A flowchart, also known as a process flow diagram, is a graphical representation of a process that shows all process steps and decision points in sequential order. The flowchart helps quality improvement teams create a shared understanding of how the process currently works, examine the actual sequence and interdependencies of process steps required to complete tasks, reveal unnecessary process complexity, identify problems, redundancies and inefficiencies in the process, and generate process improvement ideas. The flowcharts are often developed and maintained not only for quality improvement purposes, but also for ongoing management of operations, process control and identification of points for additional data collection. It is important to avoid creating flowcharts that contain excessive amount of information. Very complicated flowcharts with a lot of unnecessary details are difficult to create, interpret and maintain. The flowchart is an effective quality tool that allows the improvement teams to compare and contrast the actual versus the ideal process, identify opportunities for simplification, design a new and improved process, visually communicate expectations, provide education, and drive meaningful standardization. The figure below shows some of the common symbols and shapes used to construct flowcharts.

There are many levels of detail, variations and types of the flowchart that can be developed to examine and address different aspects of a process. For example, top-down flowcharts outline only the major steps of a process; detailed flowcharts provide a lot of specific information about the process including inputs, outputs, tasks, and decision points; deployment flowcharts show the flow of a process and tasks with responsible individuals or departments; and workflow flowcharts illustrate the flow of people, materials, documents or information in a process. The common steps needed to develop any type of the flowchart include:

  • Identify the process to be examined
  • Involve people who actually perform the process steps 
  • Clearly define the boundaries of the process
  • Obtain team agreement on the level of detail required to understand the process
  • Observe the actual process
  • Use sticky notes to identify and arrange the process steps in proper sequence
  • Create the flowchart in digital format with the appropriate level of detail
  • Verify accuracy and completeness of the flowchart by walking through the current process
  • Develop the flowchart of the ideal process
  • Identify discrepancies between the current and ideal process
  • Prioritize and implement opportunities for improvement
  • Finalize the flowchart of the new and improved process

The figure below illustrates the flowchart for interhospital assessment and management of Vein of Galen malformations (VOGMs). According to Cincinnati Children’s hospital, the Vein of Galen malformations are rare blood vessel malformations in the brain. The malformation develops before birth and may be found during pregnancy or very soon after birth. This condition affects a large vein deep at the base of the brain. The malformation causes oxygen-rich blood to flow directly through this vein away from the brain instead of delivering blood to surrounding brain tissues. This rush of blood away from the brain puts pressure on the heart and lungs, often causing congestive heart failure or pulmonary hypertension. Disclaimer: This flowchart is developed for illustrative purposes only and should not be relied upon as an accurate depiction of the process for making patient management and treatment decisions.