Hi. As we're looking at improving the workflow in our processes, we always want to make sure that we look at the specific physical flow of those processes. In healthcare there are seven areas that we want to make sure that we bring into that understanding and conversation. Patients, of course, that happens as in all of our processes. But also, what is the work-around, the actual physical movements of our clinicians and staff, the medications and supplies. And also, the equipment and information that those clinicians are using to service our patient community. Now, though the one at the very bottom are the patient families, which really I want to stress because they sometimes are left out of the conversation or the view. We will look at how patients are getting moved into our process, registered, or say pulled into the examination rooms. But sometimes, we don't put the proper focus on the experience of the families that come with them. Not only where they might be waiting in the lounge, but also how those families might find their way back to the clinical area after a procedure or something like that. So, looking at each one of those flows individually is important because all are involved in health care in one shape or another. And so, their flows must be evaluated as a single system to improve your process. Spaghetti diagram is one great tool to help identify and look at problems and resolve them in physical flow of your systems. It is really just a picture, is a graphical representation of your current state. So, it is going to give you a baseline to improve the physical flow of your process of not only movements of your staff but also all the other seven that we listed in the last slide. And by looking at each one of those, we can follow up and improve, going forward, because identifying these process flows will increase and improve the lead time. Because each time that you were moving from one place to another, there are typically are non billable systems. You can identify making things more efficient and a tighter group if you don't have things out of sight, out of mind, going down hallways in different places. Not only do you lose time but we don't want to lose our personnel. Spaghetti diagram looks like this. This is just a lay out and it's got the lines that show individual movements of any of the seven. You can use different colors to identify which is which. You could say, use blue for your staff and green for your patients. But by having a quick morning of doing observations before the diagram gets too busy, you just want to understand without documenting each and every flow just enough to show you high traffic areas and long and short distances. Because by doing that, you can identify the type of waste that we're looking at in this very diagram. And we'll just describe which waste you're actually finding later on in this talk. So the steps are, of course, you want a lay out, if you were lucky enough to have a physical flow, a floor plan of your area. Now, you're going to have a quick start but it's not all that burdensome to just take a pencil and paper and draw out the general, physical constraints of your area. What is the door that the patients come in? Where is the registration desk? What is the examination room? So, it doesn't have to be perfectly descale, you just want a representation so you can see general distances, relative distances, and of course, the frequency. So, if you have your general lay out you, of course, would like to label them if possible and also can number them if you know that there is the general sequence of stations that your customers or staff are going through. So, you could either number them: one, two, three as the regular flow or you could, if there is a lot of back and forth, you might use arrows on the lines to show the direction of the flow going from one place to the next. But once you have done that, and you do an observation for enough of a morning just to see the general flow, then you're going to be able to identify any of the issues. So in this case, you're going to see that there are high traffic areas. It's okay to have some high traffic areas but the worst thing is if you're going to have a kind of a highway of workflow but it's a long commute. So if you look at that diagram, having frequent back and forth between those two stations is okay, except that there is a bit of distance between the two of them. It's okay to have a long movement between the two places at the alternate corners because that only happens once. It's okay to have a long distance if it's very infrequent. If you're going to have a very frequent path like that one, you would like it to be shorter, so that you're not going to waste time, each and every trip. So if you look at that diagram, now, what would be the waste that we would identify here? It would be the waste of motion and transportation that we described earlier. Because motion is the hunting and gathering, so you might have a staff person that has to go back and forth to a copier or to any of their supplies, or it could be transportation moving your patient from one location to another. By identifying and eliminating those wastes, you can improve the flow and reduce the overall experience lead time of your process.
