Grace LaConte Easy Strategies to Improve Workflow ......SWOT Analysis Swimlane Diagram ... Strategy SWOT Analysis Clarity Supervision Swimlane Diagram Identify Gaps Process Improvement

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Grace LaConte, MS, RHIACommunication Strategist

LaConte Consulting

Missouri Health Information Management AssociationThursday, 04/21/2016

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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


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Twitter@l @Mi i HIMA@lacontestrategy @Missouri_HIMA#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


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StressfulM i t &◦ Manager anxiety & depression

Dangerous◦ Workplace injuries◦ Readmissions/ADEs◦ Data breaches

Disengaged◦ Employee turnover◦ Nursing shortage


Technology◦ EHRs are not plug-and-playg◦ Importance of human contact

Patient Needs◦ Boomers & Millennials◦ High expectations

InformationI ff ti◦ Ineffective ◦ Inefficient◦ Missing information


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Lack of… Communication

◦ Not listening to understand

◦ Information flow process is flawed

◦ Direct effect on patient outcomes



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The flow of work

Established pathalong which tasks are sequentially completedto accomplish a function.to accomplish a function.



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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


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


Force Field Analysis SWOT Analysis

Process Flow Diagram SWOT Analysis

Swimlane DiagramDiagram

Workflow Diagram


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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


Increase productivity

Improve employee engagement

Decrease errors


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Set-up, performance andperformance, and monitoring

of a defined sequence of tasksarrangedarranged as a workflow.


Source: “Workflow Modeling, 2nd Edition” by Alec Sharp & Patrick McDermott, 2009

Indicates forces for change


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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


Method Tools Result



Process Improvement

Process Flow Diagram Improve Efficiency


Improvement Diagram


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Strengths Weaknesses Weaknesses Opportunities Threats


InternalInternal

External


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Method Tools Result



Process Improvement



Improvement Diagram


Who does what, when

3 R’s◦ Roles◦ Responsibilities◦ Routes


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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


Roles

RoutesResponsibilities


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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






Source: “Health Information Management: Concepts, Principles, & Practice, Third Edition” Edited by Kathleen LaTour & Shirley Eichenwald Maki, p. 711

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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


7. Resident responds with concern8. Nurse takes action9. Nurse documents encounter

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Method Tools Result



Process Improvement



Improvement Diagram


Map that indicates activity◦ Spatial identitySpatial identity◦ Office settings◦ Equipment use


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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


Method Tools Result



Process Improvement



Improvement Diagram


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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



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Process (rectangle) Decision (diamond) Decision (diamond) Movement (arrow)


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


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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



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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


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


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Are you involved in using KPIs at your facility?

◦ Yes◦ No


Dangerous Discharge

Hand Hygiene

Maintenance Request


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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.


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


Diagram

Process Flow Diagram

Workflow Diagram

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Roles

RoutesResponsibilities


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.


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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


Diagram


Workflow Diagram


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.


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


Diagram


Workflow Diagram

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Strengths Weaknesses Weaknesses Opportunities Threats


How do you know if Workflow Strategies are ki ?working?

Increased productivity Better employee engagement Fewer errors


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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


The 2 ideas I will apply right away:

◦ 1. ________________________________________

◦ 2. ________________________________________


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Q&A

Takeaways


Grace LaConte MS, RHIALaConte ConsultingLaConte Consulting

[email protected] 360-984-4630

http://laconteconsulting.com

http://facebook.com/laconteconsultinghttp://facebook.com/laconteconsulting

Twitter: @lacontestrategy

LinkedIn


Documents

Grace LaConte Easy Strategies to Improve Workflow ......SWOT Analysis Swimlane Diagram ... Strategy SWOT Analysis Clarity Supervision Swimlane Diagram Identify Gaps Process Improvement