guide to help you understand the geographical space that you work in and how to arrange the environment to reduce waste, eg. motion, time, transport

1. © ABCi 2019
What is a ‘Spaghetti Diagram’?
A spaghetti diagram is a mapping tool that is used to
visually show the way staff, patients or resources
move or flow through a department during a process.
What are the benefits of using this tool?
This tool can identify areas where time, effort and risk may be reduced by mapping unnecessary
movement geographically. The time saved can be used more wisely and therefore can go on to help
reduce delays and improve patient care.
When would you use this tool?
Is used to help establish the optimum layout for a
department or ward. For instance, determining where
you situate frequently used assessment rooms, store-cupboards or equipment may increase or
minimise the footfall travelled to reach these areas each day. Reducing these distances will give time
back to busy staff.
How do you do it?
Step 1: Decide on what is going to be observed (e.g. patient flow, product or staff). You are able to
analyse a number of these at once if necessary and this can be done by assigning a different coloured
line to represent each one. Explain to the team what is being done and ask for volunteers to participate
in the process.
Step 2: Draw the layout of the area to scale (if you do not have a floor plan). Use shadowing to observe
and draw corresponding lines on the layout tracing the actual steps taken by the patient, resource or
staff member (note the time, date and process being evaluated, never name the individuals involved).
Record any stops with consecutive numbers and record the duration of each stop and the reason why
the stop occurred.
Step 3: Analyse your map: look at the lines that you have drawn, are you able to identify any
unnecessary movement or movement that introduces risk? If so, is it worth bringing these two points
closer together in order to optimise flow though the department or ward? For example, moving a
storage cupboard or where items are stored. Ask the team for their suggestions – often the best ideas
come from those undertaking the process daily!
Step 4: After analysing your map, redesign the layout on a new spaghetti diagram and test it!
What resources do I need?
 Floor plan to scale of the area in question
 Notepad
 Marker pens
 Stopwatch or smartphone with timer
Spaghetti
Diagram
ABC
improvement
iSkills for
Who needs to be involved?
Staff / patients based in the department or ward
that you are evaluating.

2. © ABCi 2019
Example of Spaghetti
Diagram before process
change
Patients and staff were
travelling around the
department unnecessarily.
Patients moved between
rooms in order to be
assessed and treated by
different clinicians.
Source: Alison Pugh, 2018, Spaghetti Diagram of Medical Day
Case Unit at Royal Gwent Hospital ABUHB
Example of Spaghetti
Diagram after process
change
The team realised that
there was a lot of wasted
movement and that this
was impacting on patient
experience so they changed
the way they worked
drastically.
Patients now stay in one
assessment and treatment
room and the clinicians
move between rooms
reducing unnecessary
footfall and improving the
patient experience.
Hints & Tips
This process will sometimes highlight when someone has not taken the necessary action, ‘Five Whys’
is useful here because it allows you manage this without assigning blame. This will often highlight
organisational issues or areas where processes need to be improved.