222 ◾ Ryan Elizabeth Wood
◾ Ideas for improvement that may arise during the development of a current state map may be
documented in the star-shaped symbol. e group will expand upon these ideas during the
brainstorming portion of a process improvement or lean project.
◾ Following development of the map, the group identies value-added versus non-value-added
steps. Non-value-added steps can be dened as process steps that do not add specic value
to the end goal for the customer. ese can be one of seven types of waste: Overhandling,
rework, duplicative work, waiting (idle time and delays), overproduction, unnecessary
motion by sta or customers, and overprocessing. Eorts should be focused on minimizing
or eliminating non-value-added steps.
Value stream maps can be much more complex than other types of owcharts. Value stream
mapping should be used when the goal is to identify and eliminate waste and to minimize delays
and reduce the overall process time. A basic example of a value stream map is demonstrated in
Figure25.4.
Spaghetti Diagrams
A spaghetti diagram is a tool that can be used in conjunction with a owchart to demonstrate the
physical layout and ow of each step in the process, to identify redundancies or duplication in phys-
ical steps, in order to develop a leaner, more streamlined process. Figure25.5 demonstrates a current
spaghetti diagram, where each step in the process is shown on the diagram of the functional area.
is diagram can then be used to identify areas of waste in order to develop potential improve-
ments and optimization. ese improvements can then be documented in a future spaghetti dia-
gram. Process steps are moved and rerouted, as appropriate, to achieve an optimal ow of steps and
reduce waste and overall process time.
How to Create a Flowchart
ere are various types of owcharts, methods for their development, and ways to create or draw
them. However, all follow some basic steps for development as outlined below.
1. Determine who will be involved in the owchart development.
a. is may be an individual, or better yet a team of people involved in the day-to-day
process(es) being discussed.
b. It is most benecial to dene steps and develop processes with subject matter experts
(SMEs). SMEs are often the frontline sta performing the steps or process on a day-to-
day or regular basis. Other sta members or leaders may think they understand what
happens in a process, but it becomes clear that this is often not the case when a process
is discussed with SMEs.
2. Identify and dene the process for which a owchart will be created.
a. Determine what type of owchart will be created at this point. e group needs to be in
agreement about which type of owchart and what level of detail is required to be eective.
b. e level of detail indentied should be consistent throughout the owchart.
3. Identify the starting and ending points of the process.
a. is is critical for assuring that all members of the team or group understand the context
and extent of the process being discussed.
Flowcharting ◾ 223
4. Dene each step in the process sequentially in words and place in the appropriate shape, as
demonstrated in Figure25.1.
a. Brainstorming can be used to list all the steps or major tasks in the process.
b. It is most eective to outline the process on ipchart paper or a dry erase board in
front of the group so that all can visualize the process and analyze if all steps have been
included. e owchart is then drawn electronically (and on paper) afterward.
c. It is also important to identify who or what role is responsible for each step. is can be
identied using words within the step description and/or by using dierent colors.
d. Process data boxes should be included in the development of value stream maps.
5. Review the process with all involved individuals in the process, most importantly the afore-
mentioned SMEs, to ensure that the owchart accurately reects the process.
Description: e process of a physician office
appointment from scheduling through billing.
Contacts: Office manager, scheduler/registrar,
medical assistant, physician, billing clerk.
Spaghetti Diagram: Physician Office Appointment
Version: 3 – APPROVED Last Edited: September 25, 2012
5
6
4
7
2
3
Patient Appointment – Medical Assistant Process
1. View patient arrival in computer system
2. Greet patient in waiting room
3. Escort patient to exam room and complete initial appointment tasks
4. Enter patient ready notification for physician in computer system
5. Complete medical preparation tasks (lab work, etc.) for patient
6. Stock and prepare exam rooms
7. View patient complete in computer system
8. Clean /prepare room for next patient
1
8
Figure 25.5 Ofce Visit Spaghetti Diagram: Current Process.
224 ◾ Ryan Elizabeth Wood
a. Another technique to make sure the owchart is an accurate reection of the identi-
ed process is to observe the process in person, making notes about the ow and who
is performing each step. Observation is also a highly eective way to identify potential
opportunities for improvement by spending time watching exactly what is occurring in
the process.
b. Update and/or correct the owchart accordingly with any identied updates or corrections.
c. Check that the process is complete and that all paths on the owchart end at an appro-
priate end point (oval shape) or are routed back into the ow.
6. Add the owchart title, the version and status of the owchart (draft, reviewed, approved), a
written description of the process, and the individuals involved in the design of the owchart.
7. If the owchart is a current reection of the process, it can be considered complete as a cur-
rent state owchart or current state map.
a. Oftentimes, a current state owchart is used to brainstorm ideas for improvement, track
data, or identify measurements and ultimately develop an improved future state ow-
chart or future state map. A future state owchart will demonstrate how improvements
can be integrated into the process.
b. Opportunities for improvement are identied within and along the owchart by con-
sidering areas where there may be waste, duplicated steps, complex communication pro-
cesses, or how it diers from the optimal or designed process.
8. If the owchart created is a future state or new process owchart, it is continuously reviewed
and updated as the new process steps and improvements are implemented. is ensures that
all team members remain clear on the new process and how it is being integrated into the
daily operations.
a. e group should continue to brainstorm and develop improvements during and following
implementation of a new process or improvement, to integrate continuous improvement.
9. If a spaghetti diagram will be developed for this process, the owchart developed is now
used to identify the location of occurrence for each step in the process.
a. e process steps should be numbered in order to identify each step on the diagram.
A owchart is a meaningful way to design and demonstrate the steps in a process. As a visual
tool, it is highly eective as a clear and concise model of a process being developed or improved.
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