Workflow Analysis Plugs into Efficiency

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Workflow Analysis Plugs into Efficiency

• Jonathan Kolarik, RN, MBA

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Workflow Analysis begins with a system.

• A system is anything that has interacting,
  interrelated or interdependent parts. Different
  kinds of systems might include
• Physiological systems -- like the nervous system,
  the endocrine system or the skeletal system
• Communication systems -- phone (telecommunication)
  systems and the postal (mail) system
• Computer systems -- like desktop systems, network
  systems, or software applications

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to effectively analyze a process

• Workflow is the process, progress, or "flow" of
  work within a system and the rate at which that
  happens.
• Workflow analysis refers to observing how this
  process takes place. The analysis also involves
  evaluating the process and improving it for
  efficiency and effectiveness.

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Contributors to the process

• Workflow Design Sequence of steps
• Track/Trend Record keeping and automation (or
  lack of)
• Motivation/Measurement explicit and implicit
  reward systems of the organization
• People Knowledge, skills, experiences
• Workplace Design, infrastructure

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Why bother?

• Potential for direct cost savings
• Potential for Hidden savings
• Potential for Intangible Benefits
• The right person, the right job, the right time

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• Many health care institutions do spend
  considerable money on IT, but the IT is often
  implemented in systems in a monolithic fashion
  that makes even small changes hard to introduce.
  Furthermore, IT applications appear designed
  largely to automate tasks or business processes.
  They are often designed in ways that simply mimic
  existing paper-based forms and provide little
  support for the cognitive tasks of clinicians or
  the workflow of the people who must actually use
  the system.

Computational Technology for Effective Health
Care Immediate Steps and Strategic Directions.
National Academy of Sciences, Institute of
Medicine January 2010
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Workflow plugs into Finance

• A single workflow failure can negatively impact
  revenues
• Commercial Industry has applied workflow tools
  and concepts successfully
• ARRA has mandated meaningful use

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Workflow plugs into HAI
In collaboration with The Chester County Hospital
and CentraState Healthcare System, Siemens
documented outcomes resulting from the
implementation of workflow analysis and
technology then measured the impact.
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Workflow Perspectives

• Every process has three versions
• The perceived process
• What we think the process is
• The reality process
• What the process actually is
• The ideal process
• What the process could be

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Workflow Process Analysis Methodology

• Frame the process
• Understand current processes
• Identify problem areas
• Identify areas of opportunity
• Develop solutions

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Frame the Process

• Identify staff involved in process and functional
  categories (nurse, physician, etc)
• Make note of culture, skills, and management
  style/structure EARLY Know your purpose,
  patients, processes, patterns, and professionals!

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Understand the Current Process

• Identify key steps in the process
• Develop initial diagrams of major steps
• -How does the work get done
• -Who does the work
• -Inputs, outputs, handoffs
• -Macro and microscopic processes

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Identify problem areas

• Does work slow or stop?
• Is work interrupted?
• Have staff developed a work-around?
• Are there redundancies or repeated steps in the
  process?
• Note problem areas on diagram

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Identify areas of Opportunity

• Connect problems with opportunities to show
  change
• Decide on the approach and prioritize
• Abandon process versus no-change
• Improve
• Re-design
• When those who benefit are not those who do the
  work, then any change is likely to fail or, at
  least, be subverted

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Develop Solutions

• Integrate solutions into workflow diagram to
  demonstrate effectiveness
• Leave no stone unturned
• Consider PDSA cycles of change

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Thanks!

• Jonathan Kolarik, RN MBA
• Oklahoma Foundation for Medical Quality
• jkolarik_at_ofmq.com