Food-Service-Manual-for-Health-Care-Institutions

selected for the issue in question. Quality improvement tools can be divided into two general
categories: those used for problem identification and those used for problem analysis. However,
some tools can be used for problem identification and analysis.
Tools used for problem identification include flowcharts and brainstorming. Recall from
Chapter 2 that brainstorming is a group session devoted to sharing ideas and information without
judging their value. A top-down flowchart is explained in Chapter 5. Another type of flowchart
is a detailed flowchart that is used to identify steps or tasks in a process. This flowchart
may identify the current path or establish a new road map or direction. Flowcharts are usually
drawn using squares, rectangles, diamonds, and circles, with circles specifying the beginning
and final steps in the process. Squares or rectangles represent the in-between steps, and diamonds
represent decision points and questions. Flowcharts are beneficial in that they disclose
duplicate steps and steps that can be combined or performed in a different order to prevent
unnecessary feedback loops. Feedback loops are steps or events that require a product or customer
to return to a previous step in the process. An example of a flowchart for the late tray
process is shown in Figure 4.4.
Tools used for problem identification or analysis include pareto charts, cause-and-effect
diagrams, and run charts. A pareto chart is simply a bar graph used to prioritize problems and
determine which should be solved first. In constructing a pareto chart, categories must be
designed and the unit of measure (for example, hour, error, dollar, or job category) selected.
After data are gathered, they must be broken down, or aggregated, by category; items should
be ranked in descending order from left to right. Efforts can then focus on the categories with
the greatest effect or frequency. An example of a pareto chart reflecting the problems associated
with late tray delivery is provided in Figure 4.5.
Cause-and-effect diagrams, also called fishbone or Ishikawa diagrams, are used to represent
the relationship between an effect and all the possible causes contributing to it. Team
brainstorming may be used to create a fishbone diagram. Causes are generally divided into four
categories: materials, methods, equipment, and employees. An example of a cause-and-effect
diagram related to late tray delivery is provided in Figure 4.6.
Figure 4.4. Flowchart for Patient Late Tray Process
Tray
order
received
Check
diet
order
Tray
order
correct
No
Call
patient
unit
Verify
order
Yes
Prepare
menu
Take
menu
tray
line
Prepare
late
tray
Deliver
late
tray
Quality Management
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