Workflow Redesign Part 2
Ajiri123
RESPONSEtoDiscussionN6421WK9.docx(Main Post)
Future-State Workflow Peer Review
The current-state workflow described above outlines the basic steps involved in the process of a patient seeking medical care at a clinic. It starts with the patient presenting to the clinic either through a referral or self-referral. Once the patient arrives, they are registered and assessed by the practitioner, who collects and reviews the patient's medical history, current symptoms, and other relevant information during the assessment.
Based on the assessment, the practitioner may order diagnostic tests such as lab work, imaging tests, or other tests to help diagnose the patient's condition. The diagnostic tests are then administered to the patient, and the results are sent to both the practitioner and the patient (Fernandes et al., 2019). The practitioner then reviews the results and orders the appropriate treatment for the patient. The ordered treatment is then administered to the patient. If needed, the practitioner may also order follow-up care for the patient, which could include follow-up visits, medications, or lifestyle modifications.
Once the treatment and follow-up care is complete, the patient is discharged from the clinic. While this current-state workflow provides a general overview of the patient care process, the gap analysis conducted in the paper identified several issues that hinder the workflow's effectiveness. The primary issue identified was a need for more efficient clinician communication caused by ineffective regulations, EHR restrictions, and staff members' lack of communication skills (Skeff et al., 2022). The lack of clarity regarding the roles and responsibilities of the various healthcare professionals involved can also lead to confusion and miscommunication, resulting in delays in treatment or mistakes in care (Haase, 2019). Additionally, the lack of a standardized workflow and an overall lack of understanding of the process by healthcare personnel can lead to confusion and inefficiency in using EHRs, resulting in decreased quality of care.
To address these gaps, the paper recommends implementing several solutions, including creating a standardized workflow, establishing an effective method of communication between practitioners, nurses, and other healthcare personnel, providing education and training to all healthcare personnel, and regularly monitoring the workflow. The current-state workflow is a useful starting point for understanding the basic steps involved in patient care at a clinic. However, as the gap analysis highlights, there are several areas for improvement to ensure that the workflow is effective and efficient and that healthcare providers can comply with meaningful use objectives. Implementing the recommended solutions will help ensure that the patient care process is streamlined and effective and provides high-quality care to patients.
The current-state workflow presented in the paper outlines the steps involved in a patient's visit to a clinic, from registration to discharge. The process begins with a patient's arrival at the clinic, either through a referral or self-referral. The patient is then registered and assessed by a practitioner, who collects and reviews the patient's medical history and current symptoms. Based on this assessment, the practitioner may order diagnostic tests such as lab work or imaging tests. These tests are then administered to the patient, and the results are sent to the practitioner and patient. The practitioner reviews the results and orders appropriate treatment for the patient, which is then administered. Follow-up care may also be ordered for the patient, such as follow-up visits, medications, or lifestyle modifications. Once the treatment and follow-up care is complete, the patient is discharged from the clinic.
References
Fernandes, S. L., Tanik, U. J., Rajinikanth, V., & Karthik, K. A. (2019). A reliable framework for accurate brain image examination and treatment planning based on early diagnosis support for clinicians. Neural Computing and Applications, 32(20), 15897–15908. https://doi.org/10.1007/s00521-019-04369-5
Haase, K. K. (2019). Addressing burnout in clinical pharmacy: What can we learn from other health care disciplines? Journal of the American College of Clinical Pharmacy. https://doi.org/10.1002/jac5.1189
Skeff, K. M., Brown-Johnson, C. G., Asch, S. M., Zionts, D. L., Winget, M., & Kerem, Y. (2022). Professional Behavior and Value Erosion: A Qualitative Study of Physicians and the Electronic Health Record. Journal of Healthcare Management, 67(5), 339–352. https://doi.org/10.1097/JHM-D-21-00070
Discussion Reply #2
Thank you for this thoughtful workflow diagram. It is easy to follow and understand, but some of your text may not be visible due to an error in sizing the text to fit the diagram symbol. Your model appears to be a functional decomposition model (FDD) as the organization of your model and its flow is in a top-down approach (Tilley, 2020). You've done a nice job identifying decision points within the model and all points are connected using arrows with a logical flow. Your model does not include swim lanes; I would encourage you to make this amendment moving forward. We both selected similar topics regarding results management, how diagnostic results are shared amongst healthcare entities and the patient and who accepts responsibility for necessary follow up care. Areas to include additional details are what types of communication are implemented from practitioner to practitioner, patient to practitioner and how both of these communicate with the electronic health record (EHR). Additionally, a description of the standardized method of communication should be included. Dependency on the assumed communications within the EHR through forwarding work responsibilities, as identified in Professional Behavior and Value Erosion: A Qualitative Study of Physicians and the Electronic Health Record, has a significant effect on interprofessional relationships and trust. A standardization of communication between colleagues that is both effective and respectful to the professional relationship is paramount to high quality care.
Tilley, S. (2020). Systems analysis and design (12th ed.). Boston, MA: Cengage.
Skeff, K. M., Brown-Johnson, C. G., Asch, S. M., Zionts, D. L., Winget, M., & Kerem, Y. (2022). Professional Behavior and Value Erosion: A Qualitative Study of Physicians and the Electronic Health Record. Journal of Healthcare Management, 67(5), 339–352. https://doi.org/10.1097/JHM-D-21-00070Links to an external site.
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7:48amApr 29 at 7:48am
Discussion Reply #2
Thanks for your post! The workflow was easy to follow and although descriptions were broad their order queue was comprehendible. I could see the workflow diagram have opportunity to expand. The consideration would be to expand the diagram into disciplines within swimlanes. Describing the processes under patient, nurse, laboratory, practitioner, front desk/registration, could organize the steps in a comprehendible way with more detail. The detail would be less in the description but more in the workflow shapes and arrows flowing in a fluid direction. The use if swimlanes provides further high level description of future processes that easily point out meaningful use objectives for key stakeholders when reviewing these diagrams prior to implementation (Bakar et al, 2020). Dividing up the processes under appropriate discipline could then be followed by a specific workflow shape such as a rectangle or square to signify initiation of the workflow process. Also I suggest the use of a diamond workflow shape or bordered shape with ending steps like “patient will be referred back for” to appear more as separate entities signifying a step back in the process rather than looking like it’s part of the workflow flowing forward. Or even coloring coding this process and similar ones could be helpful!
The use of processes such as the one I reference, and the one labeled as “the patient will be reffered back to the medical practitioner” appear to need more support. These are potential gaps that could benefit from more support via the EHR system (such as documentation from the front desk describing the referral process back to the practitioner). This will then help highlight the meaningful use of EHR utilization for enhanced patient care delivery. The meaningful use of enhanced patient care delivery w/ utilization of EHR for continuum of care for this workflow diagram can help collect future data on how the documentation of these visits could further improve the continuum care process within the organization. EHR’s are usually seen as a routine documentation step that collects data for hospitals but many do not realize how powerful these systems are in highlighting inequities in care (Getzen et al, 2023).
Creating an accurate future state workflow with this meaningful use objective in mind will not only help in creating treatment at the clinic but create enhanced policies for continuum of care through identified data within the meaningful use objectives highlighted in these potential gaps seen.
I really enjoyed your post Moses, and I actually received a lot of extra education through your thoughts and creation of the diagram. It has helped me realized the broadness, gaps and issues within my own workflow diagram as well. Overall I think your workflow sets up a strong foundation for expansion that could help meet the clinics objectives.
References
Bakar, N. W. A., Musa, S., & Mohamad, A. H. (2020, May). A mini comparative study of requirements modelling diagrams towards swimlane: evidence of enterprise resource planning system. In Journal of Physics: Conference Series (Vol. 1529, No. 5, p. 052054). IOP Publishing.
Getzen, E., Ungar, L., Mowery, D., Jiang, X., & Long, Q. (2023). Mining for equitable health: Assessing the impact of missing data in electronic health records. Journal of Biomedical Informatics, 104269.
Sijm-Eeken, M., Zheng, J., & Peute, L. (2020). Towards a lean process for patient journey mapping–a case study in a large academic setting. In Digital Personalized Health and Medicine (pp. 1071-1075). IOS Press.
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YesterdayApr 28 at 10:30pm
Discussion Reply #2
Good evening,
Thank you for sharing your future-state workflow. It was challenging to figure out how to make the workflow models without Microsoft Visio. Microsoft Office (2019) helped me create my models using SmartArt on PowerPoint, but the Flowchart Shapes are also helpful (Insert / Shapes / Flowchart). Once my model is created, I copy everything to the humble Paint application and save my work as a .png file. This step is essential because whatever is written inside the shapes will not change. I hope it helps!
Marriot (2018) stated that process mapping is an essential tool for improving the quality of healthcare delivery by providing a visual representation of its intricate processes. It aids in identifying the sequence of steps involved in the process, their timings and transfers, and the outputs that can be visualized, measured, and studied. On the same note, Weekes et al. (2018) mentioned that process mapping involves identifying start and end points, listing steps and decision points, and using swimlane diagrams to divide the process and show responsibilities.
Having said the above, I found some improvement opportunities:
2. Lack of swimlanes and process actors. Swimlanes play a crucial role in process mapping as they partition a process into lanes that demonstrate the responsibility of each person involved in various actions, leading to improved clarity and accountability. Swimlanes make it easier for stakeholders to comprehend the process flow, enabling them to identify areas that need improvement. Moreover, they can help optimize communication and minimize confusion, enhancing process efficiency.
2. Several activities were summarized in one shape. The "Patient registers and is assessed by the practitioner" activity assumes different actors and tasks. Actors: Patient, Front desk staff (not mentioned), medical assistant/nurse, and practitioner. When patients arrive at a medical facility, they must register, present their ID, and insurance card, and make payments at the front desk. A medical assistant or nurse needs to welcome them and take their vitals, and finally, they are seen by a practitioner/provider.
2. Lack of clarity in the first loop. According to the loop, the patient must register again if the answer is "No" to the first decision-making. This step needs to be revised and waste time. The loop gives me the idea that the practitioner believes he/she could make the diagnosis and order the test. What happens if the patient needs to be sent to a specialist because the practitioner could not find a diagnosis to treat?
2. Lack of clarity in the second loop. According to the loop, if the patient does not improve with the treatment, he/she is sent back to treatment for the same diagnosis with the same treatment. It would be helpful if the practitioner rethinks the treatment with the new data and then orders a new treatment.
References
Marriott, R. D. (2018). Process mapping–the Foundation for effective quality improvement. Current problems in pediatric and adolescent health care, 48(7), 177-181. https://doi.org/10.1016/j.cppeds.2018.08.010Links to an external site.
Microsoft Office. (2019). Create a flow chart with SmartArt. Retrieved from https://support.office.com/en-us/article/create-a-flow-chart-with-smartart-30f87402-ba3d-48c8-8e9f-a66bcee7e5aaLinks to an external site.
Weekes, L., Lawson, T., & Hill, M. (2018). How to start a quality improvement project. BJA education, 18(4), 122. https://doi.org/10.1016/j.bjae.2018.01.004Links to an external site.
