This document discusses concepts of workflow process improvement in health care. It describes workflow as the processes and tasks involved in clinical care and administration. Clinical workflow includes activities like patient assessments, ordering tests, and treatment. Administrative workflow covers tasks such as scheduling, billing, and referrals. The document notes that health care workflow is complex due to its human aspects, changing priorities, and need to avoid harm. Proper workflow analysis can improve efficiency, quality, and patient experience. The goal of changes are to streamline processes while maintaining safety and care standards.
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A very brief presentation to differentiate between clinical process improvement practice , guideline and pathway .
I have reflected on the basic differences between them .
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Importance of Medical Audit
Don't let COVID - 19 impact your practice. Get Free Practice Analysis and be financially healthy. Call Now - 888-357-3226
Click Here For More Information: https://bit.ly/3kw4rka
Get a Free Quote: https://bit.ly/30DFr2z
#texasmedicalbillingandcodingservices #medicalbillingauditing #medicare #medicalbillingandcoding #MBC #importanceofmedicalaudit #medicalaudit #medicalbillingguideline
Standard of care / Standard of Practice / Clinical Guideline/ Clinical Pathway Naz Usmani
A very brief presentation about the clinical process improvements including practices, standards of care , guideline and pathway . I have reflected upon the basic differences between them . Hope it is useful
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degree to which health services for individuals and populations increase the likelihood of desired health outcomes (quality principles),are consistent with current professional knowledge (professional competency),and meet the expectations of healthcare users (the marketplace)
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This is a PowerPoint presentation from Dr. Khan, Medical Director, MedPeds Medical Clinic. He has a small practice and is a certified PCMH. In this presentation he shares his strategy that led to his success. This is a powerful presentation for practices of all sizes, whether large or small. For more information, feel free to email us at: marketing@amazingcharts.com.
Standard of care / Standard of Practice / Clinical Guideline/ Clinical Pathway Naz Usmani
A very brief presentation to differentiate between clinical process improvement practice , guideline and pathway .
I have reflected on the basic differences between them .
Quality management in nursing professionSANJAY SIR
Quality improvement requires in any field to provide best services to the community in the health care system. it is uploaded to aware the the paramedics & nursing personnel to improve the quality care & helps educators to teach their students.
This workshop will look at patient care pathways and demonstrate how simulation can combine process flow across; services, clinical best practice and the progression of patients through disease states, to test the impact of improvement initiatives on patient care, outcomes, costs and resource utilization.
Using examples from recent projects on simulating care pathways within HIV services, and simulating future service needs for dementia care, we show the results of combining disease progression with service utilization.
In the workshop, we’ll consider what the ideal pathway model would look like and invite you to work with us to build a pathway using our latest technology.
Importance of Medical Audit
Don't let COVID - 19 impact your practice. Get Free Practice Analysis and be financially healthy. Call Now - 888-357-3226
Click Here For More Information: https://bit.ly/3kw4rka
Get a Free Quote: https://bit.ly/30DFr2z
#texasmedicalbillingandcodingservices #medicalbillingauditing #medicare #medicalbillingandcoding #MBC #importanceofmedicalaudit #medicalaudit #medicalbillingguideline
Standard of care / Standard of Practice / Clinical Guideline/ Clinical Pathway Naz Usmani
A very brief presentation about the clinical process improvements including practices, standards of care , guideline and pathway . I have reflected upon the basic differences between them . Hope it is useful
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Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
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Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
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Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
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CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
1. Health Care Workflow Process
Improvement
Concepts of Workflow Process
Improvement
Lecture b
This material (Comp 10 Unit 1) was developed by Duke University, funded by the Department of Health and Human Services, Office of
the National Coordinator for Health Information Technology under Award Number IU24OC000024. This material was updated by
Normandale Community College, funded under Award Number 90WT0003.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of
this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/
2. Learning Objectives
1. Describe the purpose of process improvement
in the clinical setting.
2. Identify the components of clinical workflow.
3. Describe the unique aspects of health care
which add complexity to workflow process
improvement
4. Identify the benefits of health care workflow
process improvement and the priorities to
consider when implementing changes.
2
3. Workflow is a Process
Workflow includes:
• How tasks are accomplished
− By whom
− Task order
− Task priority
− Task timing
• Choices and decisions
• Location
• Information needs
3
4. Clinical Care Activities
• Interaction with patients
• Physical assessment
• Ordering and conducting diagnostic tests
• Decision making and diagnosis
• Developing a treatment plan
• Assessing compliance with treatment regimen
• Patient education
• Follow-up on test results
• Records creation and management
• Determination of confidentiality / privacy
requirements
4
5. Administrative Activities
• Scheduling a patient visit
• Registering a patient
• Transporting and tracking a patient within a
facility
• Submitting a claim for reimbursement
• Making a referral to a specialist
• Sending / receiving health information to /
from another provider
• Food and laundry service
5
7. Examples of Roles
in Health Care Settings
• Providers
• Medical Assistants
• Phlebotomists
• Receptionists
• Billing Coordinators
7
8. Location, Location, Location
• Where tasks are performed can be
important
• Physical layout of a clinic impacts
workflow
– Patient transportation
– Hallway traffic
– Distance clinic staff must travel to accomplish
tasks
– Patient privacy
8
9. Information Needs
• What information is used and generated in
the course of a patient encounter?
• Do providers and clinic staff have ready-
access to information they need when they
need it?
• Do patients have access to information
about their health before, after and
between visits?
9
10. Unique Aspects of Health Care
• System of “experts”
– Physicians and physician extenders are ultimately ethically,
morally and legally responsible for everything that happens to a
patient
– Physicians have taken an oath to “above all, do no harm”
• Health care usually involves personal contact
• Decisions impact patient’s health and well being
• Patient care involves teams of people working in
information-intense situations
• Patterns of fundamental clinical routines are the product
of years and decades of evolution
10
11. Complexities of Health Care
• Each situation is unique
• Involve multiple people and organizations
– Many opportunities for delays and variability
• Must take patient preference into account
• Continually changing priorities
• Many interruptions, options and exceptions
• Have overlapping roles and responsibilities
• Involves Humans and organizations
• Vary from practice to practice
• Subject to time and resource pressures
11
12. Pulling it all Together
Clinical Workflow Impacts Patients
• Problems, errors and delays are not just
aggravating, inefficient or even infuriating
• In medicine, more than in other fields,
problems, errors and delays can cause
serious harm
12
13. Common Processes in Physician
Practices
• Appointment scheduling
• New patient intake
• Existing patient intake
• Exam and patient assessment
• Ordering labs/receiving & communicating
results
• Prescriptions
• Referrals out/in
• Diagnostic testing
• Billing
13
14. Confusion about Workflow
• Most people are not accustomed to
thinking of what they do everyday in terms
of workflow
• Terms used in health care that may be
confused with workflow or process
analysis:
– Regimented care
– Clinical pathways, clinical guidelines
– Accreditation and audit
14
15. Workflow Changes
• Must first, do no harm
• Must improve processes
– Increase efficiency
– Decrease delays and cost
– Increase quality and safety
– Improve the work environment
– Improve ability to care for patients
– Create a better overall patient experience
15
16. Concepts of Workflow Process
Improvement
Summary
What a Practice Workflow and Information
Management Redesign Specialist Does
• Document context and process so that it
can be analyzed
• Analyze process
• Recommend redesign options
• Implement redesign
• Evaluate, adjust and maintain changes
16
17. Concepts of Workflow Process
Improvement
References – Lecture b
References
• Allied health professionals. (n.d.). Retrieved December 29, 2011, from Association of
Schools of Allied Health Professions: http://www.asahp.org/what-is/
• Committee on Quality of Health Care in America and Institute of Medicine. (2001).
Crossing the quality chasm: A new health system for the 21st century 2001.
Washington: National Academies Press.
• Eligible provider meaningful use meaningful use core measures measure 5 of 15 -
Stage 1. (2010, November 7). Retrieved December 29, 2011, from
www.cms.gov/EHRIncentivePrograms/Downloads/5_Active_Medication_List.pdf
17
18. Concepts of Workflow Process
Improvement
Lecture b
This material was developed by Duke University,
funded by the Department of Health and Human
Services, Office of the National Coordinator for
Health Information Technology under Award
Number IU24OC000024. This material was
updated by Normandale Community College,
funded under Award Number 90WT0003.
18
Editor's Notes
Welcome to the Health Care Workflow Process Improvement, Concepts of Workflow Process Improvement. This is Lecture b, Clinical Workflows.
The objectives for Lecture b are to:
Describe the purpose of process improvement in the clinical setting.
Identify the components of clinical workflow.
Describe the unique aspects of health care which add complexity to workflow process improvement
Identify the benefits of health care workflow process improvement and the priorities to consider when implementing changes
The main focus of this component is workflow. Recall, a workflow is a process, it includes activities, entities (people or things that take part in the activities), and criteria that specify the order, priority and timing of the steps. Choices and decisions as well as the information needs are specified. Often, the physical location where the task occurs or proximity to performance locations of other activities need to be considered. All of these things together comprise workflow.
A patient visit to a provider’s office, can be broken down into their component processes; these processes are composed of more detailed activities. Examples of these activities in clinical care, listed here, include interaction with patients, physical assessment, ordering tests, making a diagnosis, developing a treatment plan, following-up on test results, etc. Successfully performing workflow analysis and process redesign in health care settings requires familiarity with common clinical activities, processes and how they vary in different clinical settings.
Clinical care also depends on administrative activities that are necessary for care. They include scheduling, transportation, documentation, billing, food service, laundry, and maintaining an inventory of supplies. These activities that impact the workflow during a clinical encounter, e.g., a visit to a provider’s office, or the flow of the visit from the perspective of the patient or provider are often considered in workflow analysis and process redesign.
Single activities (also called tasks or steps) are grouped together, “grouped activities” into processes. Some examples of activities grouped into processes include: Patient Admission, surgery, collecting lab specimens, etc.
The point is that steps in a process can be thought of in groups of smaller steps, or as individual steps. The detail level at which one thinks about clinical workflow depends on the detail level that is needed. For example, a professor teaching a new procedure to a resident will describe each single step. However, the medical assistant scheduling the procedure for a patient will think of the procedure as one step, the procedure.
There are several roles that are common to many health care practices. These include providers, (which can be physicians, physician assistants, nurse practitioners, and nurses), and allied health professionals. Allied Health professional roles are those “involved with the delivery of health or related services pertaining to the identification, evaluation and prevention of diseases and disorders; dietary and nutrition services; rehabilitation and health systems management, among others.” (ASAHP, 2011).
While the providers are licensed professionals, there can be overlap in the roles. For example, the nurse may weigh the patient and take vital signs and a history, or these tasks may be performed by a medical assistant. Patient education may be provided by any of the providers. Any of the providers or a phlebotomist may draw blood for lab tests. Thus, when analyzing workflow, the role that performs a task must be clear. Clinics that perform outpatient procedures and hospitals tend to have more complex processes that involve even more roles.
The physical layout of a clinic can impact workflow because it determines where tasks are performed. For example, can the patients be weighed on the way to the exam room, or must they go past the exam room, get weighed, then come back, creating more hallway traffic? If patients must walk down the hallway, do they pass other patients, or pass procedure rooms? Do patients have to walk past exam rooms or back through the waiting room to leave the clinic? Are printers and copiers located conveniently for clinic staff who need them?
While changes in the physical layout of a clinic may not be feasible as part of process redesign, layout and its impact on physical workflow must be taken into account.
Health care is an information-intensive endeavor, and information needs are an important part of workflow. For example, one of the Meaningful User requirements is to maintain an active medication list for patients, meaning providers are required to reconcile the information they have about medications a patient is taking at each visit. This requires that the patient knows what medications he takes, and that the provider can both access the records of medications that the patient is on AS WELL AS be able to update that list. In this situation, to better meet the patient and provider needs, this process could be improved by providing the patient information before their visit. The provider could give the patient a blank form to complete at home while they have ready access to their medications, or a pre-filled form with their medications that the doctor has on record.
Conducting workflow analysis and process redesign in health care is different than working in other settings because of the unique aspects of health care.
You will be working within a “System of ‘experts’” and a culture in which
Physicians and physician extenders are ultimately ethically, morally and legally responsible for everything that happens to a patient, and in which
Physicians have taken an oath to “above all, do no harm”
Health care involves one-on-one contact with people
Decisions sometimes make the difference between “life or death”, or have the potential to seriously impact a person’s health
Patient care involves teams of people that depend on minute to minute communication and large amounts of information, and
Patterns of fundamental clinical routines are the product of years and decades of evolution. This evolution involves complex interactions between members of the health care team, technology, information, external forces and organizational factors. Sometimes the result of this evolution is a process that operates optimally. Other times, processes are the relic of compromises or constraints that are no longer important. Only careful analysis can differentiate the two.
Other unique aspects of health care and clinical workflows that make workflow analysis and process redesign complex include the fact that clinical workflows:
Vary from practice to practice,
Involve multiple people and organizations, thus there are many opportunities for delays and variability,
Must take patient preference into account,
Have many interruptions,
Have many options and exceptions,
Have overlapping roles and responsibilities, and
Involves humans, organizations, information, and technology.
Because of the need to contain costs, health care today is subject to considerable time and resource pressure.
There are many factors that differentiate health care from other industries. One looms larger than all the rest. Health Care is about life and death. Care, including preventative care, directly impacts an individuals health and wellness. Many decisions and actions taken in the course of health care involve intervening with someone’s physical or mental functioning. Things that impact the care process directly impact patients.
Problems, errors and delays are not just aggravating, inefficient or even infuriating, they can cause serious harm.
Now that we have talked about unique aspects of health care settings, let’s return to common clinical processes. Common processes in physician practices include:
Appointment scheduling,
New patient intake,
Existing patient intake,
Exam and Patient Assessment,
Ordering Labs, and receiving and communicating results,
Prescriptions,
Referrals both out and in,
Diagnostic testing,
Billing,
Reporting, and
Monitoring patient outcomes.
On the next slide, you will have the opportunity to watch some videos and identify clinical processes mentioned.
Most people are not accustomed to thinking of what they do everyday in terms of workflow – that is why we need people trained as workflow specialists, to facilitate this process and to help practices accurately describe and analyze their workflows.
Several terms used in health care that may be confused with workflow or process analysis are:
Regimented care,
Clinical pathways, clinical guidelines, and
Accreditation and audit.
On your own, look each of these terms up and think about the similarities and differences with process analysis. If you don’t normally think of things in terms of workflow, identify three processes that you encounter in your everyday life. Then, for each of these processes, list out the steps that you identified, including those that you may not personally witness but assume to have happened so that you have a complete process described. Consider steps, their order and timing, decisions, locations, information needs, etc. This is an easy way to practice thinking in terms of workflow.
Workflow changes in the clinical setting, like physicians, “must first, do no harm,” and secondly must improve the following processes. Processes can be improved by:
Increasing efficiency,
Decreasing delays, errors, and cost,
Increasing quality and safety,
Improving the work environment,
Improving ability to care for patients, and
Creating a better overall patient experience.
This concludes Fundamentals of Health Workflow Process Analysis & Redesign. This unit consisted of 2 lectures, lecture a, Concepts of Workflow Process Improvement and lecture b, Clinical Workflow.
In summary, the purpose of Clinical Process Redesign is to improve the safety, efficiency and overall quality of health care. Meaningful use of Health IT can help do this. The Practice Workflow and Information Management Redesign Specialist role helps practices improve the safety, efficiency and overall quality of care by leveraging Health IT. The Practice Workflow and Information Management Redesign Specialist role:
Documents context and process so that it can be analyzed,
Analyzes process,
Recommends redesign options, including opportunities to leverage Health IT,
Works with practices to implement redesigned processes, and
Evaluates, adjusts and maintains changes.
The Specialist may do these things himself, or may teach groups of practices and facilitate groups to do the analysis and redesign themselves.
