PHF Combined Presentations 83146

8/10/2019 PHF Combined Presentations 83146

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Flow Chart ing

MLC Gran tee Meeting

March 20, 2009


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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]


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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


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Quick Check Of Your

Enthusiasm Level

&

MathematicalSkills


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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.html


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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


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Flow Charting

From this visual picture we can seea process and the elements

comprising it

Shows how interactions occur Makes the invisible visible


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We should writethat spot down

Flow Charting Is So Simple Even A Caveman Can Do It


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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


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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


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Flow Chart Benefits

Creates a common vision

Establishes the AS ISbaselineCurrent

State

Baseline to measure improvements

Identifies wasteful stepsactivities/wait


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Flow Chart Benefits

Uncovers variations

Shows where improvements could be made

Show potential impacts of improvements

Training tool


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Types of Flow Charts

As Iscurrent state - baseline

Could Beimproved state

transition

Should Beoptimal state


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Flow Chart Exercises


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Basic Flow Chart Symbols

Activity:Operation/Inspection

Decision

Start/EndBookends

Wait/Delay

Flow Lines


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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


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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


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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


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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.


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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.


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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


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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


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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


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Olmsted County , MNPerformance Appraisal Process


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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?


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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


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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


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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


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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


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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


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Flow Charting Forms

Flow Process Chart Before and After Comparison Flow

Chart

Work Flow Analysis Form Others?


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Before and After Comparison Flow Chart


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Before and After Comparison Flow Chart


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Adding Time Lines

As Is Flow Chart Could Be Flow Chart Should Be Flow Chart

Time Time


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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


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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?


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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


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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


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How Improvements Are Made

Standardizingall the same

Automatingif possibleTiming?

Eliminatingunnecessary

steps/waste

Combining/Rearrangingparts/steps

Simplifyingreducing complexity

Changingpeople/place/sequence

Reducingstorage/transports/rework


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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


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Process Analysis Guide

Detailed

Flow

Chart

Identify

Problem

Areas

Root

Cause

Analysis

Pareto

Critical

Mass

Recommended

Opportunities


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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.

pdf

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/


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Gantt Chart

MLC Gran tee MeetingMarch 20, 2009


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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


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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


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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.


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Gantt Charts

Some Examples


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% Complete


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p

Progress Bar


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Milestone Chart - shows only important project events or milestones:


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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


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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


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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


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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


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Some Examples

Traffic Light Gantt Chart


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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


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2008APHAProgram


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Integrating the Gantt Chart and the PDCA Cycle


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Livingston County Department of HealthAccreditation Preparation Process


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Livingston County Department of HealthAccreditation Preparation Process

Documents

PHF Combined Presentations 83146