Understanding workflow design
As you explored last week, the implementation of a new technology can dramatically affect the workflow of an organization. Newly implemented technologies can initially limit the productivity of users as they adjust to their new tools. Such implementations tend to be so significant that they often require workflows to be redesigned in order to achieve improvements in safety and patient outcomes. However, before workflows can be redesigned, they must first be analyzed. This analysis includes each step in completing a certain process. Some systems duplicate efforts or contain unnecessary steps that waste time and money and could even jeopardize patient health care. By reviewing and modifying the workflow, you enable greater productivity. This drive to implement new technologies has elevated the demand for nurses who can perform workflow analysis.
In this Discussion you explore resources that have been designed to help guide you through the process of workflow assessment.
To prepare:
• Take a few minutes and peruse the information found in the article “Workflow Assessment for Health IT Toolkit” listed in this week’s Learning Resources.
o As you check out the information located on the different tabs, identify key concepts that you could use to improve a workflow in your own organization and consider how you could use them.
o Go the Research tab and identify and read one article that is of interest to you and relates to your specialty area.
By Day 3
Post a summary of three different concepts you found in “Workflow Assessment for Health IT Toolkit” that would help in redesigning a workflow in the organization in which you work (or one with which you are familiar) and describe how you would apply them. Next, summarize the article you selected and assess how you could use the information to improve workflow within your organization. Finally, evaluate the importance of monitoring the effect of technology on workflow.
Systems Design and Workflow
Consider a clinical process or task that you perform on a frequent basis. Do you do it the same every time? Why do you proceed the way you do? Habit? Protocol? Each day nurses complete certain tasks that are considered routine, but have you ever stopped to reflect on why things are done the way they are? Perhaps you have noticed areas where there is a duplication of efforts or an inefficient use of time. Other tasks might pass seamlessly from person to person. In order to design the most efficient flow of work through an organization, it is useful to understand workflow and the ways it can be structured for the most optimal use of time and resources.
This week, you examine the concept of workflow and how the design of the workflow impacts the effectiveness and quality of an organization. You analyze a current workflow design and formulate a new workflow design to improve a process.
Learning Objectives
Students will:
• Analyze the effect of system design and workflow on health care quality
• Analyze the steps in a current workflow design
• Formulate a new workflow design to improve a process
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
• Chapter 14, “Nursing Informatics: Improving Workflow and Meaningful Use”
This chapter reviews the reasons for conducting workflow analysis and design. The author explains specific workflow analysis and redesign techniques.
Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Medical Research Methodology, 11(1), 43–61.
In this article, the authors describe an implementation of workflow engine technology to support clinical decision making. The article describes some of the pitfalls of implementation, along with successful and future elements.
Koppel, R., & Kreda, D. A. (2010). Healthcare IT usability and suitability for clinical needs: Challenges of design, workflow, and contractual relations. Studies in Health Technology and Informatics, 157, 7–14.
This article points to many health information technology designs and workflow decisions that limit their value and usage. The authors also examine the structure of the conceptual relationships between HIT vendors and the clinical facilities that purchase HIT.
U.S. Department of Health & Human Services. (n.d.b). Workflow assessment for health IT toolkit. Retrieved, June 18, 2012, from http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865
This article supplies a toolkit on the planning, design, implementation, and use of health information technology. The sections of the website provide a definition of workflow, examples of workflow tools, related anecdotes, and research.
Document: Sample Workflow of Answering a Telephone in an Office (Word document)
Note: You will use this document to complete this week’s Assignment.
Required Media
Laureate Education (Producer). (2012f). System design and workflow. Baltimore, MD: Author.
Note: The approximate length of this media piece is 7 minutes.
NURS 6051: Transforming Nursing and Healthcare through
Information Technology
“System Design and Workflow”
Program Transcript
NARRATOR: In the health care industry, the term workflow is used to describe
the many complex systems of interconnected processes that contribute to the
delivery of care. Workflow is a model used to summarize all of the steps that go
into a specific health care procedure, such as checking in a patient or having
blood work done.
Workflow is especially relevant in today\’s health care environment, which is
focused on streamlining operations and increasing quality and value for patients.
This often involves implementing technologies, such as wireless communication
devices and electronic health records, or EHRs.
Leaders and stakeholders of health care organizations often design workflow
with effectiveness and efficiency in mind. Workflow design begins with ou
tlining current procedures related to health care delivery. Then, this information is used
to define future workflow requirements and changes that could be made to improve the quality of care. This step is known as process modeling. Oftentimes, process modeling is completed using a workflow diagram, which illustrates relevant tasks and branch points where decisions or options occur. To better understand process modeling, let\’s explore an example of a current
workflow diagram and how it could be improved by integrating technology. In this
example, we will explore workflow for a patient visit to receive an injection or
immunization.
The process begins when the patient arrives for the appointment. The patient
signs in with the receptionist, who pulls the patient\’s file and asks him or her to
verify the information. If the patient needs to make a co-pay, then he or she does
so. If not, or after the co-pay has been collected, the patient takes a seat in the
waiting room.
Then, the receptionist verbally notifies the nurse that the patient has arrived and
puts the patient\’s medical record, super bill, and labels into a tray for the nurse to
collect. When a room is available, the nurse takes the documents in the tray and
rooms the patient.
The nurse checks the patient\’s vital signs, verifies the patient\’s medications and
allergies, and confirms that the patient has come for an injection or immunization.
Then, the nurse performs the procedure and records it in the patient\’s chart.
If the patient has a reaction to the injection, or if there is another problem, the
nurse must find the physician to address the issue. The physician then sees the
patient and records the incident in the chart.
When the visit is complete and all issues have been addressed, the nurse gives
the patient any relevant materials and the super bill for the visit. The nurse also
asks the patient to check out with the receptionist. If the patient does not check
out, his or her super bill will be lost.
If the patient does check out, the receptionist collects the super bill, verifies the
charges, and schedules of any follow-up appointments. Then, the patient leaves,
and if the visit is complete, the receptionist sends the patient\’s record and super
bill to billing. If there is still outstanding paperwork for the nurse to complete, the
receptionist must wait to send out the record and super bill. After the bill is sent
out, the workflow ends.
As you can see, this workflow scenario has several inefficiencies that could be
addressed by integrating technology. The first procedure that would be affected
by these changes is the receptionist pulling the patient\’s file. In an EHR workflow,
the receptionist could simply call up the record on the computer.
Later in the workflow, the receptionist could use the wireless communication
system to notify the nurse if the patient had arrived. With an EHR, the nurse also
would not have to collect the documents from the tray at the front desk. Instead,
the nurse would access the record on the computer in the medical exam room.
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This would also affect how the nurse makes notes in the patient\’s chart. If a
reaction or a problem occurred, the nurse could use the wireless communication
system to notify the physician. This would improve the efficiency of the workflow
and would add to the quality of care, because the nurse could stay with the
patient instead of leaving the room to find the physician.
At the end of the visit, the nurse would no longer hand the patient the super bill.
Instead, the nurse would update the super bill within the EHR, and this data
would be immediately available to the receptionist at the front desk. This would
eliminate the loss of information if the patient did not check out. In this case, the
receptionist would simply make a note to contact the patient for any need follow-
up.
As this example has shown, by using the steps of workflow design, leaders of
health care organizations can identify inefficiencies in current systems and
determine how the systems will be affected by tools like EHRs and wireless
communication devices
This video provides an overview of how workflow modeling can be used in a health care setting to target areas for revising current practices and procedures. The video also shows how technology and informatics can be used to improve workflow efficiency and increase the quality of care.
