Mapping a Clinical Workflow

#Follow the work as it happens

A clinical workflow is the sequence of activities through which a care task is completed. Mapping it means identifying what starts the process, what happens next and what marks completion. Begin with a defined task and setting rather than trying to describe an entire organisation in one diagram.

Use staff accounts, available process documents and appropriately authorised observation to understand actual practice. Written procedures may differ from everyday work, particularly during busy periods or outside usual hours. Include patient and carer activities where relevant, such as preparing information, waiting for contact or acting on instructions.

#Make decisions and handoffs visible

For each step, record the responsible role, information needed, system used and decision made. A handoff occurs when information or responsibility moves between people or teams. Clarify how the receiving person knows that action is required and how the sender knows the handoff has been completed.

Mark waiting periods separately from active work. Note missing information, duplicate entry, interruptions and repeated attempts to reach someone. These details help distinguish a delay caused by limited capacity from one caused by unclear ownership or system design. Do not assume that removing a step is safe merely because it takes time.

#Include variation and failure paths

A useful map includes exceptions, not just the most straightforward route. Consider incomplete records, unavailable staff, language needs and system outages. Show how urgent concerns are escalated and how work returns to a safe path after an interruption. Some variation reflects necessary clinical judgement rather than a process defect.

Review the map with people who perform and receive the work. Label uncertain steps and differences between locations or shifts. Before proposing changes, identify which decisions, safeguards and accountabilities must remain intact. Keep the current workflow separate from any proposed future workflow so that assumptions about improvement remain visible.

#Common misunderstandings

A workflow map is not the same as a policy, checklist or ideal care pathway. Those documents describe what should happen; a map of current practice describes what happens in the setting being studied. Differences between the two are useful findings, not automatically evidence that someone has done something wrong.

A detailed map is not necessarily a better map. Too much detail can hide the problem being explored, while too little can conceal important work. The right level depends on the purpose: understanding appointment booking may require different detail from examining how test results reach the responsible clinician.

Nor does a map, by itself, explain why a problem occurs. A queue might reflect limited capacity, missing information or necessary clinical prioritisation. Mapping identifies points to investigate; it does not establish causes or prove that a proposed change will help. Treat the map as a working account to check with the people involved.

#Questions worth asking a clinician

• How will you observe and validate the workflow to ensure the map reflects actual care rather than only the written procedure?
• At each decision point, who makes the decision, what information is needed, and how is responsibility transferred to the next person?
• Where do patients, staff or test results wait, and how will you record the duration and causes of those delays?
• Which exceptions change the usual care pathway, and who is responsible for deciding when and how to escalate concerns?
• When staffing shortages, missing information or system outages disrupt care, how does the team recover, and how will those recovery steps appear on the map?