"Workflow" becomes a problem when it neither works nor flows.

Someone recently wrote this on Twitter and it caught my attention. It caught my attention because everyone seems to be talking about Practice Workflow and how to optimize it. It is also being talked about in the context of EMR / EHR Software Systems. Yet majority of small practices struggle with the concept of Workflow precisely for this reason - it neither works nor flows as they expect it to. We may think it does, but it meanders, particularly for inefficient workflows. We know that a straight line should take a mile, but the inefficient meandering workflow may take 2 miles to get there. These workflows work eventually though and flow ultimately, because at the end of the day, somehow, things do seem to get done.

In a fantastic book edited by Ronda G. Hughes, PhD, published by NCBI (NIH) in 2008 titled - "Patient Safety and Quality", there is a Chapter on Organizational Workflow and its Impact on Work Quality that I think everyone should read. I have extracted some important elements here.

Some Workflows are designed, while others evolve and happen organically over time. Most often, when workflow processes are looked at in isolation, they appear quite logical (and even efficient) in acting to accomplish the end goal. It is in the interaction among these processes that complexities arise. Some of these interactions hide conflicts in the priorities of different roles in an organization, for example, what the staff is accountable to versus the physician(s) and their schedule. Practices also adapt workflows to suit the evolving environment.

Over time, reflecting on workflows may show that some processes are no longer necessary, or can be updated and optimized.

Today, the need to think about workflow re-design is important due to several factors, including:

  • Introduction of new technologies like EMR/EHR Software Systems
  • New treatment methodologies
  • Cost and efficiency pressures to improve patient flow
  • Initiatives to ensure patient safety
  • Implementation of changes to make the care team more patient-focused

Perhaps the most important reason that workflow is of pressing concern for today's clinicians is the introduction of healthcare information technology (healthcare IT). While EMR software promises benefits, it can be disruptive to existing workflows in a practice.

EMR software systems assume a workflow structure in the way their screens and steps are organized. Practices that are thoughtful about workflow design are more likely to be successful in adapting to EMR Software Systems and being successful.

Do you think just by installing a good EMR you can accomplish this?  That will depend on the kind of workflow.

Poor Workflow

Practices rely on good information. Valuable information can be lost when poor workflows impede communication and coordination or increase interruptions.

A poorly functioning workflow includes:

  • Unnecessary pauses and rework
  • Delays
  • Established 'workarounds'
  • Gaps where steps are often omitted.
  • A process that participants feel is illogical.

Good Workflow

The design of good practice workflow is not simply about improving efficiency. Workflow processes are maps that direct the team (front office, clinicians and back office) how to accomplish a goal. A good workflow will help accomplish those goals in a timely manner, leading to care that is delivered more consistently, reliably, safely, and in compliance with standards of practice.

An excellent process can accommodate variations that inevitably arise in healthcare through interaction with other workflow processes, as well as factors such as workloads, staff schedules and patient load.

Impedance and Hurdles in the way of a Good Workflow

5 primary instances why EMR Software Systems can disrupt practice workflow:

  1. Instead of using EMR Software implementation as an opportunity to re-design practice workflow, practice owners that just throw technology into the mix of an existing workflow is more likely to cause the process to become even more inefficient than before.
  2. Treating EMR Software system as a 'necessary evil' that has to be done. This thinking prevents proactive initiatives to re-design workflow.
  3. Acquiring EMR Software as if it was a 'commodity' and Shopping solely on pricing, look-and-feel etc.
  4. Not involving the entire staff in decision-making.
  5. Not being prepared to re-design your Workflow

Conclusion

In addition to looking for an EMR system that has the necessary features at a reasonable price, one should not compromise on practice workflow re-design. Most systems today have most of the features that a practice needs and industry competition has leveled the playing field where pricing differences are minimal.

Workflow re-design and optimization can be accomplished in two ways.

  1. Find a Vendor / Re-seller that knows how to do this and has experience doing so.
  2. Find a Consultant that can help.

Either way, EMR Software is anything but a Commodity.