Blueprints Before Build, Part 2: Creating Better Workflows

In the first of this two-part series, I broke down what workflow really means, why it’s such a critical aspect of clinical care, and what defines bad workflow. Below, I’ll focus on the benefits of good workflow and how it can be established.

What is ‘good’ workflow?

Good workflow just feels right. It gives clinical and administrative staff confidence that the right thing is happening. It feels like someone with your specialty configured your EMR, wrote your policies, and trained you. I’ve even heard it described as a ‘leisurely walk down a street, where the things you need pop up in front of you just when you need them — not before, and not after.’

Technically speaking, good workflow means:

1. All of your tools, both inside and outside the EMR, support the same good, evidence-based, best-practice, efficient, and user-friendly workflows.
2. The workflows are completely built out.

Generating consistently smooth and complete workflows can be difficult, due to the large number of stakeholders that all healthcare organizations have to interact with, all of whom have an impact on the local workflows and configuration:

Again, it’s important to remember that configuration isn’t just the tools inside the EMR. The tools outside the EMR are just as important, and should be roughly half of the deliverables of any clinical workflow project.

How to build a ‘good workflow.’

Building good, smooth, and user-friendly clinical workflows consistently requires strategy, planning, and infrastructure.

First, you’ll want to propose a consistent change-management process, one that has a single point-of-entry (intake process), and follows all the way through to delivery of services and the monitoring and support required after your implementation. I recently started the Twitter hashtag #Blueprintsbeforebuild to try to create awareness of the importance of this change management process.

The process shown here shows the sort of rigor and discipline that’s needed to help ensure all current- and future-state workflows are well-understood, best-practice, cost-effective, and planned for, and that all stakeholders and deliverables have been properly identified during the project planning stage.

Next, you’ll need leadership support for this change management process, as well as agreement, both inside and outside of IT, to use the new process. You’ll also need agreement on how to address complex project management situations like urgent or emergent projects that come up from time to time.

You’ll also need governance to help balance the needs of the many stakeholders who play a role in shaping your configuration and your workflows, and help prioritize projects after they have been properly evaluated, analyzed, and scoped.

Finally, you’ll need a good project intake process, one that helps your directors to submit projects that get evaluated, analyzed, and scoped in a timely basis, before they get prioritized by your agreed-upon governance and leadership.

If the above seems complicated, you’re right: it is a lot of work. Clinical Informatics professionals are constantly working on building out governance, prioritization, change management, and project management, all with the goal of delivering smoother and more complete configurations (both inside and outside the EMR), that then help improve workflows and accomplish the following:

• Increase stakeholder engagement
• Increase provider satisfaction
• Reduce variation in practice
• Increase consistency
• Increase quality of care
• Reduce clicks
• Reduce unnecessary pages/phone calls
• Reduce training time
• Reduce burnout

You can start by asking your Clinical Informatics team about your current- and future-state workflows, supporting them in these important operational discussions, and sharing your knowledge about the relationship between good change management, solid governance, great configuration (both inside and outside the EMR), and great workflow — the kind that makes both clinical and administrative users smile.

Remember, this discussion is for educational purposes only; your mileage may vary. Always check with your clinical leadership, legal team, and clinical informatics leadership before you consider any changes to your change management strategy.

This piece was written Dirk Stanley, MD, a board-certified hospitalist, informaticist, workflow designer, and CMIO, on his blog, CMIO Perspective. To follow him on Twitter, click here.