• Patient record keeping (EMR, PACS, ADT, CPOE, etc.)
• Billing & Payment
• Bed management
• VOIP and data communication
• Temperature monitoring
• CPOE
• Internet/Intranet
• Employee time keeping
• Nurse call
• Some biotelemetry and other patient monitoring devices
• Web-based networking, browser-based programs
• Kiosks
• Patient education and entertainment
• Community outreach
• Marketing

This list is by no means intended to be exhaustive; I’m sure there are systems and devices that I haven’t listed. The point is to consider our dependence on the broadband / wireless networks in our hospitals and understand that investment in these systems (to expand, upgrade, stabilize) has greater impact than we at first might imagine. Healthcare needs demand high speed and redundancy from the source to the target.

I remember when I was CCIO at Adventist Health. The dependence on our electronic systems, especially the EMR, was tremendous to provide, chart and bill for care.  Our wireless systems had to be scalable and handle a growing amount of wireless traffic.  Patients and staff should never have to “wait” on a system response and resort to paper because the system is “slow.”  This interrupts the clinical thinking that is necessary to practice quality care. 

Not too long ago, when I was working with a client providing systems evaluation by rounding on units, clinicians demonstrated dropped connections and other wireless issues that were preventing them from carrying out daily clinical responsibilities on time.  It is only through detailed planning, implementation, testing and meticulous collaborative issue resolution that these supporting infrastructure components can be realized.

1. Input from multiple stakeholders. Before any project gets off the ground, it is important to know who it will affect and to examine what possible effect changes may have—positive or negative. There’s sure to be concern, even among those who might want change. Moreover, these folks will have diverse interests, different goals and different expectations of the project’s outcomes. Maybe most importantly, they’ll have different ideas on how to achieve the desired outcomes. After examining the impact the project may have on various groups and individuals, it is in this area that input from multiple stakeholders is most valuable.  
2. Communication. We hear this over and over again: Keep the communication lines open, Clear lines of communication, Communication is key…And it’s so true! There’s no value in seeking input from others and attempting to understand another’s needs if you’re not going to a.) provide a mechanism for them to communicate their needs, wants and concerns, and b.) listen. The other idea we often hear is: Communication is a two-way street. This is true also! So as much as you may expect to receive input, you have to be willing to make clear project goals and direction. Let others know what you are thinking so that they can provide feedback. Also, encourage your team to play “Devil’s Advocate” – it can help provide a new perspective.
3. Leadership. This is the tie that binds it all together. As much as there must be input and clear lines of communication, there must be decision-makers. Consensus is wonderful and an obvious hope for any team project, but with multiple stakeholders it is often difficult to achieve. Without competent leadership, projects often fall victim to stalemate or indecision. It is necessary to have someone who can recognize ideas that the group shouldn’t move forward on – someone with the power to flip the “kill switch.” It is just as necessary to have effective leadership to help guide discussion and generate ideas.

The care plan is an essential element of patient care. It lets each nurse, physician, lab tech, resident—all those responsible for providing care—know what steps need to be taken to help improve each patient’s condition. The care plan is also a bane to nearly every nurse; the task of documenting the stages of care usually falls to nursing staff. This means that the nurse not only documents the work he does with patients, but is also supposed to keep up with what the physician and other care providers do for patients. The end result is all too often total dissolution of the care plan.

As a nurse, I understand the pains that go along with documenting patient care. As an expert in informatics, I understand that we could make the tasks of documenting much easier for our nurses and other providers. One solution is to remove the burden of documentation from nursing staff and automate the plan of care. This may not be as easy as it sounds.  Healthcare IT providers in many cases do not automate the process in a streamlined manner that addresses the information needs of the clinician.

Some ideas for automating the care plan:

1. Make sure caregivers never have to chase down information that has already been documented elsewhere
   • Manage patient status from the point of care
2. Don’t force staff to enter information that’s already been documented elsewhere
   • Integrate existing systems such as EMR, dietary services, pharmacy, imaging, nurse call and bed management
3. Eliminate delays in the information sharing process
   • This may mean going paperless, using wireless phones or implementing a real-time workflow automation solution
4.  Understand clearly the business need and workflows
   • Address this need during the contracting phase of your negotiations. Be sure that the vendor can meet the workflow needs and see the solution in use.

The results of an automated care plan are astounding, and have a tremendous impact on satisfaction, especially among nurses. Ultimately, automating the care plan cuts down on wasted time, and improves patient safety and satisfaction.

You’re forced to wonder, what’s the next hospital over doing? And when you hear that one of the other hospitals in your purchasing group just chose the EMR you’ve already crossed of your list, you feel the need to go back and reassess.

It’s time to stop wondering—stop worrying! The right solution for Medical Center X is probably not the right solution for Medical Center Y. This is not to say that discovering the right solution is easy. It involves a great deal of analysis. This analysis is best orchestrated by a team that isn’t prejudiced to certain systems or functionality. An objective perspective from a team that has experienced a variety of solutions in a number of settings can offer important insights.

Having helped hundreds of people through transitional IT periods, I can tell you: each facet of the planning and implementation process is made more efficient with strategic advisement. Without a strategy in place, it’s easy for an organization to become frayed. Irreparable divides arise because no one is there to wrap their arms around the conversation. An expert in these situations helps address needs and concerns, identifies commonality among committee members and steers all in an agreeable direction. Buy-in from key stakeholders is essential, but that won’t happen without solidarity and accord.

Making the right decisions the first time around provides organizational stability and ultimately helps reduce costs.

The reality is: if you’re conscientious enough to seek out information on CPOE and EMR implementation, you’re unlikely to fall into the rabbit hole of doom. However, if you don’t assess where you are currently and involve your staff in the decision-making that will get you to where you want and need to be…well, then you are headed for trouble.

We call it Change Management or Crossover Management. We do it so that we don’t drag an entire staff kicking and screaming into an unrecognizable environment. This is particularly important when it comes to implementing new processes and new IT because, aside from introducing something new, you have to eliminate the “old way” and years of habitual practices. Any change—even those that make the job easier or patient safer—can be hard to accept. Involving staff in the analysis and making them agents of change helps create “buy-in” and ownership on the level necessary to make change successful.

Outside of the literal IT investment, Change Management creates a structure that allows hospital to invest the time and resources required to support widespread acceptance and adoption of change. Some keys are to:

• Allow for input to ensure that selected systems and processes meet most needs
• Address training and education for staff
• Ensure efficient workflows (Obstacles should be removed, not introduced!)
• Provide resources and support for widespread acceptance and adoption

The worst thing you can bring to Crossover Management is a “Do it or Die – Take the Bull by the Horns”-type mentality. Successful Crossover Management engages staff and addresses their concerns. Don’t forget, as caregivers, we’re natural problem solvers. When presented with the issues, we solve problems—we don’t fight the answers!

We’re interested! Tell us what Changeovers you have been or are currently involved in? What issues cropped up and how are you solving them?

The group discussed that the planning for a “big bang” implementation needs to start from the beginning of the project.  This means in the contract phase, not to say that another activation approach maybe used, but that if a big bang activation may be considered,plan immediately for the possibility.   Everyone in the organization and your IT partners need to understand that the “bar has been raised”.   Your implementation approach needs to define the activities and tasks that = a successful big bang activation.

Other points of discussion regarding staffing, standardization of the order catalog, “sign offs” , service level agreements, education on future workflows, parallel testing and future workflow confirmation to include processes like billing and clinical audits.  The big bang activation approach needs to creative and well defined.

The group requested a follow up webinar that will be held in about 30 days.

“If You Want to Start Doing Something New, Stop Doing Something Old”
                                              Peter Drucker

I also began to wonder if we should actually be proud that health care organizations are “traditional”.   Traditions can be good, they can provide safety, a sense of security.  Traditions can also be inherited, established, or customary.  Traditional organizations often a characterized as “old school”, and non thinking outside of the box, set in old ways of doing things, and not open to new ideas that often can bring great benefit.

Tom Peters, in his book Talent, Develop It, Sell It, Be It-states command-and-control management “leadership” from on high… is obsolete.  New leadership draws on a new skill set-the hallmarks of which are improvisation and inspiration.  He then goes on to describe crucial guidelines for reinventing a business and transform the way we work.

I consider myself to be a change agent, or change artist, architect, or other catalyst for moving organizations forward with the use of information technology.  What does this mean in working within “traditional organizations” made up of  “traditional thinking”?   I believe it means that I have to be an even more effective communicator and strategist.

Another key question is what does it mean for the staff at the organizations that are consider themselves to be “traditional”?  Are these organizations even aware that others characterize them as “traditional”?  Is this a question that we should be asking on our organizational surveys?  Do you consider this organization? your department? your manager? to be “traditional” ?  Then why? Do you consider this positive or negative?

HITECH Made Simple
Platinum Performance in Healthcare
Resources for Optimized Healthcare Delivery

In just 2 days your staff can increase their effectiveness in providing optimal healthcare services!

The Platinum Performance in Healthcare Series presents
How to Get Started, Make It Happen, and Make it Meaningful
Workflow Analysis and System Design to Promote Optimal Operational Performance Workshop

October 22-23, 2009

At the Reston Chamber of Commerce Offices
1763 Fountain Dr, Reston, VA 20190-3344

Offer your staff effective tools and critical thinking skills:

• effectively evaluate the current state, recommend improvements and a best practice future state.
• integrate workflow process and system design.
• identify obstacles, waste, source of issues, and needed changes.

Continental breakfast and lunch will be provided.

Attendees who complete the class will receive 4 hours of virtual assessment related to organization workflow analysis and design. To receive this added benefit, you must register before Sept. 1, 2009.

Presenter:

Amy Walker, MS, RN, CPHQ, FACHE, NEA-BC – Ms. Walker combines her unique background of healthcare leadership, quality improvement, clinical expertise, and information technology to present practical and comprehensive guidance in the delivery of services.  Ms. Walker has extensive experience in workflow evaluation and requirements development to transform and enhance the clinical workflow processes to improve efficiency, resulting in increased patient safety and the quality of health care delivery.

Please call 703-760-4484 for more information.

Reston, Virginia, is conveniently located only 7 minutes from Dulles International Airport and 30 minutes from Washington, DC.

Special discounted accommodations are available at the Hyatt Regency Reston. For reservations visit reston.hyatt.com and use Group/Corporate # 27004.
Or call 1-800-233-1234 and ask for the Negotiated Reston Town Center rate.

]]> http://optimizeitconsulting.com/blog/index.php/2009/07/10/workflow-analysis-and-system-design-to-promote-optimal-operational-performance/feed/ 0 http://optimizeitconsulting.com/blog/index.php/2009/06/11/lets-get-started/ http://optimizeitconsulting.com/blog/index.php/2009/06/11/lets-get-started/#comments Thu, 11 Jun 2009 14:52:47 +0000 amywalker http://optimizeitconsulting.com/blog/?p=11 First, welcome to the Optimize IT Consulting Blog.  As a way to get started let’s get to know one another.