Supply chain management seems to be the buzzphrase of the decade. Even a Google search of the term "supply chain" provides 23,100,000 hits. While the meaning of supply chain management continues to evolve, the basic premise of this term has not changed much over the last few years. Managers are looking at processes and determining if there are procedures that should be improved and then design changes and implement them in the simplest way; and one of the primary ways to improve a process is by using a flow chart.
Many of the quality development tools that are in use today are derivatives of a flow chart. These include Pareto charts, cause-and-effect diagrams and histograms. A flow chart is one of the oldest quality improvement tools. As a means of documenting work practices, flow charts have been around for centuries, perhaps beginning with the scratchings of Neanderthals on the roofs of caves, documenting hunting methodologies. What has improved over time is our ability to chart process flow effectively.
A flow chart is a means of conveying information about a process. It is a diagram showing the movement or action of persons or things in any complex system. Many professionals are unaware that there is an ISO quality standard that describes flow charts. This standard, ISO9004.4 Section A.6.2, describes a flow chart as "a pictorial representation of the steps in a process, useful for investigating opportunities for improvement by gaining a detailed understanding of how the process actually works.... Flow charts are constructed with easily recognized symbols."
A flow chart must communicate the steps in a process clearly and unambiguously. It must be possible for any team in an organization to examine a flow chart created elsewhere and immediately understand it.
Most organizations have a need to document very complex processes. If a single flow chart for an entire organization were to be drawn, its size would make it totally unmanageable, even for small companies. The best way to simplify a flow chart is to create a layered diagram that matches the way an organization is layered. In other words, the use of subprocesses is required. This allows a flow chart to be built for a top senior management layer, with each step containing complete flow charts for the next sub-senior management layer. Steps within this layer would contain further sub-flow charts and so on. This layered diagram approach enables each process to be viewed and analyzed in detail at the appropriate level.
When you design a flow chart you need to ensure certain steps are taken to clearly represent a process--every feedback loop must have an escape, each decision must be followed through to its logical conclusion and each question must be answered. There can be only one output arrow per process box, otherwise a decision diamond should be used; this arrow should have a direction. Further, ISO9004.4 states that a flowchart should be dated. Dated records allow foolproof comparisons of the process situation before and after improvements.
When analyzing a flow chart, chart the present process flow, then examine how the current process works and where problems are as well as where things run smoothly. It is advisable to get staff involved; ask if the perceived problems are problems to them. Together you can revise flows in the areas that do not run smoothly and redesign a new flow chart. As staff establishes ownership of each stage of its development, it is more likely the new flow chart will produce the desired effectiveness.
Start by choosing a simple process that you understand such as case carts. Write "start" in the oval. Step 1 is to print case cart requisition by room number and the time the case is scheduled to begin. This would be a rectangle or an activity. Step 2 is a decision point or a diamond. If an item is in stock, put it on the case cart, then move to the next step. If no, mark missing item and write it on the missing list. Follow each step in the process until the case cart is complete. Have a staff member review the process to make sure they understand what you have done and ask them to help look for processes that don't add value, a.k.a., loops--you will quickly discover that some very sophisticated loops exist. Breaking them down allows you to get closer to them to work on some of the issues. Soon you'll be joining the ranks of the experts in supply chain management.
Michael Murphy is manager of central sterilizing services at the University of Iowa Hospitals, Iowa City.
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