“The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency. “- Bill Gates
Where is the H&P? Has the Anesthesia Consent been signed? Where is the Surgical Consent? Does the Request for Admission (RFA) denote any antibiotic allergies that we need to be aware of? Has the antibiotic needed for the procedure been ordered? These are common refrains heard each and every day from the entire spectrum of healthcare providers in caring for a patient during a hospital stay. In addition to these questions among the staff about the patient, the patients themselves are asked for the same information over and over again. Healthcare by its very nature is documentation intensive. With all that is required for total patient care and payment, it is akin to a game of ‘healthcare solitaire’ collecting decks of paper in order to get to a proverbial completed four suits to end the game. As for caring for the patient, this ‘game’ of healthcare solitaire stacks it against them as it diverts attention to documentation rather than patient needs.
The challenge is that these decks of documentation are vital to:
- Track and provide the appropriate level of patient care
- Enable the hospital to be aligned with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards;
- Receive timely payment for services rendered.
Employing Process Engineering (PE) coupled with Organizational Change Management (OCM) techniques enables a future framework to be built that increases the focus on patient care and therefore begins to unstack the deck.
A recent project engagement with a regional academic medical center that is redesigning perisurgical workflows and converting two clinical information systems validates that healthcare providers can systematically identify and eliminate inefficiencies and waste to maintain or improve quality of care. The project involved documentation of current state process workflows and information movement through a structured data collection process. Other information in regard to inputs, outputs, systems and forms utilized was collected and a high level process relationship map to ‘bring to life’ process dependencies and relationships from Surgery Scheduling through Patient Discharge was created. Once the current state process flows were documented and presented to the stakeholders with all the steps, systems, and forms involved the understanding of where process efficiencies could be gained was self- evident.
After review and validation of the current state results, an impact analysis was performed to develop recommendations for change initiatives, of which seventy five were finalized for specific potential actions. Nearly one hundred proposed opportunities for incremental workflow improvement (with or without electronic system involvement) were identified coupled with potential business metrics, including technology enabled new workflows that capitalized on best practices within or outside the organization. Visual future-state process workflows were created to facilitate communication of agreed-upon target processes, including a tactical implementation roadmap outlining the necessary high-level steps, a model of an electronic patient tracking board with informative indicators, future state high level process relationship map, and key communication elements needed to improve perisurgical operations through deployment of new applications, and adjustments to other related systems and processes.
“What’s measured improves” – Peter Drucker
As the deck of healthcare solitaire continues to get unstacked and as business requirements are developed for implementation for these new applications based on the proposed future-state processes and vision, process efficiency and waste reduction need to be built into the organizational strategy. As this is implemented over time, there needs to be a focus on managing the metrics of the processes rather than the tradition of staying within budget due to the fact that in order for change to occur it needs to be measured. This will translate into continuous improvement and efficiency of time and resources that will result in a prescription for reduced waste in an environment where deadline oriented critical decision making is the norm.
“Technology moves in one direction, memory in another” – William Gibson
There is a tension that pulls of being efficient with time and resources and living in a documentation intensive world as healthcare providers are accustomed. Relying on decks of documentation in order for patient care and throughput to occur also implies a reliance on human memory, which we all know is not infallible.
As healthcare providers focus on and implement technology enabled process efficiencies and waste reduction efforts, it will translate into a more sustainable model of care that enhances the experience of the patient and manages the cost of delivery. Subsequently the game of healthcare solitaire against a stacked deck will turn into a distant memory of its own.
