8/10/2019 PHF Combined Presentations 83146
1/64
Flow Chart ing
MLC Gran tee Meeting
March 20, 2009
8/10/2019 PHF Combined Presentations 83146
2/64
PHF Mission:
Improving public
health infrastructureand performancethrough innovativesolutions and
measurable results.
Innovat ive Solut ion s.
Measu rable Results .
http://www.phf.org
Jack MoranSenior Quality Advisor
[email protected]: 202-218-4423
mailto:[email protected]:[email protected]8/10/2019 PHF Combined Presentations 83146
3/64
Continuous Improvement
Act
DoCheck/
Study
PlanThe continuous improvementphase of a process is how you
Make a change in direction.The change usually is becausethe process output is deterioratingOr customer needs have changed
8/10/2019 PHF Combined Presentations 83146
4/64
Quick Check Of Your
Enthusiasm Level
&
MathematicalSkills
8/10/2019 PHF Combined Presentations 83146
5/64
If you can't describe whatyou are doing as a process,you don't know what you're
doing.
W. Edwards Deming
http://www.brainyquote.com/quotes/quotes/w/wedwardsd133510.htmlhttp://www.brainyquote.com/quotes/quotes/w/wedwardsd133510.html8/10/2019 PHF Combined Presentations 83146
6/64
Flow Charting
Flow charting is the first step we takein understanding a process
Organized combination of shapes,
lines, and text Flow charts provide a visual
illustration, a picture of the steps the
process undergoes to complete it's
assigned task
8/10/2019 PHF Combined Presentations 83146
7/64
Flow Charting
From this visual picture we can seea process and the elements
comprising it
Shows how interactions occur Makes the invisible visible
8/10/2019 PHF Combined Presentations 83146
8/64
We should writethat spot down
Flow Charting Is So Simple Even A Caveman Can Do It
8/10/2019 PHF Combined Presentations 83146
9/64
Mapping
MapQuest Takes directions and
coverts them into a
picture
Shows various routesto a destination
Shows communities
you pass through to
reach a destination
Flow Chart Takes procedures and
converts them into a
visual
Shows the routesinputs travel to
become outputs
Shows handoffs
8/10/2019 PHF Combined Presentations 83146
10/64
Mapping
MapQuest Shows connecting
roads
Shows faster and
slower routes Provides alternative
routes
Flow Chart Shows connecting
processes
Highlights areas for
improvement Triggers ideas to
improve a process
8/10/2019 PHF Combined Presentations 83146
11/64
Flow Chart Benefits
Creates a common vision
Establishes the AS ISbaselineCurrent
State
Baseline to measure improvements
Identifies wasteful stepsactivities/wait
8/10/2019 PHF Combined Presentations 83146
12/64
Flow Chart Benefits
Uncovers variations
Shows where improvements could be made
Show potential impacts of improvements
Training tool
8/10/2019 PHF Combined Presentations 83146
13/64
Types of Flow Charts
As Iscurrent state - baseline
Could Beimproved state
transition
Should Beoptimal state
8/10/2019 PHF Combined Presentations 83146
14/64
Flow Chart Exercises
8/10/2019 PHF Combined Presentations 83146
15/64
Basic Flow Chart Symbols
Activity:Operation/Inspection
Decision
Start/EndBookends
Wait/Delay
Flow Lines
8/10/2019 PHF Combined Presentations 83146
16/64
Flow Charting Construction
Clearly define the process boundaries to bestudied
Define the first and last stepsstart and endpoints
Get the right people in the room
Decide on the level of detail Complete the big picture firstmacro view
Fill in the detailsmicro view
8/10/2019 PHF Combined Presentations 83146
17/64
Flow Charting Construction
Gather information of how the process flows: Experience Observation Conversation Interviews
Research Clearly define each step in the process
Be accurate and honest
8/10/2019 PHF Combined Presentations 83146
18/64
Flow Charting Steps
Use the simplest symbols possiblePost-Its
Make sure every loop has an escape
There is usually only one output arrow out of a
process box. Otherwise, it may require a decision
diamond.
Trial process flowwalk though it in real time
8/10/2019 PHF Combined Presentations 83146
19/64
Flow Charting Steps
Circulate the flowchart to other people involved in
the process to get their comments
Make changes if necessary
Identify time lags and non-value-adding steps.
8/10/2019 PHF Combined Presentations 83146
20/64
Flow Chart Construction
There is no one right way to develop a flowchart,
but the following guidelines provide a generalstructure:
Start with a simple one-line description or title ofthe process being flowcharted , e.g., "How to..."
Using a top-down hierarchy, start with an ovalsymbol named Start.
8/10/2019 PHF Combined Presentations 83146
21/64
Flow Chart Construction
Connect each successive action step in thelogical sequence of events.
Reference detailed information throughannotations or connectors.
Follow the process through to completion,denoted by an oval symbol named End
8/10/2019 PHF Combined Presentations 83146
22/64
Flow Chart Construction
Use common symbols
Use a form of Post-It Noteseasier
to rearrange
Realize everyone is not doing it the
same waythere will be
disagreements
It will take multiple passes to get to
the As Is State
8/10/2019 PHF Combined Presentations 83146
23/64
Flow Chart Symbols
Activity:Operation/Inspection
Decision
Start/EndBookends
Document
Wait/Delay
Storage
Data Base
Transport
Input
Output
Flow Lines
A Connector
Forms
CommentCollector
Input/OutputData
ManualOperation
Preparation
ManualInput
Display
Unfamiliar/Research
8/10/2019 PHF Combined Presentations 83146
24/64
Olmsted County , MNPerformance Appraisal Process
8/10/2019 PHF Combined Presentations 83146
25/64
Constructing a Flow Chart Asking questions is the key to flow
charting a process.
For this process: Who is the customer(s)?
Who is the supplier(s) ?
What is the first thing that happens?
What is the next thing that happens? Where does the input(s) to the process come
from?
How does the input(s) get to the process?
Where does the output(s) of this operation go?
Is their anything else that must be done at thispoint?
8/10/2019 PHF Combined Presentations 83146
26/64
SIPOC + CM
A High level Process Map Helps in developing the As Is State
Defines knowns from unknowns
Shows gaps in QI Teams knowledgeof a process
Focuses data gathering activities
8/10/2019 PHF Combined Presentations 83146
27/64
High Level S I P O C+ CM Collection Form
A Form to identify all relevant elements of aprocess before starting a flow chart
Suppliers - internal and external
Inputs
Process - activities
Outputsservice provided
Customersinternal and external
+ Constraintsfacing the system or process + Measures - being used or to be used
8/10/2019 PHF Combined Presentations 83146
28/64
Process/Activities:
Begins With:
Ends With:
Inputs:
Suppliers:
Outputs:
Customers:
Constraints:
S I P O C+CM Collection FormProject Title:____________________
Measures of Effectiveness:
S I P O C+ CM Collection Form
8/10/2019 PHF Combined Presentations 83146
29/64
Process/Activities:
Begins With:
Ends With:
Inputs:
Suppliers:
Outputs:
Customers:
Constraints:
Tidbit of valid,valuable info onPH
Funding, Priorities, Time Feedback ofinformation
effectively received
Measures of Effectiveness:$$, support, outcomes,leadership,acknowledgement,recognition, policy orbehavior change
Current methods and channels to disseminatepublic health information to elected officials
Data, supporting documentation,policies and procedures, maps, healthadvisories, standards (filters forinformation), priority communications
CDC, community partners, state,local hospitals, PHD functions
Information, tangible mechanism ofinformation format, data (who, what,when, where, why, how, etc), Policiesand Procedures.
Board of Advisors, residents,community, Mayor, communityleaders
S I P O C+ CM Collection FormProject Title: Effectively and efficiently disseminate information about publichealth needs and priorities to elected officials
8/10/2019 PHF Combined Presentations 83146
30/64
CautionsIn most processes:
Few people have seen the total process and fully
understand the process
Departments are managed, processes are oftenunmanaged
Those that designed the process are no longer there
Work is being done that adds no value to customers
Work the customer needs isnt being done
Rework is built into the process
Inefficiencies are built into the process
Workarounds have been developed that make the
process appear to be working better than it really is
8/10/2019 PHF Combined Presentations 83146
31/64
Flow Charting Forms
Flow Process Chart Before and After Comparison Flow
Chart
Work Flow Analysis Form Others?
8/10/2019 PHF Combined Presentations 83146
32/64
Before and After Comparison Flow Chart
8/10/2019 PHF Combined Presentations 83146
33/64
Before and After Comparison Flow Chart
8/10/2019 PHF Combined Presentations 83146
34/64
Adding Time Lines
As Is Flow Chart Could Be Flow Chart Should Be Flow Chart
Time Time
8/10/2019 PHF Combined Presentations 83146
35/64
8/10/2019 PHF Combined Presentations 83146
36/64
Flow Chart Quality Improvement
Analyze the As Is flow chart
Look for Critical Processes Look for Handoffs
Analyze with a Cause and Effect Diagram
Develop potential solutions
Develop the Should Be state
Communicate all changes
Track implementation progress
Document results Present results
8/10/2019 PHF Combined Presentations 83146
37/64
Analyzing A Flow Chart
Examine each:
Activity symbolvalue/cost?
Decision pointnecessary/redundant?
Rework looptime/cost?
Handoffis it seamless?
Document or data pointuseful?
Wait or delay symbolwhy?/reduce/eliminate
Transport Symboltime/cost/location?
Data Input Symbolright format/timely? Document/Form Symbolneeded/cost/value?
8/10/2019 PHF Combined Presentations 83146
38/64
Improvement Opportunities
What to look for on a Flow Chart:
Duplication of effort Unnecessary Activities/Steps/Tasks
Delays/Waits
Transports
Storage Illogical Sequencing of Activities
Unclear Lines of Responsibility
Opportunities for Error
Supplier Error Opportunities Disconnects
8/10/2019 PHF Combined Presentations 83146
39/64
Improvement Opportunities
Use a Cause and Effect Diagram to
investigate areas identified on the AsIs flow chart as areas that could beimproved
Can complete a micro level flow chart
on specific process steps as required
Fix the low hanging fruit firstquicksuccess
Involve customer/suppliers before anychanges are made
8/10/2019 PHF Combined Presentations 83146
40/64
How Improvements Are Made
Standardizingall the same
Automatingif possibleTiming?
Eliminatingunnecessary
steps/waste
Combining/Rearrangingparts/steps
Simplifyingreducing complexity
Changingpeople/place/sequence
Reducingstorage/transports/rework
8/10/2019 PHF Combined Presentations 83146
41/64
Continuous Improvement
Act
DoCheck/
Study
PlanThe continuous improvementphase of a process is how you
Make a change in direction.The change usually is becausethe process output is deterioratingOr customer needs have changed
8/10/2019 PHF Combined Presentations 83146
42/64
Process Analysis Guide
Detailed
Flow
Chart
Identify
Problem
Areas
Root
Cause
Analysis
Pareto
Critical
Mass
Recommended
Opportunities
8/10/2019 PHF Combined Presentations 83146
43/64
More Resources
Online QI Trainingaccess course through TRAIN
by searching for course ID #1014545www.train.org
Public Health Infrastructure Resource Center
www.phf.org/infrastructure/
Public Health Memory Jogger II PHF QI Learning Series Catalog
www.phf.org/pmqi/PHF_QI_Learning_Series_082008.
Public Health Quality Improvement Handbook,
Quality Press, American Society of Quality, Spring2009
http://www.train.org/http://www.phf.org/infrastructure/http://www.phf.org/pmqi/PHF_QI_Learning_Series_082008.pdfhttp://www.phf.org/pmqi/PHF_QI_Learning_Series_082008.pdfhttp://www.phf.org/pmqi/PHF_QI_Learning_Series_082008.pdfhttp://www.phf.org/pmqi/PHF_QI_Learning_Series_082008.pdfhttp://www.phf.org/infrastructure/http://www.train.org/8/10/2019 PHF Combined Presentations 83146
44/64
Gantt Chart
MLC Gran tee MeetingMarch 20, 2009
8/10/2019 PHF Combined Presentations 83146
45/64
History
The first Gantt Chart was developedby Karol Adamiecki, who called it a
Harmonogram
Because Adamiecki did not publishhis chart until 1931, this famous
chart bears Henry Gantt's name
(18611919) designed his chart in1910
Wikipedia, the free encyclopedia
8/10/2019 PHF Combined Presentations 83146
46/64
Gantt Chart
Henry L. GanttWWI
Franklin Arsenal 1910
Progress Chart
Work planned and accomplished are
shown in the same space
Emphasizes work movement through time
Deals with plans and progress
Helps identify and eliminate obstacles
8/10/2019 PHF Combined Presentations 83146
47/64
Gantt Charts
A Gantt chart is a matrix diagram
The vertical axis lists all the tasks to be
performed for a project
Each row contains a single task
identification
The horizontal axis is headed by columns
indicating estimated task duration in
hours, days, weeks, months, etc.
8/10/2019 PHF Combined Presentations 83146
48/64
Gantt Charts
Some Examples
8/10/2019 PHF Combined Presentations 83146
49/64
% Complete
8/10/2019 PHF Combined Presentations 83146
50/64
p
Progress Bar
8/10/2019 PHF Combined Presentations 83146
51/64
Milestone Chart - shows only important project events or milestones:
8/10/2019 PHF Combined Presentations 83146
52/64
8/10/2019 PHF Combined Presentations 83146
53/64
8/10/2019 PHF Combined Presentations 83146
54/64
4/5 4/12 4/19 4/26 5/3 5/10 5/17 5/24 5/31 6/7 6/14 6/21 6/28
Task 1
Task 2
Task 3
Task 4
Task 5
Task 6
Task 7
Task 8
Task 9
G Ch M i R i
8/10/2019 PHF Combined Presentations 83146
55/64
Gantt ChartMorning Routine
Tasks AM Time Ending Assign To:
6 6:10 6:20 6:30 6:40 6:50 7:00
Wake Up
Make Coffee
Shower
Dress
Leave
You
Coffee Maker
You
You
You
U Of G tt Ch t
8/10/2019 PHF Combined Presentations 83146
56/64
Use Of Gantt Charts
Establish order of tasks: Sequential and Parallel
Identify resources requirements
Timing of resource needs Identify the critical path
Monitor the project On-Time Schedule
Alerts where remedial action is required
B fit Of G tt Ch t
8/10/2019 PHF Combined Presentations 83146
57/64
Benefits Of Gantt Charts
Overview of all the tasks
Identifies major milestones Easy to review with top management
Guidancesuppose to be here now
Alerts to problem areas Measurement of progress
Summary document when project is finished
Training tools for future projects
S E l
8/10/2019 PHF Combined Presentations 83146
58/64
Some Examples
Traffic Light Gantt Chart
8/10/2019 PHF Combined Presentations 83146
59/64
Task: City of XYZ HD 29-Feb 7-Mar 14-Mar 21-Mar 28-Mar
Finalize assessment analysis X
Gain consensus on priorities X
Identify comm. with elected off. X
Plan PHF consultant visit X
Set agenda and travel schedule X
City HD/PHF PI meeting X
On Schedule
Watch
Late or at Risk
8/10/2019 PHF Combined Presentations 83146
60/64
8/10/2019 PHF Combined Presentations 83146
61/64
2008APHAProgram
8/10/2019 PHF Combined Presentations 83146
62/64
Integrating the Gantt Chart and the PDCA Cycle
8/10/2019 PHF Combined Presentations 83146
63/64
Livingston County Department of HealthAccreditation Preparation Process
8/10/2019 PHF Combined Presentations 83146
64/64
Livingston County Department of HealthAccreditation Preparation Process