Quality Improvement Workflow Design Lecture a This material (Comp12_Unit6a) was developed by Johns...

Quality Improvement

Workflow Design

Lecture a

This material (Comp12_Unit6a) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000013.

Workflow Design Learning Objectives─Lecture a

• Assess decision-making requirements in health or healthcare.

• Construct a work process flowchart.

2Health IT Workforce Curriculum Version 3.0/Spring 2012

Quality Improvement Workflow Design

Lecture a

Definitions

• Workflow: series of linked steps through which a process is accomplished within a given system

• Workflow analysis: description of the sequence of events that are part of a process

• Flowchart: the tool used to perform the workflow analysis that provides a graphic representation of the process



Lecture a

Use of Workflow Design in HIT

• Implement existing HIT solutions/products in clinical sites

• Design new HIT solutions/products for use in the health care field

• Enhance and update existing HIT solutions/products



Lecture a

Why Perform a Workflow Analysis?

• Shows unexpected complexity, problem areas, redundancy, unnecessary loops, and areas where improvement is possible

• Compares actual vs. ideal flow of processes• Allows team to come to agreement as to where

to make changes for improvement• Identifies areas where additional data are

needed• Serves as a training tool (Brassard & Ritter 1994)



Lecture a

Workflow Analysis Methods

Qualitative• Ethnographic

observation• Shadowing of individual

clinicians• Surveys and

questionnaires• Human-intensive;

produce low-volume, high-quality data

Quantitative• Sensor technologies

such as passive infrared sensors, radio identification tags, and pressure sensors

• Video recordings• Allow time stamping;

produce high volume abstract data

(Vankipuram et al 2010)6Health IT Workforce Curriculum

Version 3.0/Spring 2012


Lecture a

Analyze Requirements:Workflow Integration Matrix

• Analyze workflow

• Verify and prioritize findings with clinicians

• Communicate with development team

• Conceptualize and evaluate design (Jalote-Parmar A., et al, 2010)



Lecture a

Work Process Flow



Lecture a

Work Process Flowchart



Lecture a


• Simple diagrams

• Used to define and analyze processes

• Clarifies understanding of a process

• Communicates how a process works

• Illustrates a step-by-step picture of a process

• Identifies areas for standardization or improvement in a process



Lecture a


• Elongated circle = start or stop point

• Rectangle = actions or instructions

• Diamond = decision-point

• Arrow = connector that shows the flow



Lecture a




Lecture a


High Level• Shows 6–12 steps• Presents a

panoramic view of a process

• Shows the major blocks of activity

• Useful in early phases of a project

Detailed• Close-up view• Presents a detailed

view of process steps• Shows complexity• Useful once issues

have been defined and changes are to be made



Lecture a


• Get the right clinicians in the room

• Define the start and end points of the process

• Complete a high level picture

• Decide on the level of detail required

• Brainstorm tasks and decisions made

• Describe the process as it really exists



Lecture a


• Clearly define each step in sequence

• Include problems

• Identify delays or non-value added steps

• Make notes about unfamiliar steps

• Go back and fill in the branches

• Assign action items to fill in unfamiliar steps and verify accuracy



Lecture a

Create a Workflow

• Your team determines it is having issues documenting tuberculosis skin tests (PPD). This is a process that spans over three days and involves providers and support staff.

• When the provider orders a PPD, the medical assistant places it in the forearm. It takes three days for the body to react, by which time the patient needs to come back to the clinic with an appointment (which needs to be made before the patient leaves).

• When the patient arrives in three days, the nurse examines the result. If the result is negative the nurse documents it in the EHR. If it is positive the provider is contacted for a follow-up decision and the result is documented.



Lecture a

Flowchart:The PPD workflow



Lecture a

Workflow Design Summary─Lecture a

• Work process flowcharts are useful in defining and analyzing processes.

• Understanding workflow and information flow is required to maximize HIT use.

• Lean thinking is helpful in maintaining a patient-centered approach.

• The key to success is to involve those who know the process best.



Lecture a

Workflow Design References─Lecture a

References• Brassard, M. & Ritter, D. Flowchart. The Memory Jogger II. GOAL/QPC 1994• Jalote-Parmar, A., Badke-Schaub, P., Ali, W., Samset, E. Cognitive processes as integrative component for

developing expert decision-making systems: a workflow centered framework. J Biomed Inform. 2010 Feb; 43(1):60-74. Epub 2009 Jul 14.

• Vankipuram, M., Kahol, K., Cohen, T., Patel, V.L. Toward automated workflow analysis and visualization in clinical environments. J Biomed Inform. 2010 May 29. [Epub ahead of print]

Images

Slide 8: An Alarm Clock. Creative Commons. Alan Cleaver_2000. Available from: http://www.flickr.com/photos/11121568@N06/4293345633

Slide 9: Work Process Flowchart. Courtesy Dr. Stephanie Poe

Slide 11: Work Process Flowchart. Courtesy Dr. Stephanie Poe

Slide 12: Work Process Flowchart Symbols. Courtesy Dr. Stephanie Poe

Slide 17: PPD Workflow Courtesy Dr. Stephanie Poe



Lecture a

http://www.flickr.com/photos/11121568@N06/4293345633

Quality Improvement Workflow Design Lecture a This material (Comp12_Unit6a) was developed by Johns...

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