Follow these tips for effective flowcharts

Nine steps to success

A good flowchart creates a clear visual representation of a case management process. Flowcharts can used to train new case managers, improve existing case management processes, and plan new programs. There are nine steps to creating a good flowchart, says Suzanne K. Powell, RN, BSN, CCM, the director of case management and continuous quality improvement (CQI) for the Health Services Advisory Group, Arizona's peer review organization, in Phoenix. Those steps are:

1. Decide what needs to be charted. "Not everything needs to be flowcharted," notes Powell. "Only flowchart those processes that need improvement. Flowcharts help you locate the bottlenecks in your process that lead to poor outcomes."

2. Assemble a team that has process knowledge.

3. Clearly define the first and last step in the process.

4. List the steps involved in the process.

5. Sequence the steps. "I find that Post-It notes are very useful for creating flowcharts," Powell says. "I use Post-It notes in different colors and shapes to represent different steps in a process. Then I move them around until I get the correct sequence for the steps on the flowchart."

6. Create a graphic design of the process using appropriate symbols. Add the arrows. "You can create a good flowchart with a handful of symbols," she says. Those include a circle to represent the beginning and the end. A square usually represents a process or action. A diamond represents a decision. A circle with an "A" inside represents a break or continuation in the process. Arrows link other elements to show connections.

7. As needed, break down the activities to show their complexity. "Decision points should be phrased in the form of a question," she notes. "If your decision point cannot be answered with a'yes' or'no' answer, then break down the process further."

8. Title and date the diagram. "Some organizations also put the names of the CQI team members on flowcharts," she notes.

9. Test the process. "This is where you check for CRUD [complexity, redundancy, unnecessary steps, and delays]," she says. "Are your staff members following the process? Are there obvious complexities in the process?"

Powell offers case managers these additional tips for creating useful flowcharts:

o Know what to flow.

o Bite off the right amount.

o Stay at the same level.

o Include only two possible answers for each flowchart decision.

o Use the right symbols.

o Show the process as it is, not as it should be.

o Flow everything toward the end.

o Ensure flowcharts are understandable, readable, and useable by nearly everyone.

"Once your flowchart of your current process is complete, write a flowchart of the process as it should ideally be done and compare the two to find opportunities for improvement," Powell suggests.