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Quality Improvement Course

Flow Charts

Purpose: A flowchart is a pictorial representation of the steps in a given process. The steps are presented graphically in sequence so that team members can examine the order presented and come to a common understanding of how the process operates.

Flowcharts can be used to describe an existing process or to present a proposed change in the flow of a process.  Flowcharts are the easiest way to "picture" a process, especially if it is very complex. Flowcharts should include every activity in the process. A flowchart should be the first step in identifying problems and targeting areas for improvement.

Steps in Flowcharting a Process:

  1. Decide on the process to flowchart.
  2. Define the boundaries of the process: the beginning and the end.
  3. Describe the beginning step of the process in an oval.
  4. Ask yourself  "what happens next?"  and add the step to the flowchart as a rectangle.  Continue mapping out the steps as rectangles connected by one-way arrows.
  5. When a decision point is reached, write the decision in the form of a question in a diamond and develop the  "yes" and  "no" paths. Each yes/no path must reenter the process or exit somewhere.
  6. Repeat steps 4 and 5 until the last step in the process is reached.
  7. Describe the ending boundary/step in an oval.
  8. When drawing a flowchart, constantly ask   "what happens next?", "is there a decision made at this point?", "does this reflect reality?", "who else knows this process?",   etc. When possible, do a walk-through of the process to see if any steps have been left out or extras added that shouldn't be there. 

The key is not to draw a flowchart representing how the process is supposed to operate, but to determine how it actually does operate.  A good flowchart of a bad process will show how illogical or wasteful some of the steps or branches are.

Tools:

Defines the boundaries of a process; shows the start or stop of a process.
Designates a single step in a process. Briefly describe the step inside the box.
A diamond signifies a decision point in the process. Write the type of decision made inside the diamond in the form of a question. The question is answered by two arrows-- "yes"  and  "no" --which lead to two different branches.
A small circle that surrounds a letter signifies where you pick up a process on the same page; represents a connection.

Examples:

  • Basic Flow Chart - This flow chart depicts the patient admission process through the ED.
  • Cross-Functional Flow Chart -When a flowchart describes a process in which a number of different people, departments, or functional areas are involved, it is sometimes difficult to keep track of who is responsible for each step. A useful additional technique for tracking this, is to divide the flowchart into columns. The header for each column should be the name of the person, entity, or function involved in the process. Each step of the process they perform should be in their column. This particular functional flowchart documents the patient ID process in the Vanderbilt Emergency department.  As you can see, bands represent functions by role, from the greeter to the ED doctor.
  • Flow Chart with Timeline

This page was last updated August 21, 2007 and is maintained by