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4/1/2016
1
Grace LaConte, MS, RHIACommunication Strategist
LaConte Consulting
Missouri Health Information Management AssociationThursday, 04/21/2016
4/1/2016
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Can workflow strategies help me?
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Grace LaConteF d & L d C l◦ Founder & Lead Consultant at LaConte Consulting
A Word of Thanks
What You Will Learn
My Promise
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Twitter@l @Mi i HIMA@lacontestrategy @Missouri_HIMA#MoHIMA16
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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StressfulM i t &◦ Manager anxiety & depression
Dangerous◦ Workplace injuries◦ Readmissions/ADEs◦ Data breaches
Disengaged◦ Employee turnover◦ Nursing shortage
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Technology◦ EHRs are not plug-and-playg◦ Importance of human contact
Patient Needs◦ Boomers & Millennials◦ High expectations
InformationI ff ti◦ Ineffective ◦ Inefficient◦ Missing information
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Lack of… Communication
◦ Not listening to understand
◦ Information flow process is flawed
◦ Direct effect on patient outcomes
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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The flow of work
Established pathalong which tasks are sequentially completedto accomplish a function.to accomplish a function.
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Movement diagramdiagram, layout, orvisualization
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting Source: http://www.hospitalmedicine.org
Spatial workflow◦ PerformPerform
tasks together
◦ Use equipment efficientlyefficiently
◦ Wireless sensors
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Source: ATR http://www.irc.atr.jp/~noma/project/E-Nightingale-Projects.pdf
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Goals: ◦ Business process redesignBusiness process redesign◦ Optimal efficiency
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Force Field Analysis SWOT Analysis
Process Flow Diagram SWOT Analysis
Swimlane DiagramDiagram
Workflow Diagram
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Have you ever used workflow tools in your workplace?p
◦ Yes, I’ve used some◦ No, we don’t currently use them
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Increase productivity
Improve employee engagement
Decrease errors
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Set-up, performance andperformance, and monitoring
of a defined sequence of tasksarrangedarranged as a workflow.
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Source: “Workflow Modeling, 2nd Edition” by Alec Sharp & Patrick McDermott, 2009
Indicates forces for change
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Method Tools Result
Strategy SWOT Analysis Clarity
Supervision Swimlane Diagram Identify Gaps
Process Improvement
Process Flow Diagram Improve EfficiencyImprovement Diagram
Mapping Workflow Diagram Map Effectiveness
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Method Tools Result
Strategy SWOT Analysis Clarity
Supervision Swimlane Diagram Identify Gaps
Process Improvement
Process Flow Diagram Improve Efficiency
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Improvement Diagram
Mapping Workflow Diagram Map Effectiveness
4/1/2016
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Strengths Weaknesses Weaknesses Opportunities Threats
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
InternalInternal
External
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Method Tools Result
Strategy SWOT Analysis Clarity
Supervision Swimlane Diagram Identify Gaps
Process Improvement
Process Flow Diagram Improve Efficiency
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Improvement Diagram
Mapping Workflow Diagram Map Effectiveness
Who does what, when
3 R’s◦ Roles◦ Responsibilities◦ Routes
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Roles◦ Actors who complete steps in the processActors who complete steps in the process
Responsibilities◦ Individual steps each actor performs
Routes◦ Decisions that connect steps
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Roles
RoutesResponsibilities
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Frame the process◦ Clarify the scope: What does it & doesn’t it contain?Clarify the scope: What does it & doesn t it contain?
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. 711MoHIMA Annual Mtg
Thursday 04/21/2016 LaConte Consulting
Frame the process◦ Clarify the scope: What does it & doesn’t it contain?Clarify the scope: What does it & doesn t it contain?
Understand the current (as-is) process
Design the new (to-be) process
Develop use-case scenarios
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Source: “Health Information Management: Concepts, Principles, & Practice, Third Edition” Edited by Kathleen LaTour & Shirley Eichenwald Maki, p. 711
4/1/2016
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Frame the process◦ Clarify the scope: What does it & doesn’t it contain?Clarify the scope: What does it & doesn t it contain?
Understand the current (as-is) process
Design the new (to-be) process
Develop use-case scenarios
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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 it contain?Clarify the scope: What does it & doesn t it contain?
Understand the current (as-is) process
Design the new (to-be) process
Develop use-case scenarios
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Source: “Health Information Management: Concepts, Principles, & Practice, Third Edition” Edited by Kathleen LaTour & Shirley Eichenwald Maki, p. 711
4/1/2016
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Describes how people will interact
Shows future process
Bridges gap between◦ User needs◦ System functionalitiesSystem functionalities
Source: “Health Information Management: Concepts, Principles, & Practice, Third Edition” Edited by Kathleen LaTour & Shirley Eichenwald Maki, p. 713MoHIMA Annual Mtg
Thursday 04/21/2016 LaConte Consulting
1. Resident presses call light at bedN ’ t ti i l t d i b2. Nurses’ station is alerted via beep
3. Nurse identifies patient & room number4. Nurse turns off call light5. Nurse walks to room6. Nurse assesses resident situation
R id t d ith
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
7. Resident responds with concern8. Nurse takes action9. Nurse documents encounter
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Method Tools Result
Strategy SWOT Analysis Clarity
Supervision Swimlane Diagram Identify Gaps
Process Improvement
Process Flow Diagram Improve Efficiency
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Improvement Diagram
Mapping Workflow Diagram Map Effectiveness
Map that indicates activity◦ Spatial identitySpatial identity◦ Office settings◦ Equipment use
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Source: “Basic Tools for Business Process Design,” ch. 4
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Would you say your office space is designed for maximum efficiency?for maximum efficiency?
◦ Definitely◦ It’s OK◦ Not efficient at all
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Method Tools Result
Strategy SWOT Analysis Clarity
Supervision Swimlane Diagram Identify Gaps
Process Improvement
Process Flow Diagram Improve Efficiency
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Improvement Diagram
Mapping Workflow Diagram Map Effectiveness
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Map that marks every step in a process◦ Decision pointsDecision points◦ Waiting periods◦ Feedback loops
Can be High-Level Flowchart◦ Brief overview◦ Only major events
Source: HealthcareAnalytics.info, Sarianne Gruber. http://healthcareanalytics.info/2012/02/is-it-a-metric-or-a-key-performance-indicator-kpi
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Process (rectangle) Decision (diamond) Decision (diamond) Movement (arrow)
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Source: AHIMA http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_045551.hcsp?dDocName=bok1_045551
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Source: Covisint http://www.covisint.comMoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Method Tools Result
KPIs Scorecard Monitoring
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Metrics◦ Used to manage outcomes compared to standardUsed 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
C t Cost Timeliness Quality Satisfaction
Source: HealthcareAnalytics.info, Sarianne Gruber. http://healthcareanalytics.info/2012/02/is-it-a-metric-or-a-key-performance-indicator-kpi
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Inpatient flow1 Bed turnover1. Bed turnover2. Readmission rate3. Occupancy rate4. Average length of stay5. Average cost per discharge6. Inpatient mortality rate7 H 1 000 i d7. Harm events per 1,000 patient days8. Resident satisfaction
Source: Becker’s Hospital Review http://www.beckershospitalreview.com/strategic-planning/16-potential-key-performance-indicators-for-hospitals.html
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Revenue cycle1 Total operating margin1. Total operating margin2. A/R days due to coding3. Total A/R days outstanding4. Total A/P days outstanding5. Cash receipt to bad debt6. Claims denial rate7 D f h h d7. Days of cash on hand
Source: Becker’s Hospital Review http://www.beckershospitalreview.com/strategic-planning/16-potential-key-performance-indicators-for-hospitals.html
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Are you involved in using KPIs at your facility?
◦ Yes◦ No
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Dangerous Discharge
Hand Hygiene
Maintenance Request
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Overview A Transitional Care Unit resident is cleared for
d h f ll d l f 3discharge 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
hgo home. Nurse decides to discharge anyway and notes the
elevated BP and HR in the chart but cancels the EHR alerts.
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Key Problems◦ Elevated HR and BP recorded but not acted uponp◦ Alerts ignored; physician not alerted◦ Discharged against protocols
Workflow Strategy◦ Determine where breakdown occurred
Tools
SWOT Analysis
SwimlaneDi
Solutions◦ Swimlane diagram: Roles,
Responsibilities, Routes◦ Review P&Ps; disciplinary action
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Diagram
Process Flow Diagram
Workflow Diagram
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Roles
RoutesResponsibilities
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Overview A social worker on a busy hospital unit notices a soc a o e o a busy osp ta u t ot ces 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 H di Wi d i i h iHandi-Wipes and sanitizer, per her supervisor, but that it is not convenient to do it more than twice a shift.
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Key Problems◦ Resident safety due to poor hygieneResident safety due to poor hygiene◦ Lack of proper training◦ Inadequate washing locations
Workflow Strategy◦ Assess where to add washing areas
Tools
SWOT Analysis
SwimlaneDi
Solutions◦ Process Flow Diagram for new locations◦ Review Training and protocols
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Diagram
Process Flow Diagram
Workflow Diagram
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Source: “Basic Tools for Business Process Design,” ch. 4
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Overview Charge Nurse notices a broken air conditioner and
b itt d i t t 2 dsubmitted 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 comfort due to Worried about her resident s comfort due to
respiratory issues, Nurse A writes a note in the chart, emails the DON, tells the unit staff she is angry, and complains to the assistant maintenance manager in front of staff and residents.
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Key Problems◦ Maintenance responses not documentedMaintenance responses not documented◦ Nurses not alerted to deliveries◦ No warning of upcoming work order
Workflow Strategy◦ Consider breakdowns in process
Tools
SWOT Analysis
SwimlaneDi
Solutions◦ SWOT of Maintenance activities◦ Adjust documentation methods
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Diagram
Process Flow Diagram
Workflow Diagram
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Strengths Weaknesses Weaknesses Opportunities Threats
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
How do you know if Workflow Strategies are ki ?working?
Increased productivity Better employee engagement Fewer errors
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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1. Workflow is◦ The flow of workThe flow of work
2. Workflow Tools◦ SWOT Analysis◦ Swimlane Diagram◦ Process Flow Diagram◦ Workflow Diagram
3. Case Studies◦ Dangerous Discharge◦ Hand Hygiene◦ Maintenance Request
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
The 2 ideas I will apply right away:
◦ 1. ________________________________________
◦ 2. ________________________________________
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
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Q&A
Takeaways
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting
Grace LaConte MS, RHIALaConte ConsultingLaConte Consulting
[email protected] 360-984-4630
http://laconteconsulting.com
http://facebook.com/laconteconsultinghttp://facebook.com/laconteconsulting
Twitter: @lacontestrategy
MoHIMA Annual MtgThursday 04/21/2016 LaConte Consulting