\begin{tikzpicture}[node distance=2.5cm]
\tikzstyle{process} = [rectangle, minimum width=1.5cm, minimum height=0.8cm, text centered, draw=black]
\tikzstyle{resource} = [rectangle, minimum height=0.8cm, text centered]
\tikzstyle{arrow} = [thick,->,>=stealth]
\node (start)[process] {ward};
\node (stage1)[process, right of=start, xshift= 0.5cm]{PHU};
\node (stage2)[process, right of=stage1]{OR};
\node (stage3)[process, right of=stage2, xshift=0.5cm]{PACU};
\node (stage4)[process, right of=stage3]{ICU};
\node (nurse)[resource, below of=stage1, yshift=0.6cm, xshift= 1.25cm]{nurses (circulating/scrub/anesthetist)};
\node (surgeon)[resource, above of=stage2, yshift= -1cm, text width=5cm]{surgeons/anesthesiologist/ tools and equipment};
\node (bed)[resource, below of=stage3, yshift= 1.2cm]{recovery bed};
\node (discharge)[resource, below of=start, yshift= 1.2cm]{patient discharge};
\node (arrival)[resource, left of=start, text width=1.3cm]{patient arrival};
\draw [arrow] (arrival)--(start);
\draw [arrow] (start)--(stage1);
\draw [arrow] (start)--(discharge);
\draw [arrow] (nurse)--(stage1);
\draw [arrow] (stage1)--(stage2);
\draw [arrow] (nurse)--(stage2);
\draw [arrow] (surgeon)--(stage2);
\draw [arrow] (stage2)--(stage3);
\draw [arrow] (bed)--(stage3);
\draw [arrow, densely dashed] (stage3)--(stage4);
\draw [arrow] (nurse)-|(stage4);
\draw [arrow] (stage3) -- +(0,2.2) -| (start);
\draw [arrow, densely dashed] (stage4) -- +(0,2.2) -- +(-2.5,2.2);
\end{tikzpicture}
this is my code for this pic
but I need the pic like this pic

\documentclassand the appropriate packages so that those trying to help don't have to figure them out. This is especially important fortikzas there are numerous libraries, even though in this case other libraries were not needed. – Peter Grill Feb 04 '20 at 08:55