Process Improvement with Electronic Health Records A Stepwise Approach to Workflow and Process Management

Introduction to Workflow and Process Management in Health Care
Context of Workflow and Process Management in Health Care
Workflow and Process Management for Clinical Transformation
Challenges of Workflow and Process Management in Health Care
Workflow and Process Management Defined for Health Care
     Case Study 1.1: Workflow for Preventive Screening
Workflows and Processes Performed by Knowledge Workers
     Case Study 1.2: Diagnosis-Drug Selection
Challenges and Needs for Workflow and Process Management for Knowledge Workers
     Case Study 1.3: Sequencing of Data in an EHR
Key Points
References

Workflow and Process Management Overview
Definitions of Terms: Workflow and Process Management
Definitions of Terms: Process and Workflow
     Case Study 2.1: Poor Dataflow Yields Medical Error
Definitions of Terms: Workflow and Process Mapping
Relationship of Workflow and Process Management for EHR and HIT to Other CQI Methodologies
Health Care Workflow and Process Management Timing
Health Care Workflow and Process Management Stakeholders
     Case Study 2.2: Redesigning a Patient Room for a New Hospital
     Case Study 2.3: Clinic Staff Mapping the Refill Process
Relationship and Importance of Workflow and Process Management to Change Management
Steps in Workflow and Process Management
Key Points
References

Step 1: Assess Readiness for Workflow and Process Management
Understand Organizational Culture for Change
     Case Study 3.1: The Itinerant C Suite
Change an Organization’s Culture
Assess End-User Readiness for the Clinical Transformation That EHR
and HIT Represent
Educate Stakeholders about EHR and HIT
Set S.M.A.R.T. Goals
     Case Study 3.2: On-board and Overboard with Goal Setting
Workflow and Process Management Governance
Key Points
References

Step 2: Compile Process Inventory
Process Inventory Description and Purpose
Process Inventory Worksheet
     Case Study 4.1: Clinic Processes
     Case Study 4.2: Hospital Processes
Generic Lists of Processes
Compiling the Process Inventory
Managing the Process Inventory
Process Inventory Database
Key Points
References

Step 3: Select Tools and Train Team
Workflow and Process Mapping Tool Selection
Workflow and Process Mapping Tools
     Case Study 5.1: Nurse Travel Time in a New Hospital
     Case Study 5.2: Downstream Time Savings Saves the Day
Selecting the Right Tool(s) and Following Tool Conventions
Level of Detail
Training the Workforce to Perform Workflow and Process Mapping
Key Points
References

Step 4: Map Current Workflows and Processes
Documenting While Doing
     Case Study 6.1: Mini-EHR Serves a Dual Purpose
Documenting Current Processes
Documenting Boundaries
Documenting Current Operations
     Case Study 6.2: Credentials Make a Difference
Documenting Variations in Operations
     Case Study 6.3: Process Variation
Documenting Appropriate Operational Detail
     Case Study 6.4: Too Little Detail
     Case Study 6.5: Too Much Detail
Documenting Decision Making
Clinical Decision Support
Documenting Decisions in a Process Map
Annotating Frequency of Decision Making, Operations, and Boundaries
Documenting Flow
Flowcharting Conventions
Special Symbols
Flowcharting Software Support
Subsidiary Documents
Process Mapping Template
Key Points
References

Step 5: Obtain Baseline Data
Purposes and Uses of Baseline Data Collection in Workflow and Process Management
Types of Benefits Studies
Risks and Benefits of Baseline Data Collection
Metrics for Benefits Data
     Case Study 7.1: Why Does it Take Twice as Long to Document?
     Case Study 7.2: Dismayed Physician Resolves to Acquire EHR
Strategies for Conducting Benefits Realization Studies
Data Collection Tools
     Case Study 7.3: Patient Perspective Survey
Sampling Methodology
Communications Surrounding Baseline Data Collection and Benefits
Realization Studies
Key Points
References

Step 6: Validate Workflow and Process Maps
Need for Validation
Collaboration
     Case Study 8.1: Obscure Terminology
Issues in "As-Is" Maps are Common
Seven Deadly Sins of Workflow and Process Mapping and Their Salvations
Taking a Validation Timeout
Key Points
References

Step 7: Identify Process Redesign Opportunities
The Process of Redesign
     Case Study 9.1: Contrarian Contributions to Process Redesign
Key Characteristics for Redesign
     Case Study 9.2: Clinically Relevant Duplication
     Case Study 9.3: Was the Task Performed, or Is Socialization Needed?
     Case Study 9.4: Reorganize the Environment to Improve the Use of EHR
     Case Study 9.5: Beating the System
Documenting the Redesigned Workflows and Processes
Validating the Redesigned Process
Key Points
References

Step 8: Conduct Root Cause Analysis to Redesign Workflows and Processes
Cause and Effect
     Case Study 10.1: Causality of Noncompliance with BC-MAR System
Weighing Potential Solutions
Requirement for Root Cause Analysis
Tools and Techniques to Aid Root Cause Analysis
     Case Study 10.2: New Workflow Results in Construction Project
Key Points
References

Step 9: Implement Redesigned Workflows and Processes
Implementing Redesigned Workflows and Processes
     Case Study 11.1: Consequences of Training Without Workflow and Process Management
Making Change Management a Priority
Creating Change Agents
     Case Study 11.2: Grime Scene Investigators Focus on the Hand Hygiene Process
Change Management Tools
     Case Study 11.3: Forces Impacting EHR Adoption
     Case Study 11.4: Physician Strategy Impacts All
Key Points
References

Step 10: Monitor Goal Achievement with Redesigned Workflows
Monitoring Goal Achievement
Measuring Results
Planning for Monitoring and Measuring
Celebrating Success
     Case Study 12.1: Celebration Gone Awry
     Case Study 12.2: A True Celebration for Learning
Correcting Course
Summary
References

Index

Biography

Margret Amatayakul