Flowchart as Theory and Prediction

Flowchart as Theory and Prediction

Last week, I spoke with a management team at a health center that has several clinic sites. 

The health center has been working to improve the care they provide for patients with diabetes.    Care teams and their managers recognize that missed blood and urine tests make it more difficult to monitor the health status of their patients.   What can they do to increase the odds that patients will get the right tests?

Recently, one of the clinics has changed the sequence of steps to help patients get their tests and integrate the test information into clinical care:  when a patient with diabetes is scheduled for a follow-up exam in the clinic, pre-order blood and urine tests so that the results are ready to review in the follow-up exam.   

This change revises the traditional flow of having labs taken after the exam and decreases the need for separate follow-up if the tests indicate a need for additional action.

Here’s a picture of the workflow now in place:

The flowchart is a picture of the clinic’s theory for getting tests done and ready for review; it is plan for the work.    “Any rational plan, however simple, is prediction concerning conditions, behavior, performance of people, procedures, equipment or materials.”  (W.E. Deming (1994), The New Economics For Industry, Government, Education, MIT CAES, Cambridge, MA, p. 103).

The flowchart embodies a specific prediction:  carry out the steps, in the order shown, and the patient and care team will have the lab results for review at the patient’s visit.

While there are tools like driver diagrams to help make a causal theory visible, a flowchart like the one shown looks good enough to inform both control and improvement.

Using the flowchart for control

When we observe the work, how easy is it to complete each step correctly and on time?   Use the flowchart as a data check sheet to count problems.  What can supervisors and staff do to adjust conditions, equipment or substeps to do the work according to the plan?   

Using the flowchart for improvement

The flowchart also provides a planning tool for improvement:  which step has the most problems; stated another way, which step is furthest from perfection?   That is, which step is the weakest link?

Goldratt’s insight says to work to improve the weakest link.   Trying to improve other work is a waste of your limited capacity to improve.  


Another Application of the Test-Implement Table

Another Application of the Test-Implement Table

More notes from the Field:  The role of leaders in sustaining and spreading improvement

More notes from the Field: The role of leaders in sustaining and spreading improvement