CNEA Question #4, Workflow Redesign

The support that the network- Redwood Community Health Coalition (RCHC) -provides in workflow redesign is integral to EHR implementation. The process of assessing current workflows and developing new ones can be daunting to health center staff looking at EHR implementation, but RCHC has made it manageable in two major ways: 1) through training on workflow design as a central component of QI methodology and 2) in working onsite with staff as they redesign their workflow prior to implementation. RCHC has identified and prioritized essential workflows common to all health centers staff and this helps staff focus their efforts.

Tools and Techniques: A crucial technique was the incorporation of workflow process mapping as part of RCHC's Quality Culture Series (QCS). Executive Directors, Medical Directors and Operations directors were trained on the principles and the techniques of workflow development. Thus, leadership of the health centers was bought into the importance of workflows. Furthermore, key health center staff were trained in Microsoft Visio, the most important tool for creating and documenting workflows. The best setting for workflow redesign is for all the staff involved in a given workflow together to 1) first track how they do it now adn 2) then what improvements there could be. The Visio flowchart may be projected on a screen or if Visio is not available, a flip chart and/or dry erase board is used.

Challenges: Workflow redesign is very time consuming. Because of QCS, health center leaders allocate staff time to workflow development activities. However, all required participants in a workflow are not always available due to competing priorities- seeing patients. Many of the highest hurdles of workflow redesign are overcome by training health center staff on workflow principles and by sharing expertise and practices.

Impact on EHR implementation: Teaching workflow redesign has been a great asset and mentioned by many members as being influential in their level of readiness for EHR. Health centers with more developed expertise in workflow development tended to have smoother implementation; with more vigorous examination of their processes, health centers staff could better adapt to a rapidly changing environment and better deal with unexpected circumstances. The time invested to develop workflows before implementation is better spent before go-live than after. The time spent before is a proactive investment; after go-live, the time is reactive, and can negatively impact implementation. RCHC works with its members to approach workflows in proactive and strategic manner, preparing for a smoother transition to EHR.

RCHC will post our tools for workflow redesign soon.