--- Adapt to your context and pre-test prior to use ---
HEALTH WORKER FLOW MAPPING TOOL
INSTRUCTIONS FOR OBSERVER:
As an observer, you will follow the selected health workers for 1-2 hours each and record their
movements on the attached form. Please use a separate form for each health worker. You will
move around with the health worker to see where s/he goes in sequential order, recording the time
the health worker moves to a given room or area (such as a consultation room or the outpatient
department) and what the health worker is doing there. For example, you might record “10:15 a.m.
to pharmacy to obtain medicine for patient.”
As another example, you might follow a health worker from when he first arrives and signs in, to
seeing his first patient, followed by his going out to the waiting room to call for the next patient, to
seeing another patient and going to the laboratory for a result. The time between one recorded
activity to the next in line would show how much time the health worker spent at each place or
each purpose (e.g., the health worker could be in the consultation room for two hours straight
without leaving while patients keep coming in and out). Please be sure to pay particular attention
to and record the “in-between things,” such as walking from here to there, time spent waiting (e.g.,
for results, prescriptions, or patient records) or socializing with colleagues, as these are factors that
can affect productivity.
Please note that you will observe what the health workers are doing and not how well they are
performing the task. In other words, you will not assess whether they are following all the steps of a
clinical protocol. However, if you do witness more obvious displays of quality issues, such as not
wearing gloves to inject a patient or not washing hands between patients, these would be helpful
to note in the “Comments” section.
If there are not enough patients at the facility to observe health workers for 1-2 hours, then you
should continue watching what the health workers do for the next 30-60 minutes as they wait for
more patients to arrive. That is, do they spend their time productively on administrative work or
cleaning equipment? Or do they leave early, read the newspaper, etc.?
Depending on the size and layout of the health facility, you may be able to station yourself in a
central area from where you can see the movements of each of the health workers under
observation at the same time. However, if you need to move to see where one of the health
workers is going, and you return and see that a second staff member under observation has
moved, you should go see where they went and not be unduly concerned over having missed the
exact moment. This method is meant to generate reflection on how efficient or inefficient service
provision at the health facility may be and is not as precise as a time and motion study would be.
In the ”Comments” column, please record any relevant observations. Some examples include
noting that there is a large distance between the consultation area and the laboratory, or that the
lab attendant was not present, meaning that the health worker had to return to the consultation
room without the patient’s result and had to seek the lab result later, or that patients do not have
enough seating or any negative comments you may overhear patients say.
Health Worker Flow Mapping Form
Province:
District:
Health worker type observed:
Time
□ Doctor
Facility:
□ Clinical Officer
Service delivery area/room
□ Medical Assistant
□ Nurse □ Midwife
Describe what the health worker is doing
Date: ___ /___ /______
□ Other ____________________________________________
Comments
Time
Service delivery area/room
Describe what the health worker is doing
Comments