Workflow, a set of tasks grouped into processes, require the interaction of people and resources to accomplish defined goals. Methodologies for examining workflows, like care coordination, equipment optimization or ER admission, within a hospital or clinic, can optimize systems for better efficiency, safety and satisfaction. In this article, we’ll review how healthcare system workflows help characterize and develop usability design approaches for greater efficiencies, reduced risks, regulatory snafus and benefit patient care.
In healthcare, processes may be interdependent and overlap various areas of responsibility, potentially impacting patient experiences and outcome. In a hospital setting, for example, the ED team and the ICU team may involve the same patient care continuum but comprise different roles and responsibilities, like unique equipment, protocols and reporting requirements and thus different workflow processes. While there is agreement of what to accomplish, these tasks can be disruptive when divergent workflows or unanticipated events occur, affecting efficiencies or heightening risks. Interactions among disparate processes, technology, resources and individuals can cause complexities, challenges, or pinch-points.
The continuum of care journey involving a patient and their loved ones’ experience addresses quality of care and hospital business interests. Continuity of care, clinical efficacy, patient safety and medical-legal affairs involve procedural protocols. Rigorous methodologies can streamline the continuum of care through observational studies that inform the development of an infographic process map. Collaborative analysis can translate study findings into insights, characterizing pinch-points/needs. Continuation of a collaborative approach, like a cross-functional workshop, yields actionable requirements and concept proposals for new systems or optimization of existing ones.
During the early months when the pandemic swept the nation and overwhelmed hospitals and care practices, organizations reexamined how providers and patients interacted with the healthcare system to best configure workflows in response to the impact of caring for the critically ill. A process mapping approach can address this need for systems and workflows to become more resilient and vetted for risk prevention.
Usability Design – A New Way Forward
The thought of reconfiguring a health care workflow, or understanding if it needs to be changed, can be daunting but achievable by following a usability design process with specific milestones and guidance based on a thoughtful project plan.
This approach creates the foundation upon which new systems/processes/workflows/best practices are developed. Such discovery, for example, covers the challenges and patterns of behavior to understand work-arounds. Have these work-arounds been successful in one area but introduced risk in another area of the care continuum? Can they be revised or enhanced to meet goals for all involved?
This foundation helps to uncover hurdles that impact efficiency, wellness, safety and risk management for patient care and regulatory. It elevates everyone to the same level of understanding – operations, administration, clinicians, patient, technicians, risk management, etc. – all have a vested interested in successful clinical outcomes and are part of proactive planning. The map becomes the Rosetta Stone for enabling collaboration.
Mapping a process delivers the following insights:
- Reveal spoken and unspoken needs, challenges and aspirations of applicable stakeholders
- Identify and characterize usability challenges, risk, near misses, work-around patterns and implications
- Discover new opportunities for improvement and innovation
- De-skill a procedure (design a procedure that enables all levels of users to have an optimal outcome)
Mapping can visualize aspects of related insights and metrics:
- Time/motion efficiencies
- User roles & responsibilities
- Equipment interoperability
- Resource life-cycle and waste
- Use error
The resolution of a process map is a function of the focal perspective of scope. The focus can be as granular or as broad as the following:
- Environment, e.g., ICU, OR, Imaging, Central Supply, IR Lab, etc.
- Continuum of care, e.g., Patient/Family Journey
- Equipment Life-cycle
Planning Strategic Initiatives
The project charter defines the general objectives and the strategic approach. The charter should be flexible as the project moves forward and is revisable when necessary, if previously undiscovered opportunities or challenges are revealed.
Next establish deliverables. For charter objectives, what does the outcome of the project look like? Based on newly discovered insights, deliverables may need updating throughout the project. Identifying stakeholders and introducing them to the project plan and its deliverables is next. Once embarking on the mission to optimize a system – whether throughout the entire healthcare organization, continuum of care or a specific focus on a procedure, collaboration will serve as the foundation for success.
Research, the Creative Fuel
Developing an approach for collecting data to inform the mapping process is key. Often better approaches employ different methods to discover truths like a combination of subjective and objective techniques. Deficiencies are often revealed in methods such as surveys and questionnaires. First, you have to assume you know the right questions to ask and depending on how you ask the question, you can get a different answer. Then, what if you don’t know what you don’t know? Second, study participants will have a multitude of biases in their answers; the most common is inaccuracy in memory.
An observational approach, like contextual inquiry or ethnography, can minimize biases and is not dependent on knowing the right question to ask – “show me, don’t tell me.” For example, posing questions like, “how do you complete that task?” will certainly elicit answers, often what is their expectation of the “right” answer. However, watching teams in action in real time may result in slightly or even very different practices that could impact the ultimate design of the workflow. Not to say that interviews are not useful, especially if they are informed by observational methods. In addition, there are several techniques to minimize biases.
Analysis, the Cornerstone in the Project
Regardless of the methodologies employed, this type of research can generate a great deal of data that has to be resolved. This is a most critical step. There are many techniques, many involving cross-functional teams, for dissecting research findings into relevant groupings, identifying patterns and trends, use related risk assessment and determining root cause in order to characterize problems. The analysis may require further research, as gaps are found and those questions you didn’t know to ask are discovered. The data will evolve from raw findings, to insights, to needs.
Synthesis Translates Research into Action
If analysis dissembles the data into its base components to understand relationships and patterns, synthesis reassembles the data in novel ways to create new ideas. Translating research insights into user needs, actionable requirements and concepts eventually requires buy-in from the stakeholders involved in the process. A carefully orchestrated workshop plan may include:
- Orientation/review of the map and research results emphasizing pinch-points and patterns
- Team discussion of the review identifying problem statements and innovation opportunities
- Divergent ideation by cross-functional teams addressing each of the problem statements and opportunities
- Convergent ideation by cross-functional teams developing divergent ideation output
- Development of brainstorming outputs into requirements and concept proposals
- Prioritization and codification of workshop outputs
- Summarization of next steps, timelines and milestones to achieve charter deliverables
Workflows in a healthcare system are impacted by many internal and external factors which, if the workflow process is not resilient and periodically tailored, can compromise efficiencies, introduce risks and regulatory snafus, ultimately affecting patient outcomes. Guided by usability experts, a workflow design process can be developed that exemplifies best practices and leads to the optimization of the continuum of care.