions for process improvements
Step 8 Place blue and red Post-its on flowchart
Step 9 Review suggested changes
Step 10
Quiet Time 3		 Ask each participant to pick the three changes that offer the best combination of ease of implementation and impact on objective
Step 11 Conduct multi-vote to select changes to initially pilot test
Step 12 Discuss next steps

The event is a group exercise where up to 25 participants, who regularly participate in an identified process, create a flowchart of a process. Typical event resources include: a roll of brown paper or wallpaper; three different colors of Post-its: yellow, red, and blue and a flipchart and markers (for parking lot issues). Using the Post-it notes and paper, as a group they map the process flow using common flowcharting symbols (see the next section), identify potential bottlenecks, and generate solutions to remove causes of waits and delays.

Several guidelines for the event facilitator are:

  • Arrange for an appropriate venue (preferably offsite),
  • Allow 1 hour for set-up (e.g. arrive 1 hour before scheduled start time, and
  • Have lead clinician or administrator kick-off meeting.

Flowcharting Tips

  • The job of the facilitator is to ask "why"; ensure that everyone in the group actively participates; develop a plan to communicate to those not involved; and allow for time at the end of the event to plan next steps.
  • The Golden Rule of group flowcharting is to focus on fixing systems, not individuals (avoid the blame game).
  • To streamline the processes reduce the number "touches (& steps!) in the process and encourage efficient multi-tasking.
  • To remove bottlenecks, encourage efficient multi-tasking as well as parallel processing.

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