Clinical Workflow Analysis & Process Redesign: Part 1
So why and what are we doing when we analyze clinicians' workflow? What do we want to accomplish by redesigning their processes? Why do it?
The big picture answer is: We in clinical informatics have been charged with implementing information system tools to improve the quality of care, increase safety, improve efficiency, decrease errors, and - related to healthcare reform - achieve compliance with federal mandates, i.e., meaningful use. The answer at the individual healthcare organization level is that they, too, have been charged with implementing information system tools such as computerized provider order entry (CPOE), barcode medication verification (BMV), electronic medical records (EMRs), etc., to improve quality of care, increase safety, improve efficiency, decrease errors and achieve compliance with federal mandates.
CPOE, BMV, EMRs (and all the other associated acronyms) automate clinical care by automating the care delivery processes of clinicians.
But automation for automation's sake is poor practice. Automation for automation's sake is not our objective and it should NEVER be our objective. We also DO NOT want to automate an already poor process.
It is a well-known fact that the implementation of information systems technologies within the clinical setting impacts clinical processes and workflows. Doctors fear the new CPOE implementation will negatively impact their productivity. Nurses are concerned the implementation of the EMR and computers at the bedside will take away from their nurse-patient interactions.
It's true the implementation of clinical information systems can't help but impact how clinicians practice - how they render care, perform their daily tasks and how they do their jobs. Those technological changes impact the clinical environment, the clinician and the patient. Ideally we want that "impact" to be positive not negative.
By understanding and adequately performing clinical workflow analysis and process redesign prior to implementing information system technologies, we further ensure the success of the technological changes and also that we achieve our original goals of: improving the quality of care, increasing safety, improving efficiency, decreasing errors and achieving compliance with federal mandates.
Earlier I wrote that automation for automation's sake is not our objective. There are other objectives achieved as a result of understanding the why and best practices of clinical work flow analysis and process redesign.
Do No Harm
This is the first objective. Analysis and redesign decreases the potential for harm, injury or death to the patient.
Improving Clinical Practice
How many times have you heard this? "It's about the patient - patient care comes first." If one of our goals is to improve clinical practice and we know that done correctly the implementation of information systems technologies has the potential to improve patient care and thereby clinical practice - then it stands to reason that the utilization of workflow analysis and process redesign can help us improve clinical practice and thereby patient care.
Clinical Practice vs. Technology
As clinical informaticists it is our responsibility to make sure the technology is not dictating or driving clinical practice but that clinical best practices drive the technology and that the technologies are utilized as effective tools by the clinicians. We DO NOT want the tail wagging the dog. Do we?
Seize the Opportunity - Carpe Diem!
Our objective should be to perform workflow analysis and process redesign before implementation. This is where the true opportunities come to improve, optimize, re-engineer and streamline inefficient clinical processes and workflows.
If we truly want to control the impact that implementing technology will have on clinical practice (the patient and the clinician) than analysis and redesign are a must. A doctor once told me: "Angela, your job is to make this process as painless as possible!"
In my next post, Part II, will look at:
- Clinical Workflows - The Good, the Bad and the Ugly
- Analysis, Approaches, Tools and Methodologies
- Future State and Testing
- Our Original Questions and Ultimate Goals