Hi there!

About six months ago, The Mainichi paper on July 17, 2019, reported that « City officials said the woman, a resident of the city, applied to undergo screening for stomach cancer at the Central Public Health Center in Gifu on Jan. 10. On Jan. 28, she received notification telling her that no abnormalities had been found. ». Consequently, the woman died of stomach cancer.

In the past post, « Operation of Stomach Screening Test without Checking the Manual« , I described the problems with stomach cancer screening tests and their improvements. If you haven’t read that post yet, I’d like you to read it in advance.

Organization of Workflow and system of implementing the operations

If there is a problem with sharing business performance results and handing over the operations, as with the cause of this incident, it will be solved by organizing the workflow and establishing the system of implementing the operations as follows.

Organizing the workflow

Workflow refers to a flow of work – there are Tasks (a blue squared icon) between the start icon and the end icon – which reveal the following things:

  • The person responsible for handling
  • The order in which they are to be handled

Typically, you create a workflow diagram while organizing it. A diagram can help the interested parties share a common understanding of the work and discuss improvements.

Regarding this cancer screening process, there is already a manual for the work, so the workflow is already organized to some extent (enough information to create a workflow diagram is available). To make the current workflow even better, you can consider incorporating the Task of sharing that you have read and verified the notifications into the workflow.

You add the Task of reporting the read and verified results to your supervisor as shown in the following figure.

Improve to let the read and verified results share
The staff should share the results of operations with superiors as well as complete them

However, on the site in question the following things happened:

  • The manual was not followed
  • Ignoring the manual continues

There is a high possibility that the organized workflow could be ignored or become a mere facade. So what you need at this point, is a system that allows you to do the work according to the workflow.

System of implementing the operations

For establishing a system that enables work to be performed according to a set workflow, you can use a Workflow system.

A Workflow system can achieve various things, such as:

  • Tasks are delivered and received according to the workflow diagram
  • You can view and enter data in the Tasks set in the workflow (in a prepared screen)
  • You can see the progress or stagnation of the Issue on a graphical screen

Once you’ve organized a workflow (completed the workflow diagram), the system is completed with a few settings.

Outline of the Workflow System
Main functions of the workflow system

As for the work that is done this time – the operations performed by The Gifu Municipal Government after receiving the screening test results from the medical institutions and sending them to the medical examinees as a notification, you can think of the system of implementing the operations in the following diagram.

Cancer screening workflow diagram

The Central Public Health Center where the mistake happened perform more than 30 stomach cancer screening tests within a year (lung and breast cancer ones as well). Each operation starts with planning and preparation.

Workflows for Stomach Cancer Screening Tests (Sample)
Workflow of a cancer screening test, from preparation to sending notifications after the test

Examples of a cancer screening workflow process screen

In the workflow system, once you create a workflow diagram and set the types of business data to be handled, an input screen is offered in each Task (such as « Enter the Test Results » and « Read/Verify & Report ») in the workflow diagram.

In the input screen of the work process, the members of the screening test team enter the date and time when they entered the screening test results in the system, the date and time when they read and verified the results, the names of the participants, etc. Then, the members advance the Token (the progress indicator) to the next Task.

Screen of reading and verifying & report (Sample)
Record and report detailed information, rather than simply reporting what you have done

Examples of the confirmation screen for the progress and stagnation of the cancer screening workflow

Because more than 30 stomach cancer screening tests are performed within a year, some instances start in the cancer screening workflow at the same time. When that happens, it becomes difficult to understand how far each Issue has gone and how long it has remained on a particular Task. Some workflow systems provide a graphical feature for this situation.

Progress situation of Workflows for Stomach Cancer Screening Tests (Sample)
You can see where each test is going now
You can see where there are many Tokens in each Task while so many tests are going on


The accident in Gifu city described in this article could have been avoided with a system that makes the officials observe the operational manual. The best way to create a system where the operational manual is not ignored is to organize your cancer screening workflow and use the Workflow system to help you complete operations.

We, Questetra have been creating and improving workflow systems since our establishment in 2008. If you think of organizing a workflow or creating a system where work can be done according to a workflow diagram, we recommend you try the cloud-based workflow Questetra BPM Suite.

Thank you for reading!


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