Sunday, October 27, 2013

The "Poor Man's Document Sharing" Strategy

Hi - Sorry it's been a while since my last post. As most of you in #HealthIT know, Meaningful Use Stage 2 (MU2), Health Information Exchange (HIE), and ICD-10 - It's a family of acronyms that can keep you very busy.

For today, I wanted to continue talking about document management, and share a creative solution I lovingly call the "Poor Man's Document Sharing" strategy.

Now, I generally pride myself on being vendor-agnostic, so please forgive me as I refer to Microsoft's SharePoint, a fairly popular solution to document management woes, although not the only one out there. Again, please note there are plenty of other solutions to this problem, and this is not an endorsement - I'm mainly using SharePoint as a teaching example, so I can explain a particular problem that sometimes plagues healthcare projects.

Anyway, for those of you who don't know what SharePoint (or document sharing software) is, here's a great video that will give you a basic introduction to the problem :

The video really highlights the problems with emailing a document around for discussion and review :
  • It doesn't help organize any discussions - It's very hard for a group to see everyone else's feedback.
  • It tends to create monologues, not dialogues. (Generally from sender to recipients only, not recipient-to-sender, or recipient-to-other-recipient.)
  • It delays the time to developing a good, well-developed, well-reviewed document.
After all, if you are managing any workflow change, you will need to create documents. Borrowing from the CMIO's Checklist, you might need to revise or create documents like :

1. Charters (e.g. Committee Charters, Project Charters)
2. Committee Agendas
3. Committee Minutes
4. Project Plans (e.g. Project plans, testing plans, education plans, etc.)
5. Orders
6. Order Sets
7. Policies and Procedures
8. Clinical Guidelines
9. Clinical Documentation
10. Clinical Protocols
11. Staff Education (e.g. Posters, Powerpoints, emails)
12. Patient Education (e.g. Patient handouts)
13. Spreadsheets
14. Notes

... among other documents/tools that you will need to support your mission.

So how you get people to collaborate successfully will depend on :
  • How you set up your documents
  • How your team uses those documents
  • How you manage your projects
Now, as I said, SharePoint is a fairly popular solution to this problem, although there are other solutions out there too. But what if you belong to an organization that doesn't yet have the resources to purchase such a solution? For those of you who have to make do without, I'm going to present this solution - A basic recipe for The Poor Man's Document Sharing.

The Goal :
To create a standard set of shared folders/documents that your team uses to share ideas and build documents collaboratively.

Ingredients you'll need :
1. An organization with anywhere from 5-500 employees.
2. An organizational computer network with some sort of a shared drive (e.g. the "J: drive")
3. Multiple computers capable of accessing the shared J: drive.
4. A copy of Microsoft Office (2007 or later will do) on each of the computers in #3 above.
5. Some standardized email system that your entire organization uses. (e.g. Outlook)
6. Standardized archetypes of your favorite document types (project plans, policies/procedures, order sets, protocols, guidelines, etc.)
7. A dedicated manager of this solution (e.g. a fearless informaticist) who knows how to hyperlink to a folder and a file.

The Basic Recipe :
1. STEP 1
Set up a shared project development folder on your shared J: drive, one that you plan lots of people to be able to use to work together, for example :
2. STEP 2
Create two sub-folders inside this folder :
  • J:/shared/Informatics/templates
  • J:/shared/Informatics/projects
3. STEP 3
Inside the J:/shared/Informatics/templates folder, create the following sub-folder:
J:/shared/Informatics/templates/project templates
4. STEP 4
Inside the J:/shared/Informatics/templates/project templates folder, create the following sub-folders :
  • ./Charter - Drafts/
  • ./Agendas - Drafts/
  • ./Minutes - Drafts/
  • ./Project Plans - Drafts/
  • ./Policies and Procedures - Drafts/
  • ./Clinical Documentation - Drafts/
  • ./Orders - Drafts/
  • ./Order Sets - Drafts/
  • ./Guidelines - Drafts/
  • ./Staff Education - Drafts/
  • ./Patient Education - Drafts/
 ... and fill these folders with your favorite document templates (the ones that your organization uses to standardize the look, appearance, and function of these documents.)
Don't forget :
  • It's helpful if all of your document templates have standardized filenames, like : 
DRAFT - ORDER SET - Standardized Order Set Template - Drafted mm-dd-yyyy.doc
DRAFT - POLICY - Standardized Policy Template - Drafted mm-dd-yyyy.doc
  • If you do not have standardized templates yet, consult your friendly neighborhood informaticist for help developing these!)
You have now built a standard project template, with a standard set of project folders, filled with standardized templates, that you can literally copy-and-paste into another folder, to get any project up-and-running quickly.

5. STEP 5
Now start developing standardized, shared workspaces for your projects. It helps if you create some standard way of organizing them. For example, you might consider creating the following set of sub-folders, based on speciality, where your teams can actually work together :
  • J:/shared/Informatics/projects/Anesthesia
  • J:/shared/Informatics/projects/Emergency Medicine
  • J:/shared/Informatics/projects/Medicine - General
  • J:/shared/Informatics/projects/Medicine - Critical Care
  • J:/shared/Informatics/projects/Medicine - Nephrology
  • J:/shared/Informatics/projects/Medicine - Endocrinology
  • J:/shared/Informatics/projects/Medicine - Cardiology
  • J:/shared/Informatics/projects/Medicine - Gastroenterology
  • J:/shared/Informatics/projects/Medicine - Infectious Disease
  • J:/shared/Informatics/projects/Surgery - General
  • J:/shared/Informatics/projects/Surgery - Orthopedics
  • J:/shared/Informatics/projects/Surgery - Urology
  • J:/shared/Informatics/projects/Surgery - Plastics
  • J:/shared/Informatics/projects/Surgery - ENT
  • J:/shared/Informatics/projects/Surgery - Podiatry
  • J:/shared/Informatics/projects/Psychiatry
  • J:/shared/Informatics/projects/Pediatrics - General
  • J:/shared/Informatics/projects/Pediatrics - Nursery
  • J:/shared/Informatics/projects/OB-GYN
  • J:/shared/Informatics/projects/Radiology - General
  • J:/shared/Informatics/projects/Radiology - Interventional
  • J:/shared/Informatics/projects/Radiation Oncology
  • J:/shared/Informatics/projects/MULTISPECIALTY PROJECTS
* - Note : You will need a "MULTISPECIALTY PROJECTS" sub-folder to put all of the projects that cover multiple disciplines (e.g. MU2, Med Reconciliation, Pharmacy projects, etc.)

6. STEP 6
Give READ/WRITE access to your J:/shared/Informatics folder, to as many clinical directors, chiefs, regulatory staff, quality staff, IT staff, analysts, and other clinical and administrative positions as you can.

This may take some getting used to, especially if you aren't used to that level of collaboration. Remember, that means that everyone you appoint internally will have access to all of your development files, which admittedly carries some risk, but remember - 
  • These are only DRAFT files.
  • This is the "Poor Man's Document Sharing."
7. STEP 7
Need to work on something big like Med Reconciliation? Create a new shared development folder :
  • J:/shared/Informatics/projects/MULTISPECIALTY PROJECTS/Med Reconciliation
... and copy-and-paste the standard project folder, with all of your standardized templates, from :
  • J:/shared/Informatics/templates/project templates
... into your new shared development folder! You will now have a shared working space that your entire team can find easily and work on collaboratively. It will also be full of the standardized templates that your organization has approved, so they can find them and use them easily.

8. STEP 8
Now try to focus all of your discussions on the documents inside these folders - If you want your group to work on a particular policy in a folder, instead of sending your team an email with a copy of the drafted policy, send your team a hyperlink to the drafted policy document in the shared folder.

For example, in the following sample email below, I've highlighted the hyperlinks in yellow :

"Hi team,
In our shared project folder :

J:/shared/Informatics/projects/MULTISPECIALTY PROJECTS/Med Reconciliation

... is the shared policy draft :

DRAFT - POLICY - Med Reconciliation Policy - Drafted 10-22-2013.doc

Please click on the above hyperlinks to :

1. Open the drafted policy.
2. Review the drafted policy.
3. Edit the policy, using Track Changes, if you need to.
4. Add or delete comments to the document.
5. ave the drafted policy document right back into our shared folder.

Please review it and add your comments within the next 48 hours. After we collect comments and feedback from the team, we will schedule our next meeting to review the comments and plan for next steps.

Email me with any questions."

... This then allows your team members to, very quickly :
  • Receive the email from the team leader.
  • Open the document with one click.
  • Edit the document.
  • Leave their comments.
  • Have quick access to help (in case they don't know how to use track changes or add comments, the links about tracking changes, adding comments, and saving a document are all actual links to the Microsoft help pages.)
  • Save the document back to your shared folder.
If two team members try to access the file at the same time, don't worry - Microsoft (and most computer networks) support file-locking : the one who opens it last will get an error message : "FILE CURRENTLY IN USE BY USER __________, would you like to open a read-only version?" which basically helps make sure only one person is working on it at a time.

If someone makes a significant edit, again it's very simple to change the filename and have it save back into your shared project folder. I actually recommend people change the filename if they make any significant edits, and if you use this as your filename :

DRAFT - POLICY - Med Reconciliation Policy - Drafted 10-22-2013.doc

then it is very easy to change it to :

DRAFT - POLICY - Med Reconciliation Policy - Drafted 10-23-2013.doc

Unfortunately, it's also very easy for a team member to delete the working draft, or edit it beyond comprehension. To reduce the risk of this, I usually email myself a "SNAPSHOT - WORKING DRAFTS" copy of the drafts in the team's folder, before I send the hyperlinks out to the team.

9. STEP 9
Been working for months on a policy? Have six different versions in your shared project folder? People getting lost in the folder? Reduce clutter by creating a sub-folder :
  • ./Previous Versions
... and cut-and-paste the older draft versions into the folder. (You might need them for comparison sometime later.)

10. STEP 10
Once you have your project's documents well-built, and well-reviewed by all of the required stakeholders, using your standardized templates, in one common folder - it will probably be very easy to get them approved!

IN CLOSING - This "Poor Man's Document Sharing" recipe may not be the fanciest or most elegant solution, but it does make collaboration a much more organized, standardized, efficient and productive process. 

It's all about making higher quality documents through better communication, improved standardization, and improved productivity.

Like all the posts on this blog, this is for education, fun, and discussion purposes only - Your mileage may vary. Have you developed other ways of collaborating electronically? Any simple tips/tricks I missed? Send me your thoughts or comments!

Sunday, April 14, 2013

Why document management and archetypes matter

QUICK QUIZ : What do the following pictures all have in common?

Graffitti in Northampton, MA, taken December 2012
Artwork from Thomas Stanley, age 4 (from Jan 2013)

ANSWER : They are all powerful reminders of the anthropologic relationship between human beings and their documentation. In other words, I think that very human attempt at self-understanding, expression, and communication :

... is still very much reflected in the organizations and businesses of today :

In other words, I think one way to help understand organizational dynamics is to see an organization as just many, many iterations of this same loop :

... by asking yourself :
  • A - Who are the people in the organization?
  • B - What are the documents in the organization?
  • How do A and B interact?
This is why document management matters. Documents are tools - Every document serves a unique function.  So the way you manage your documents and information will, at least in part, determine the actions and behaviors of your employees, and collectively the functioning of your organization :
  • Give them the right tools to express themselves, in the right way, at the right time - and you will empower your directors and managers to make changes in your organization. (WRITE)
  • Publish those tools in the right place, in the right way, at the right time - and you will empower your staff to learn your values, beliefs, and operational standards. (READ)
  • Update those tools regularly, and you will make sure that both your documents and employee behaviors are current, and reflect your ongoing changing needs. (GOVERNANCE)
And so, you want to make sure :
  • Your managers/directors make the best tools.
  • Your tools are published the best way, so people can easily find, read, and learn from them.
  • Your tools are updated regularly.
What exactly are those tools? I outlined some common healthcare-related tools in the CMIO's checklist, but they vary from industry to industry. But what you *do* want to make sure of is :
  • Each tool has a specific, well-defined purpose. (E.g. Apples=Sweet, Onions=Spicy)
  • Your managers have clear guidelines about how to develop the tools (So they grow apples and onions, and don't build a hybrid apple/onion that people are confused by)
  • You have some kind of quality check before tools are published (e.g. to weed out the occasional apple/onion hybrid.)
  • Your front-line staff knows where to find those tools (so they know to find apples in the apple bucket and onions in the onion bucket
  • Your front-line staff knows when and how to use those tools (e.g. apples for baking pies, and onions for making soups).
The reason I bring up the issue about hybrid tools is because, unlike real-world, physical tools - The engineering and safety of paper tools is not quite as intuitive.

For example, a hammer is fairly intuitive :
  • It serves one purpose : To drive in nails
  • Its safety is fairly intuitive : You can see it, touch it, and feel its weight, and once you hit your thumb by accident, you'll quickly learn how not to do that again. 
  • Its utility is fairly intuitive : If the hammer doesn't successfully bang the nail in, you'll quickly know you need a bigger hammer. And it's fairly easy to see that you shouldn't use a hammer to put in a screw.
Paper tools are tricker
  • It might not be as immediately clear if the purpose is vague, ambiguous, or serves multiple purposes.
  • You might not immediately notice any safety issues, or know when the tools is malfunctioning.
  • You might not quickly see if the tool isn't serving its purpose.
This is why it's important to ask yourself about how your paper tools are designed and used. For maximum efficiency, you'll want them to work the best they can - And that means not just designing good clinical documentation, but reviewing it properly, approving it properly, publishing it properly, and monitoring it properly.

Think of your paperwork as the lifeblood of your organization. If the blood doesn't flow from heart, to finger, and back to the heart - Then it's not doing it's job : To transfer information from the center to the periphery, and back again, in a continuous loop.

This is why document archetypes are important in healthcare - They are a big help when it comes designing your paperwork - Which can be a big influence with the READING part of the loop between your employees and your leaders.

This is one of those terms that Informaticists sometimes use, that can sound scary or weird, until you know how simple it is - and then it becomes very friendly and helpful.

According to Wikipedia, an archetype is a "universally understood symbol, term, statement, or pattern of behavior, a prototype upon which others are copied, patterned, or emulated..." Think of it as the mold you are going to use to cut your cookies - If you want round cookies, then it helps to have a round cookie-cutter :

  • If you wanted a compelling hero template that could serve as a role model (template) for all heroes, to write a blockbuster science fiction movie, then you might make a superhero archetype and name the character "Luke Skywalker".
  • If you wanted a compelling policy that could serve as the role model (template) for all policies, to have a blockbuster policy manual, then you will similarly need a superpolicy archetype to set the example for all of your policies.
(One quick unrelated side note : In this way, I think comic book superheroes actually benefit society - By creating templates/archetypes that kids can use to model at least some of their behaviors. I think this is also why it's unusually heartbreaking to see sports heroes sometimes fall from grace: We hold them up as archetypes of goodness, teamwork and fairness - and then feel great disappointment when we find out that they're actually only human.)

Anyway, having well-defined archetypes helps make sure that every document / tool serves a common purpose, and is developed, used, and monitored in a standardized way. It's that predictability that creates harmony, clarity, and efficiency in your organization.

So ask yourself - What are your documentation role models/archetypes? Perfection is near impossible, but you still probably want your documents to be pretty close to superheroes. Are they already superheroes, or do they need help? Once you have some super archetypes that your employees can use to model behaviors and communication, you will generally start to see a real improvement in your quality, operation, and efficiency. 

Remember, these posts are only for fun, education, and friendly discussion - Remember to check with your own experts and superheroes before you take any actions! And I'm always interested to hear people's thoughts and feedback, so feel free to comment below! :)