Communication-Driven Workflow for Better Patient Care Delivery

Katie Myers, Director-Clinical Workflow Management, RiverMend Health
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Workflow without communication and trust becomes ‘work stop’. When I think of workflow, a definition you would find on Wikipedia comes to mind. “A workflow consists of an orchestrated and repeatable pattern of business activity enabled by the systematic organization of resources into processes that transform materials, provide services, or process information. It can be depicted as a sequence of operations, declared as work of a person or group, an organization of staff, or one or more simple or complex mechanisms.” On the other hand, maybe what Oxford Dictionaries would say, “The sequence of industrial, administrative, or other processes through which a piece of work passes from initiation to completion”. One might assume that communication is a natural part of making workflow a reality. My experience with assumptions is that they are dangerous. Moreover, without communication, there is no trust. Without trust, the wheels come off the rails and the prospective workflow ends up being a train wreck.

  ​Without collaboration and the skills necessary to turn ideas into realities, we stagnate 

The goal is turning “resources into processes” and taking an idea from “initiation to completion.” This is the crux of it all. Who doesn’t want to turn resources into processes that are more efficient, easier to understand and use, and improve outcomes from start to finish? Nevertheless, how do we get to that goal? What are the means to that end? From my perspective, it all starts with communication and trust.

In healthcare, much like any other industry, without proper (read efficient) workflow you have ‘work stop’, which at best is costly and at worst is dangerous. ‘Work stop’ costs thousands, if not millions of dollars and compromises patient safety. It leaves room for error, confusion, lost productivity. Patients are already in a place of duress when being admitted to most healthcare facilities; not having a smooth workflow only creates additional (read unnecessary) stress. When looking at workflow from a healthcare provider perspective, it may look very different depending on who you talk to. When you talk to a physician, they have ideas, wants, and needs. When you talk to an IT specialist, they have an entirely different set of thoughts running through their minds. This may be one of the reasons there is so much disparity when healthcare providers complain about EMRs. “It’s clunky, it’s not intuitive, it’s a pain and a hassle.” You have ‘right brains’ (social workers, creative minds, emphasis on feeling and aesthetics) competing against ‘left brains’ (IT, logical minds, emphasis on analysis and accuracy). But what if we looked at it with the whole brain? What if we could all come to the table and add value by sharing our unique experience and perspective. Perspective is everything, isn’t it so?

True story: a social worker starts working for a start-up company. She has been hired to be a clinician. Instead she is told she needs to start working on the project of getting an Electronic Medical Record up and running for a new site. She knows people--she does not know IT. She knows who to call when her computer goes down, and that is about it. She ventures into the world of IT and finds it completely overwhelming. That is, until she gets connected with someone who values her non-IT way of thinking and even encourages it. Effective and efficient workflow is about perspective and oftentimes merging two incompatible worlds (social work and IT) for the best outcome. An efficient workflow started with communication and building trust.

Some of our best ideas have come from providers in the field who have sheepishly come forward to ask, “I don’t know if this will work, but….” they have a simple idea that no one on the IT team thought of. Not because they aren’t brilliant and capable people, but because they just have a different way of looking at things (right brain vs left brain). The major issue I see here is the sheepish manner in which many of our clinicians come forward. They too often do so with fear, that is until they feel safe (they begin to trust). The only way this type of sharing can happen is if there is an environment of safety and true collaboration. Without it, you will have a frustrated and resentful workforce that eventually translates to poor and inefficient workflow.

We must all be able to come to the table. Without collaboration and the skills necessary to turn ideas into realities, we stagnate. If we stay put and don’t allow new people to come to the table, our industry suffers as a result.

Workflow is tricky business in the healthcare field. With governing bodies such as The Joint Commission (TJC), the Commission on Accreditation of Rehabilitation Facilities (CARF), as well as state rules and regulations, there are a lot of compliance hoops to jump through. This is an even stronger reason for creating an environment where all parties can come to the table to find solutions and improve workflow. When I have spoken with colleagues about the process of getting TJC certified, many have said, “It takes a village to get through that!” Yes, a village indeed. One that communicates well, allows all to be heard, builds trust, and comes up with the best solution for efficient and effective workflow that will ultimately trickle down to the care of our patients every day. 

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