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Answered By: Kristie Keuntjes
Last Updated: Aug 29, 2018     Views: 12

What is workflow?

Workflow refers to the series of steps performed by different staff members that accomplishes a particular objective/task.  It represents how work actually gets done and not the protocols that have been established to do the work.  It is the sequence of physical and/or mental tasks performed by various people that can happen sequentially and/or simultaneously.  

In short, the workflow refers to the who, what, when, where, and how things get done in your clinic.


Why do we need to know about workflows?

Clinicians and staff in busy practices feel one of the most helpful tasks to complete is to map key workflows as it can help identify areas of improvement to increase efficiency, reduce errors, and improve outcomes. Focusing on workflows can help better prepare and train staff, decrease significant interruptions in client care and communication, and increase the ability to plan ahead.


Are there different types of workflows?

Yes, here are some examples of workflows you will encounter in clinic:

  • Inter-organizational workflow:  This refers to the workflow between different organizations involved in client care.  Here are some examples of inter-organizational workflow:
    • The workflow between a physician and the pharmacy
    • The workflow between an emergency department physician and a primary care physician to share information about a client
  • Clinic-level workflow:  This refers to the flow of a physician, nurse, or client through physical space and the flow of information among people at a practice or clinic.
  • Intra-visit workflow:  This refers to the workflow during a patient visit.  Here is an example of an intra-visit workflow:
    • Problem list
    • History and physical
    • Prescription of treatment
  • Cognitive workflow:  This refers to the workflow of the mind, and this is unlikely to be observable.  Here is an example of a cognitive workflow from a clinician's view:
    • Listen for any significant acute problems and deal with those first
    • Investigate any concern about spousal abuse
    • If I don't hear any concerns, focus on the chronic problems

How is workflow analyzed?

The most common method to evaluating workflow is flowcharting.  Flowcharts show how processes really happen and help clinicians understand what contributes to different types of flows for the same process.  Flowcharts can also help to identify areas of improvement needed in the workflow.  

Here is a five-step process to reviewing workflows:

1. Decide what process needs to be examined.  

2. Create a preliminary flowchart to identify the steps and activities involved in the process you are examining.  The preliminary flowchart can help identify the steps and activities involved in the process.  It can also help you identify the important stakeholders and who should be represented on the analysis team.

3. Add detail to the flowchart.  After you have created the preliminary flowchart, add detail with the help of the analysis team.  Questions to ask during this process:

  • Who does this step?
  • What technology/resources are used?
  • What policies and rules are determining who/what/when/where/why/how this step is executed?
  • What supervision is involved?
  • What other people might be involved in the step?
  • What information is needed to complete this step?

4. Determine who you need to observe and interview.  This will depend on the process being evaluated.  If you are reviewing the patient charts, you will need to observe staff in medical records.  If you are reviewing check-in procedures, you will need to observe the front desk staff.

5. Complete the observations and interviews.  It is important to observe and interview the people doing the process to really determine the details involved. Things to consider during this process:

  • Identify the major ways processes vary
  • Observe 3-5 episodes of the process for each major way it can vary
  • Record the details of what is observed

For interviews, use the same questions used during the initial flowcharting process:

  • Who does this step?
  • What technology/resources are used?
  • What policies and rules are determining who/what/when/where/why/how this step is executed?
  • What supervision is involved?
  • What other people might be involved in the step?
  • What information is needed to complete this step?

How do I create a flowchart?

For help with creating a flowchart, please see the following resources:

References

Agency for Healthcare Research and Quality. (2010). How do I evaluate workflow[PowerPoint slides]. Retrieved from Agency for Healthcare Research and Quality website: https://healthit.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/presentations

Agency for Healthcare Research and Quality. (2010). What care about workflow? [PowerPoint slides]. Retrieved from Agency for Healthcare Research and Quality website: https://healthit.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/presentations

Agency for Healthcare Research and Quality. (2010). What is workflow? [PowerPoint slides]. Retrieved from Agency for Healthcare Research and Quality website: https://healthit.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/presentations