IF EVER THERE WAS an administrative process tailor-made for top-down direction, it’s workflow redesign. It starts with a senior executive master plan and gravitates through the organization under the guidance of a steering committee and chief facilitator. If successful, the new methodology should eliminate substantial excess overhead while greatly improving operational efficiencies.
Automating processes using information technology is at the heart of any workflow redesign project because it helps reduce labor-intensive manual procedures that are known to increase liability and, thus, expected costs.
Proponents say digitally streamlining operations – especially as a byproduct of creating an electronic medical record for patients – has a tremendous impact on reducing the number of staff required to perform routine tasks while simultaneously boosting productivity.
“With manual processes there are handoffs, workarounds and duplication of efforts,” said Kate Reynolds, RN, senior director of medical informatics for inpatient care for Evanston (Ill.) Northwestern Healthcare. “People don’t realize how much effort goes into getting information. Workflow redesign is about taking out the duplication and maximizing your investment.”
Instrumental in a system-wide implementation of a fully integrated electronic medical record initiative, Reynolds led a team that mapped out and redesigned the entire clinical inpatient workflow at Northwestern. The Healthcare Information and Management Systems Society designated the system as a “Gold Standard” for EMR implementation.
Reynolds insists that executives in the C-suite should lead all workflow redesign projects, and from there its dispensation should trickle downward. Management needs to create a planning committee, which in turn must designate a coordinator to direct the proceedings. The person selected for that job, she said, assumes a significant burden.
One of the most daunting tasks in the redesign process is creating a list of workflows within the organization, which in a hospital can number in the thousands.
“We had 500 high-level workflows alone,” Reynolds said. “From there, you drill down to get the medium and low workflow levels.”
Christy Stafford, director of information technology at Borland-Groover Clinic in Jacksonville, Fla., is coordinating a workflow redesign at the 45-physician practice. She agrees with Reynolds that the scope of the job is huge, but says it’s because workflow redesign itself is such a colossal undertaking.
Although a fully operational workflow redesign should yield financial gains such as staff reductions, Stafford said it wasn’t the driving factor behind the initiative.
“Financial savings would be great, but it wasn’t our primary goal,” she said. “It’s about patient care. Our operation suffers when we can’t put a finger on the information we need. Workflow redesign is a process that will allow us to cut out extra steps.”
Physicians Simeon Schwartz, MD, and Barney Newman, MD, have had a couple of years to reflect on the workflow transformation at their clinic in White Plains, N.Y., and can attest to the savings it generates: Approximately $7 million to $8 million a year from an $80 million budget. Overall, Westchester Medical Group has been able to pare its full-time equivalent staff by 40 percent.
“And the return on investment for all facets of the project came in less than three months,” said Schwartz, president of the 120-physician practice.
Not only did the workflow redesign dramatically reduce costs, it enabled the practice to quantify patient outcomes, earning Westchester Medical Group a special citation from the National Committee for Quality Assurance this year.
“That was our vision – to produce better quality of care, especially on quality measurement and quality standards while dramatically reducing costs to make us financially successful,” Schwartz said. “Every industry but healthcare had done this. Healthcare has had virtually no improvement in productivity.”