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! :)


Anonymous said...

Dr Stanley

Great post. I very much enjoyed it.

Having designed dozens of EHR screens, I see a few broad categorizations of screens (forms/documents) in the electronic world. First, is understanding one fundamental difference between electronic documentation and paper. That in paper, the input format is the output. In a computer, those can be disinter mediated so that the output doesn't have to look anything like the input. This attribute is paramount to good system and screen design.

Healthcare is one enormous teamwork play between dozens of clinicians - nurses, MDs, specialists, pharmacists, lab techs, etc. Each of these people sees just their piece of the puzzle, and usually has little understanding of the other pieces. Good systems present the right information to the right people at the right place at the right time.

What makes document design in the electronic world so challenging is knowing what to automatically pull from elsewhere, what to make available as FYI information on screen (Ie showing weight when ordering drugs), what to make available to "copy forward", what to include in documentation for the actual clinical record, and what to include in the document for legal/audit purposes. All of the parties are pulling at central issues from their own vantage points, most of whom don't see the others view points. It's extremely hard to design UIs and workflows in these applications that meet all of the demands of all of these people

hardy said...

the various renovations and revolutions in the field of digital imaging and document management really helps these area of science to make a accurate record on it.

Anonymous said...

Well done, Dirk. One day I'll get you involved in our documentation with the other archetype clinical jedi!... National programs in AU, NO, SI, BR and soon UK (England). UK grassroots movement too.

You coming to Medinfo in Brazil? I'll introduce you to our international colleagues!