Depicting Flow in Cancer Care

A clinical administrator asked for "...a simple flow chart of the processes that take place in Radiation Oncology in order for us to deliver efficient, quality care." At first glance, that's pretty basic. But then it went further: "Our hope is to visualize the impact each of us has on our core values and to personalize those results into tangible outcomes." Flow charts and values don't often show up in the same place.

So we planned an Appreciative Inquiry with the staff, looking into their experiences with flow more as Mihály Csíkszentmihályi would describe it. We found four elements that made up their positive core in these experiences. These were presented back to them for consideration, and they then amplified them on posters.

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To get to a flow chart, they gathered around a large sheet of paper placed on a table, with just a circle on it. They were asked to describe a process, and they chose the development of a treatment plan. As it was described, they passed a ball of yarn among them, unrolling it as the process unfolded. At each point, their names were added to the sheet and they held the yarn in place with their fingers; everyone was touching and holding. Once done, they named the various steps. Next, they were asked to show where the four elements of the positive core occurred by placing little boxes wrapped in copies of their posters. Their work was then translated into a the final graphic shown below.

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A video was made to walk through the processes. Their thinking is that they would like to share this with the physicians and others to build understanding about what they do when they're successful.

Clinicians here are terrifically busy so we took lots of chances to minimize their time away from patients, but it seemed to work. Their use of the yarn was mesmerizing,  and the non-linear flow chart showed how they gather around common values and shared outcomes.