Healthcare Process Improvement Through Workflow Analysis
Meaningful Use, HIPAA, HITECH, ARA and many more rules yet to come, make it necessary to review clinic processes and how they are affected by the advancing tide of government regulation.
New regulations mean new processes.
To ensure your clinic remains in compliance, a process called Continuous Process Improvement should be implemented. This program will ensure you regularly review clinic workflows to ensure those workflows support the intent of any regulatory guidance issue by the government.
The following is a simple 10-step program to ensure painless process implementations and modifications.
Defining Process Improvement
What is Process Improvement?
At its most basic level, Process Improvement is simply a means to improve how processes are purposefully modified to create more productive outcomes.
In healthcare we often see processes that have evolved based on the changing influences on the medical practice. These influences can be internal or external to the practice. In either case, the chances were typically put in place and never reviewed for efficiency or practicality.
The Cambridge Dictionary defines Process Improvement as the job of examining the processes used in a company, department or project to see how they can be made more effective.
To put is in healthcare terms, Process Improvement is the activity of analyzing current clinical workflows and developing focused alternative workflows to simplify processes while improving patient safety.
How hard is Process Improvement?
Process Improvement is aimed at analyzing and changing the base level operation of a medical clinic and this can causes employees to react emotionally to the process. Most people do not like change, even when they know that change is needed.
So yes, Process Improvement can be difficult. But it doesn’t have to be. Start by getting the informal leadership involved in the process early and they will smooth the way for any needed changes.
Who Needs Process Improvement?
Everyone needs Process Improvement! No process is ever perfect, just as no process lasts forever. The run effectively, every clinic should implement a program to review its processes and workflows on a regular basis.
Healthcare is changing, that’s a fact of modern life. The Federal government is increasing regulation on the healthcare community. Many smaller medical practices do not have the time, personnel or expertise to keep up with the changes. This puts them at risk of violating new regulations and could put them out of business.
While larger healthcare organizations have employees dedicated to keep up with these changes, smaller medical practices do not.
Defining Workflow Analysis
What is Workflow Analysis?
Workflow Analysis is the act of studying how an activity if conducted and defining ways to make the process more effective and efficient.
Workflow analysis is an important component of Process Improvement in that it is the primary tool used to effect improvement at the base level of an organization.
We will examine this process here by defining a 10 step workflow analysis process.
How to Implement Workflow Analysis?
To overcome an addiction, you must first understand you have a problem and that something needed to be done about that problem. Process Improvement is similar in that you must recognize the need for continuous process improvement.
Once you make the decision, the really hard part is over. Now it’s just following through with your decision. Here we will discuss a simple 10 step framework to help you implement a process improvement program through workflow analysis and redesign.
Step One: Observing the Current Workflow
When I start out to conduct a workflow analysis I like to just observe what the current processes are. Just watch. You will be amazed at the things you observe when people are going through their work tasks.
You will see those tasks without interpretation by the employees or management staff. This provides a great basis for when you interview the stakeholders and ground zero users.
Next, I like to interview the stakeholders. This is where I learn how they think their practice is functioning. How they think their processes are working. Often I find that the higher levels of management have a distorted view of what happens at ground zero.
Interviewing Ground Zero Users
Finally I interview the ground zero users. These are the employees who actually interact with the patients. These are the ones who really know how the clinics current workflows are functioning. You’ll be amazed at how different their view is from the higher level management’s view.
Step Two: Analyze the Analyzing the Current Workflow
Step Two is where you start to put together a picture of how the clinic workflows are accomplishing their designed tasks.
Can the process be improved?
As a workflow specialist, you should ask yourself some important questions to ensure you really understand what the workflow is trying to accomplish.
What is the workflow trying to accomplish? Is the workflow accomplishing its goal? Is it doing so efficiently? Can the workflow be improved?
The answers to these questions will drive you next steps.
Should the Process be improved?
While not all change is bad, not all change is good. If a process is working, it may not need to be changed. After identifying what the workflow process is intended to accomplish, you may find it does not need improvement. If so, then move on to the next workflow.
What Areas need to be improved?
As you are putting together the information you have gathered from your Step One activities create a list of workflow that need to be addressed. Often I find that more than one workflow needs improvement.
This is necessary for two reasons, the workflow in inefficient or by changing one workflow we introduced changes on another workflow. Remember, business is built on interrelated concepts and activities and changing one can affect another.
Creating the Current Workflow Process Map
Once you have gathered and analyzed your information, you need to create a workflow model. I find using a process flow chart to be the easiest way for me to visualize a workflow process. However, some people relate better to a process list.
Whichever method you choose, the workflow model should clearly identify each step and component needed to complete the process.
Step Three: Develop New Workflow based on data developed in Steps 1 and 2
Identifying Areas Needing Improvement
Once you complete your workflow model, you need to identify areas needing improvement. This can be simply areas needing small changes to improve efficiency or areas that need complete retooling.
Be clear because you will need to be able to explain not just what areas need to be modified, but why they need to be modified. Expect hard questions here from your stakeholders here.
Developing / Defining the Needed Improvements
To effectively answer why a change is needed, you must develop the reason for the changes. Be specific and detailed here. This is going to be you ammunition when you report to the stakeholders.
Create an outline detailing each change and why it needs to be changed. Do this with processes you intend to keep also.
Creating the New Workflow Process Map
Now if the time to put everything together, build your new process map the same way you build the current process map. This will make it easier for your stakeholders to understand the changes in workflow.
Be very detailed here, but keep the model easy to understand. You may have to break it into smaller, more manageable sections.
Step Four: Review new workflow with Stakeholders
Presenting Current Workflow Process – Flow Chart
When you resent your findings and proposal to your stakeholders, do so in a concise and logical flow. Do not confuse them.
How they view their processes may not be what you found when you preformed your workflow study. It is at this point where you will have to educate them on what’s happening in their clinic. Expert some push back here.
Make sure that everyone understands the current workflow and the problems inherent in that workflow. This will make presenting your new workflow much easier. You might even highlight the problem areas, in color, on your workflow map.
Drive these problems home professionally, but firmly.
Presenting the New Workflow Process – Flow Chart
The next step is to present the new workflow to the stakeholders. This is where you can expect a lot of questions.
Your recommendations may cause some stakeholders some pain, be ready to address these issues when they are expressed. And believe me, they will be voiced. Sometimes loudly! Be firm and professional.
Walk them thought the new workflow point by point. Keep them with you and don’t let them get ahead. You might use PowerPoint to present your workflow step by step until you reach the end of the presentation. This is extremely important because you want them focused on you and your explanation, not of what comes next.
Don’t confuse them!
Allowing for Stakeholder Input
No matter how well you presented your new workflow, or the old one for that matter, expect many questions. I find it important to pay attention to how the question is asked as much as what the question is about.
Expect to clarify misconceptions. Expect to counter purposeful misinterpretations. You may not be aware of all the dynamics between the various stakeholders.
Above all, you must consider their input. It’s their clinic. Don’t take their questions personal, be professional you will experience much less stress.
You must be ready to fully explain how your workflow will improve their clinic.
Step Five: Modify New Workflow based on Input from Stakeholders
After you have presented your improved workflow to the stakeholders, you will probably need to make modifications to account for stakeholder bias and information that you did not have access to earlier in the process.
Step Six: Present to Stakeholders for approval to implement
Presenting Final Workflow to Stakeholders
After making the required modifications, you must get approval from the stakeholders to move forward with the process.
Don’t be surprised if you have to make the exact same explanations again. Most likely to the same people as last time. They man have a hidden agenda, pr may just be confused. Be professional and have a thick skin.
Gaining Acceptance of final Workflow Process
I find having a champion among the stakeholder is the easiest way to gain their approval. It gives me someone who will answer the concerns that will be voiced after the meeting.
Regardless, you must gain approval for the project to continue at this point.
Step Seven: Implement New Workflow Process
Discussing New Work Flow Process with Mid-level Management – Gaining Buy-in
I have found that implementing a project successfully requires a continuous process gaining the confidence of everyone in the process.
After gaining approval from the stakeholders, you still have to implement the approved process with the mid-level management and ground zero employees.
Mid-level management personnel are always looking for ways to be more effective. Present it to them as a way to make their lives easier by providing them a way to more effectively manage their teams. They will be on board and will become your champion.
Training Ground Zero Users on New Work Flow Process
Training the ground zero users can be one of your most difficult tasks. You must show them that it will make things easier for them.
One way to help gain their approval is to enlist the aid of the informal leaders. Every group had an informal leader, that one employee everyone looks to for help or approval. Gaining their assistance will make your implementation must easier. Failing to gain it could sink your project irrevocably.
Remember to listen to the workers in this group. Even at this state of the implementation you will learn factors that have to be address in your workflow. Don’t be afraid to make the modifications. Many times they were simply overlooked during Step One.
Step Eight: Monitor Workflow Adoption and Use
Following Up on Adoption Process
The implementation isn’t over after you train the new workflow. You must monitor the employees as the practice and learn how to operate within the new workflow. This is an important step.
It is in this step that you will need to reinforce the new workflow. Reinforce and redirect until the new process becomes accepted and integrated into the clinic.
Monitoring for Compliance
It seems like every group has that one person that refuses to follow any new process. Be careful with this person. They could derail your entire process.
Again, engage the informal leaders and mid-level management and redirect as necessary.
Step Nine: Adjust Workflow as Necessary
No Work Flow is Ever Perfect
Keep it in mind that no workflow or process is ever perfect and that others may be more able to see a problem because they are not invested in the project as heavily as you are. Listen to them, they may be right.
Adjusting Workflows as Needed
Don’t let your project fail because you were too ridged to may needed adjustments. Project managers invest a lot of effort to complete a project; do not let that keep you from looking at it objectively.
If a legitimate problem is identified, fix it and move on.
Keeping the Final Goal Firmly Set
Always keep the end-state firmly in mind. Be wary of scope creep.
Scope creep is where your project grows beyond its original mandate. This can happen because you discovered more issues than was originally thought or your stakeholder have added requirements after the project started.
TO be successful, a project manager must be able to control scope creep.
Step Ten: Conduct a Post-Implementation Review
Review with Ground Zero Users First
In an earlier phase we meet with the stakeholders first. In this step, I like to start with the ground zero employees first. This gives me good feedback which I can take to the next level.
It also may allow me to identify problems and propose solutions before I have my final meeting with the stake holders.
Review with Mid-level Management
When you meet with the mid-level management find out how they view the success of the implementation. Again, you can identify any problems needing addressed here. Also, this is your last chance to clear up any misconceptions or confusion.
Remember, these are the people who will be managing your workflow after the project moves into the normal operations phase.
Final Review with Stakeholders
You would think that by this point all questions have been addressed and resolved, but it doesn’t always work that way.
Be prepared to field a host of questions. I have found that most questions here are most for reassurance than anything else, unless you haven’t been transparent with your stakeholders. Keep them updated!
This is where you finalize the project.
Continuous Process Improvement is a necessary step that will ensure your clinic is in compliance with governmental regulations as well as a method of keeping it running efficiently.
It should be a matter of clinic policy to establish mandatory reviews of all processes and workflows as frequently as possible, but at least yearly. Additional process reviews should be conducted anytime regulations change. Noncompliance can be very expensive.
By following this simple ten step project plan, you will be able to quickly and efficiently implement any needed changes.
For assistance with conducting a workflow analysis or running a continuous process improvement program contact the The Nurse™.