4/1/2016. Grace LaConte, MS, RHIA Communication Strategist LaConte Consulting

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1 Grace LaConte, MS, RHIA Communication Strategist Missouri Health Information Management Association Thursday, 04/21/2016 1

2 Can workflow strategies help me? Grace LaConte Founder & Lead Consultant at A Word of Thanks What You Will Learn My Promise 2

3 Twitter #MoHIMA16 1. What is Workflow? When, where, how to apply 2. Workflow Tools SWOT Analysis Swimlane Diagram Process Flow Diagram Workflow Diagram 3. Case Studies Dangerous Discharge Hand Hygiene Maintenance Request 3

4 Stressful Manager anxiety & depression Dangerous Workplace injuries Readmissions/ADEs Data breaches Disengaged Employee turnover Nursing shortage Technology EHRs are not plug-and-play Importance of human contact Patient Needs Boomers & Millennials High expectations Information Ineffective Inefficient Missing information 4

5 Lack of Communication Not listening to understand Information flow process is flawed Direct effect on patient outcomes 5

6 The flow of work Established path along which tasks are sequentially completed to accomplish a function. 6

7 Movement diagram, layout, or visualization Source: Spatial workflow Perform tasks together Use equipment efficiently Wireless sensors Source: ATR Projects.pdf 7

8 Goals: Business process redesign Optimal efficiency Force Field Analysis SWOT Analysis Swimlane Diagram Process Flow Diagram Workflow Diagram 8

9 Have you ever used workflow tools in your workplace? Yes, I ve used some No, we don t currently use them Increase productivity Improve employee engagement Decrease errors 9

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11 Set-up, performance, and monitoring of a defined sequence of tasks arranged as a workflow. Source: Workflow Modeling, 2nd Edition by Alec Sharp & Patrick McDermott, 2009 Indicates forces for change 11

12 Method Tools Result Strategy SWOT Analysis Clarity Supervision Swimlane Diagram Identify Gaps Process Improvement Process Flow Diagram Improve Efficiency Mapping Workflow Diagram Map Effectiveness Method Tools Result Strategy SWOT Analysis Clarity Supervision Swimlane Diagram Identify Gaps Process Improvement Process Flow Diagram Improve Efficiency Mapping Workflow Diagram Map Effectiveness 12

13 Strengths Weaknesses Opportunities Threats Internal External 13

14 Method Tools Result Strategy SWOT Analysis Clarity Supervision Swimlane Diagram Identify Gaps Process Improvement Process Flow Diagram Improve Efficiency Mapping Workflow Diagram Map Effectiveness Who does what, when 3 R s Roles Responsibilities Routes 14

15 Roles Actors who complete steps in the process Responsibilities Individual steps each actor performs Routes Decisions that connect steps Roles Responsibilities Routes 15

16 Frame the process Clarify the scope: What does it & doesn t itcontain? Understand the current (as-is) process Design the new (to-be) process Develop use-case scenarios Source: Health Information Management: Concepts, Principles, & Practice, Third Edition Edited by Kathleen LaTour & Shirley Eichenwald Maki, p. 711 Frame the process Clarify the scope: What does it & doesn t itcontain? Understand the current (as-is) process Design the new (to-be) process Develop use-case scenarios Source: Health Information Management: Concepts, Principles, & Practice, Third Edition Edited by Kathleen LaTour & Shirley Eichenwald Maki, p

17 Frame the process Clarify the scope: What does it & doesn t itcontain? Understand the current (as-is) process Design the new (to-be) process Develop use-case scenarios Source: Health Information Management: Concepts, Principles, & Practice, Third Edition Edited by Kathleen LaTour & Shirley Eichenwald Maki, p. 711 Frame the process Clarify the scope: What does it & doesn t itcontain? Understand the current (as-is) process Design the new (to-be) process Develop use-case scenarios Source: Health Information Management: Concepts, Principles, & Practice, Third Edition Edited by Kathleen LaTour & Shirley Eichenwald Maki, p

18 Describes how people will interact Shows future process Bridges gap between User needs System functionalities Source: Health Information Management: Concepts, Principles, & Practice, Third Edition Edited by Kathleen LaTour & Shirley Eichenwald Maki, p Resident presses call light at bed 2. Nurses station ti is alerted via beep 3. Nurse identifies patient & room number 4. Nurse turns off call light 5. Nurse walks to room Nurse assesses resident situation Resident responds with concern 8. Nurse takes action 9. Nurse documents encounter 18

19 Method Tools Result Strategy SWOT Analysis Clarity Supervision Swimlane Diagram Identify Gaps Process Improvement Process Flow Diagram Improve Efficiency Mapping Workflow Diagram Map Effectiveness Map that indicates activity Spatial identity Office settings Equipment use 19

20 Source: Basic Tools for Business Process Design, ch. 4 20

21 Would you say your office space is designed for maximum efficiency? Definitely It s OK Not efficient at all Method Tools Result Strategy SWOT Analysis Clarity Supervision Swimlane Diagram Identify Gaps Process Improvement Process Flow Diagram Improve Efficiency Mapping Workflow Diagram Map Effectiveness 21

22 Map that marks every step in a process Decision points Waiting periods Feedback loops Can be High-Level Flowchart Brief overview Only major events Source: HealthcareAnalytics.info, Sarianne Gruber. 22

23 Process (rectangle) Decision (diamond) Movement (arrow) Source: AHIMA csp?ddocname=bok1_

24 Source: Covisint Method Tools Result KPIs Scorecard Monitoring 24

25 Metrics Used to manage outcomes compared to standard Key Performance Indicators Tied to organization s goals Shows progress towards (or away from) goals Tied to target Volume Cost Timeliness Quality Satisfaction Source: HealthcareAnalytics.info, Sarianne Gruber. 25

26 Inpatient flow 1. Bed turnover 2. Readmission rate 3. Occupancy rate 4. Average length of stay 5. Average cost per discharge 6. Inpatient mortality rate 7. Harm events per 1,000 patient days 8. Resident satisfaction Source: Becker s Hospital Review Revenue cycle 1. Total operating margin 2. A/R days due to coding 3. Total A/R days outstanding 4. Total A/P days outstanding 5. Cash receipt to bad debt 6. Claims denial rate 7. Days of cash on hand Source: Becker s Hospital Review 26

27 Are you involved in using KPIs at your facility? Yes No Dangerous Discharge Hand Hygiene Maintenance Request 27

28 Overview A Transitional Care Unit resident is cleared for discharge following a myocardial infarction 3 weeks ago. Prior to discharge, the nurse checks the resident s vital signs. She notes a substantially elevated BP and heart rate. Attending physician could not be reached; previous orders said resident is well enough to go home. Nurse decides to discharge anyway and notes the elevated BP and HR in the chart but cancels the EHR alerts. Key Problems Elevated HR and BP recorded but not acted upon Alerts ignored; physician not alerted Discharged against protocols Tools Workflow Strategy Determine where breakdown occurred Solutions Swimlane diagram: Roles, Responsibilities, Routes Review P&Ps; disciplinary action SWOT Analysis Swimlane Diagram Process Flow Diagram Workflow Diagram 28

29 Roles Responsibilities Routes Overview A social worker on a busy hospital unit notices a nursing assistant going from resident to resident without washing her hands. Later that day, she speaks to the nursing assistant about proper hand-washing for resident safety. The assistant responds that she has been using Handi-Wipes and sanitizer, i per her supervisor, but that it is not convenient to do it more than twice a shift. 29

30 Key Problems Resident safety due to poor hygiene Lack of proper training Inadequate washing locations Workflow Strategy Assess where to add washing areas Solutions Process Flow Diagram for new locations Review Training and protocols Tools SWOT Analysis Swimlane Diagram Process Flow Diagram Workflow Diagram Source: Basic Tools for Business Process Design, ch. 4 30

31 Overview Charge Nurse notices a broken air conditioner and submitted a maintenance request 2 days ago. While in the resident s room, Nurse A realizes it is warm and that the AC still isn t working. She checks the logbook and notices the maintenance request has not been completed. Unbeknownst to her, a new unit is being delivered today. Worried about her resident s s comfortdueto to respiratory issues, Nurse A writes a note in the chart, s the DON, tells the unit staff she is angry, and complains to the assistant maintenance manager in front of staff and residents. Key Problems Maintenance responses not documented Nurses not alerted to deliveries No warning of upcoming work order Workflow Strategy Consider breakdowns in process Solutions SWOT of Maintenance activities Adjust documentation methods Tools SWOT Analysis Swimlane Diagram Process Flow Diagram Workflow Diagram 31

32 Strengths Weaknesses Opportunities Threats How do you know if Workflow Strategies are working? Increased productivity Better employee engagement Fewer errors 32

33 1. Workflow is The flow of work 2. Workflow Tools SWOT Analysis Swimlane Diagram Process Flow Diagram Workflow Diagram 3. Case Studies Dangerous Discharge Hand Hygiene Maintenance Request The 2 ideas I will apply right away:

34 Q&A Takeaways Grace LaConte MS, RHIA LinkedIn 34