I distinctly remember a hallway comment from a clinical leader years ago that went like this: “Edith, we need to get together next week to talk about a new system; but don’t worry, because we want one just like our current one.”
I challenged him with the thought that, if this is truly the case, then why don’t we avoid the arduous budget approval process and save our money for something else. Why was he looking for a new system if everything was working well and he did not want to use technology to achieve any better patient, staff or financial outcomes?
Finding and implementing a new system is expensive and time consuming, so any conversation needs to be clear about why the change should be made, and every possible opportunity should be explored to maximize the investment in capital and training.
From my experience, this approach to understand and actively seek workflow process redesign opportunities distinguishes organizations from peers. Organizations that understand workflow and continually strive to improve process have a shorter time to market by delivering better outcomes at lower costs.
In a recent ambulatory EHR installation, I arranged for an introductory meeting over lunch with the new chief medical officer and a local process improvement expert to discuss a potential workflow analysis engagement to prepare his division for software delivery. The time between contract signing and software delivery is the perfect time to organize your team and analysis current workflow to spot new opportunities as staff learn more about the functionality of new software. His reaction was in a nutshell, are you crazy; I know our workflow.
As anyone who has HIT implementation experience will suspect, the live events and end-user acceptance period was prolonged and more painful and expensive than necessary. This division insisted that the new functionality needed to support their current workflow and that they would not use it until it did so. However, they were not precisely sure what needed to change. What they knew was that they couldn’t keep doing what they had done. They gave numerous examples of how the system needed to change. Among them:
- The system won’t let me chart a medication without first doing the 5Ps safety check.
- We cannot allow patients to send us unstructured emails because we need a medical record number on all correspondences.
- We cannot close a visit without first charting a diagnosis
Understanding and redesigning workflow is equally important and more complex in the acute-care setting, in light of the numerous patient touch points and interdisciplinary interactions. Automated workflow adjustments can actually offer better interdisciplinary communication and hence increase staff productivity. The changes do not have to be large to offer greater efficiencies that lead to increase staff productivity.
To illustrate, during a recent post live rounding, I observed a unit secretary and asked how things were going for her. She was cheerful and said that the new system was great. She then jumped out of her seat and wrote something on the printout behind her. I asked her what she had just written, because we spent a lot of time redesigning this requisition—what did we miss? She replied that the patient’s medical record number needs to be in the upper right hand corner. I asked her to read what was printed in the upper right hand corner, and she discovered that it was the medical record number and asked me – the IT person- if she still needed to write it on the requisition.
New software is not the only event that benefits from a clear understanding of staff workflow. Relocation and renovations also requires thoughtful consideration of workflow. Perhaps the most obvious workflow question for the newly designed space is whether patients will have privacy to talk with staff. I remember a number of difficult openings where clinical leadership demanded IT presence on-site because the current system was causing problems for patients in the new space. For example, patients were complaining that no one answers the phones, so IT needs to drop what they are doing and fix the phones as soon as possible. As it turned out, during the equipment placement design process with clinical leadership, phones were located on unmanned workstations.
New space renovations and system upgrades offer ongoing opportunities to understand internal workflow and interdisciplinary handoffs better and to make technology-supported enhancements. This alternative proactive approach to change empowers staff, rather than victimizes them.
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