Another Trick for Untangling Workflows - Improved Document Design

 Hi fellow CMIOs, CNIOs, and other Clinical #Informatics and #HealthIT friends,

In my last blog post, I shared some slides from a recent talk I gave to a group of newcomers to the world of Applied Clinical Informatics, and shared my first trick for untangling and controlling workflows - technical procedure writing ('the Cupcake Test'). 

For today's blog post, I'd like to share another helpful trick for untangling and controlling workflows - Designing documents, both inside and outside of your EMR, to help clarify and improve workflow.

There's a common saying in both Applied Clinical Informatics and technical document writing : "Control your documents, before they control you." This is basically how I learned to love documents - They actually do create standards, but only if you know how to use them properly. 

Documents are tools used to record and transmit information. To help better explain the power of documents, it's helpful to look back at patterns set into motion by our earliest human ancestors, when they first learned to document on the walls of caves. Their ideas could be turned into images and symbols, that would in turn put information into other heads. It was the first time that humans really learned the power of documentation : 

And so, an organization is simply four walls, into which a bunch of people and documents have been placed : 

• If the documents are clear and easy-to-find, your staff will use them to understand your values and needs, and will create predictable patterns and outcomes. 
• If the documents are vague or not easy-to-find, your staff will not use them to understand your values and needs, and will not create predictable patterns or outcomes. 

Interesting to note is that if you were to create a whole new hospital, from scratch - you would need about 24 document types to effectively run any hospital - About 12 are commonly found inside your EMR, and about 12 are commonly found outside your EMR : 

So if we assume that all of healthcare depends on these 24 document types to run, then this helps us simplify change management into three key steps : 

1. STEP 1 : Define your current-state worfklow. ("Point A") 
2. STEP 2 : Design your desired future-state workflow. ("Point B")
3. STEP 3 : Identify which of the 24 tool(s) (both inside the EMR and outside the EMR) you need to get FROM the workflow defined in step #1 above, TO the workflow defined in step #2 above. 

Another nice side-benefit to improving your document design is the opportunity to help get people better aligned in their understanding of commonly-used tools and concepts. 

For example, let's say you'd like to help get clinical staff better aligned in their understanding of the term "PROTOCOL". It's a term that is particularly difficult to nail down and define, so many people have slightly different interpretations of what-exactly-a-protocol-is-and-what-it-does : 

After first reviewing your State and Federal regulations, and then your own operational needs, you can then use these four steps to increase clarity and understanding : 

1. STEP 1 : DEFINITION - Write a clear, simple, one-sentence, policy-grade definition to answer the question, "What is a protocol, and what does it do?"
2. STEP 2 : TEMPLATE - After you have a good working definition, design a template for creating protocols. 
3. STEP 3 : PROCEDURE - After you have a good working definition and template - design a good procedure for drafting, reviewing/vetting, approving, publishing, monitoring, and archiving protocols. 
4. STEP 4 : EDUCATION - After you have the procedure in step #3 nailed down, you can start to educate your staff about your new definition, template, and process - And soon people's common understanding will increase, with this new foundation and support for this important document. 

This kind of foundational work is especially helpful when trying to get teams of people to work on complex clinical workflows. 

Need some guidance about how to go about writing clear, simple, one-sentence, policy-grade definitions (as in step #1 above)? - For this, I first recommend first working with your legal, regulatory, and compliance staff to review the applicable Federal, State, and local regulations. After reviewing the regulations, you can then use a spreadsheet to draft a "CMIO's Checklist", which is very helpful in creating definitions that meet or exceed these regulations : 

You can use this type of spreadsheet to work on elevating your definitions, for presentation back to your legal and compliance team, for their review and final approvals. With improved definitions comes improved understanding. 

In my next post, I'll share two more helpful tricks (from my recent presentations) that clinical leaders and informaticists can use to help untangle workflows. 

Remember - This blog is for education and discussion purposes only - Your mileage may vary. Always review with your Clinical Leadership, Legal/Compliance teams, and Informatics leadership before publishing or changing any definitions or document templates. 

Have any experience with redesigning document archetypes to enhance clarity or understanding? Feel free to leave in the comments section below!