Flowchart

A flowchart, or flow diagram, is a graphical representation of a process and depicts either an actual or an ideal sequence of steps. These steps are portrayed through the use of geometric shapes that represent actions (rectangles), decision points (diamonds), and terminal events (rounded rectangles). Arrows, or flow lines, are used to represent the flow of material, information, and events that occur within the process. A flowchart can be very simple or highly intricate, depending on the complexity of the process being studied.

Members of quality control circles initially used flowcharts in the manufacturing industry in Japan. In these voluntary circles, factory workers studied the quality control process. Quality expert Kaoru Ishikawa assisted circle members by providing guidance on a number of problem-solving techniques. From his work in the quality arena, seven basic problem-solving tools have emerged to include the flow diagram, the cause-and-effect chart, the Pareto chart, the run chart, the histogram, the scatter diagram, and the control chart.

Flowcharts are particularly useful in the health services industry because of the many health care processes involving complex interactions and unseen steps. One example of the usefulness of flowcharting is in the area of patient safety. When a medical error or a near miss occurs, a root cause analysis is conducted to determine the most basic cause of the problem and prevent its recurrence. The flowchart is an essential component of this analysis and serves to provide all members of a quality team with a common understanding of the process. By thoroughly and systematically documenting all the steps in a given process, inefficiencies, redundancies, disconnects, and flaws can be readily identified.

The flowchart can be used in either a prospective or a retrospective process analysis. In a prospective analysis, it serves as the basis for brainstorming sessions that seek an ideal process design or a best practice model. In a retrospective analysis, it provides a launching point for clarification, discussion, and further analysis of an existing[Page 216] process that needs improvement. Often, quality teams use both types of analysis and then conduct a gap analysis that compares the ideal process flowchart with the process as it actually occurred.

Flowcharts are perhaps the most frequently used quality improvement tool. Their usefulness lies in their flexibility and their fundamental purpose: ensuring a thorough and systematic understanding of all the steps in a process so that meaningful dialog and process improvement can occur.