This document discusses the importance of workflow analysis and redesign when implementing new health technologies. It outlines the key steps in the workflow redesign process, including building an interdisciplinary team, analyzing the current workflow, identifying waste and non-value-added activities, designing an optimal future workflow, managing the change process, and evaluating metrics to measure results. Nursing informatics professionals play a critical role in workflow redesign to help ensure technologies meet clinical needs and improve patient outcomes and safety.

1. Chapter 14
Nursing
Informatics:
Improving
Workflow and
Meaningful Use

2. Objectives
• Provide an overview of the purpose of
conducting workflow analysis and design.
• Deliver specific instructions on workflow
analysis and redesign techniques.
• Cite measures of efficiency and effectiveness
that can be applied to redesign efforts.

3. Introduction
• An astounding 98,000 Americans are injured each
year as a result of medication errors
(Institute of Medicine (IOM), 1999).
• Not only is there an impact on patients from
these errors but there is also a significant
financial impact to healthcare organizations.
• IOM report suggests to improve care delivery and
minimize error one of the most important tools
to employ is the use of electronic records and
information system to provide point of care
decision support and automation.

4. Workflow and Technology
• Workflow is a term used to describe the action or
execution of a series of tasks in a prescribed
sequence. Another definition of workflow is a
progression of steps (tasks, events, interactions)
that comprise a work process, involve two or
more persons, and create or add value to the
organization's activities.
• One school of thought suggests that technology
should be designed to meet the needs of clinical
workflow.

5. Optimization
• Optimization is the process of moving
conditions past their current state and into
more efficient and effective method of
performing tasks.
• Nursing informatics should always be included
in these activities to represent the needs of
clinicians and to serve as liaison for
technological solutions to process problems.

6. Workflow Analysis and
Informatics Practice
• A critical aspect of the informatics role is
workflow design. Nursing informatics is uniquely
positioned to engage in the analysis and redesign
of processes and tasks surrounding the use of
technology.
• As we examine how workflow analysis is
conducted it is important to note that while the
nursing informaticist is an essential member of
the team to participate in or enable workflow
analysis; a team dedicated to this effort is
necessary for its success.

7. Building the Team
• The workflow redesign team is an
interdisciplinary team consisting of “process
owners.”
• Process owners are those who directly engage
in the workflow to be analyzed and
redesigned.
• They are individuals who can speak about the
intricacy of process, including process
variations from the norm.

8. Value Add Versus Non-Value Add
• A value-added activity or step is one that
ultimately brings the process closer to
completion or changes the product or service
for the better.
• Some steps in a process do not necessarily
add value but are necessary for regulatory or
compliance reasons.

9. Waste
• Underpinning the Lean philosophy is the
removal of waste activities from workflow.
• Waste is classified as unnecessary activities or
an excess of products to perform tasks.

10. Variation
• Variation occurs when workers perform the
same function in different ways and usually
occurs because of flaws in the way a process
was originally designed, lack of knowledge
about the process or because a process
cannot be executed as originally designed due
to disruption or disturbances in the workflow.

11. Transitioning to Future State
• Future state is constructed with the best possible
knowledge of how the process will ideally work.
• To move from the current state to the future state; gap
analysis is necessary.
• Gap analysis zeros in on the major areas most affected
by the change, namely technology.
• What often happens in redesign efforts is an exact or
near-exact replication of the current state using
automation.
• Gap analysis discussion should generate ideas from the
group how about best to utilize the technology to
transform practice.

12. Informatics as a Change Agent
• Technology implementations alone represent a
significant change for clinicians as does the
workflow redesign that accompanies technology.
• Often the degree of change and its impact is
under-appreciated and unaccounted for by
leadership and staff alike.
• Engagement of the end-user is a critical aspect of
change management and therefore adoption.
Without end-user involvement, change is resisted
and efforts are subject to failure.

13. Informatics as a Change Agent
• There are many change theories to explore
but regardless of the change theory adopted
by the informatics specialist know that
communication, planning and support are key
factors of any change management strategy.
• Informaticists should become knowledgeable
about at least one change theory and use this
knowledge as the basis for change
management planning as part of every effort.

14. Measuring results
• Metrics provide understanding about the
performance of a process or function
• Process metrics are collected at the initial stage
of project or problem identification.
• Current state metrics are then benchmarked
against internal indicators. When there are no
internal indicators to benchmark against, a
suitable course of action is to benchmark against
an external source such as a similar business
practice within a different industry.

15. Future Directions
• Although workflow analysis principles are
described within the context of acute and
ambulatory care; the need to perform process
analysis on a macro-level will expand as more
organizations move forward with Health
Information Exchanges (HIE) and medical home
models.
• Health Information Exchanges require the Nursing
Informaticist to visualize how patients move
through the entire continuum of care and not just
a select patient care area.

16. Future Directions
• Technology initiatives will become
increasingly complex and therefore Nursing
Informaticists will need greater preparation
in the area of process analysis and
improvement techniques to meet the
growing challenges technology brings and
operational performance demands of fiscally
impaired healthcare organizations.

17. Summary
• Workflow redesign is a critical aspect of technology
implementation and when done well yields technology
that is more likely to achieve the intended patient
outcomes and safety benefits.
• Nursing Informatics professionals are taking on a
greater role with respect to workflow design and this
aspect of practice will grow in light of meaningful use
driven objectives.
• Other initiatives that impact hospital performance will
also drive informatics professionals to influence how
technology is used in the context of workflow to
improve upon the bottom line.