The CMIO’s Guide to Untangling Complex Clinical Workflows

By | September 15, 2020

Dirk Stanley, MD, CMIO, UConn Health

For today, I thought I’d share an easy trick for untangling even the most complicated clinical workflows.

Let’s say you’re asked to help troubleshoot a particularly complicated workflow, where the end-users tell you things like, ‘It’s so complicated, I can’t even describe it!’, or ‘It’s very non-linear.’ You want to help, but aren’t sure where to start.

Here’s my tip: Start by just writing procedures.

While many people in the industry commonly write their workflows as ‘swimlane’ diagrams, I find that these can sometimes quietly have room for error. In the wrong hands, with an untrained eye, it’s possible to draw up a swimlane diagram with ‘hidden gaps’ that are hard to spot until you talk through each step in the process, usually with a group of end users.

Indeed, swimlanes are the usual industry standard for planning or troubleshooting complex workflows, but writing good procedures can be equally as effective, with some added benefits:

  • Procedures can usually be edited dynamically, on-the-fly, with a group of people (e.g., in a video conference), as an easy way of quickly collecting their understanding of their workflow/process.
  • Procedures also make it easier to spot missing pieces. If you use my format above, you’ll always know when the who (stakeholder) is missing, when it’s not clear what’s a required (will) task or an optional (may) task, or what exactly the task is.
  • Procedures can also usually be easily converted into policies or education, for those times when you want a policy to help back up and reinforce a procedure, or educate it out to the people who need to follow your new workflow/procedure.
  • Procedures are also generally ‘naturally lean.’ Missing pieces, redundancies, or design problems usually become obvious as you write out the procedure, allowing you to address those questions before you build your new process.
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If you use the outline above, with the optional modifiers, you can even estimate the time it takes to do each task, allowing you to anticipate the total time, people, and resources you will need to achieve your desired outcome. This can even be helpful in developing a Total Cost of Ownership and Return-on-Investment for your workflow.

And it’s generally easier to stitch procedures together than it is to try to stitch swimlane workflows, which can take some time to move objects around, edit text, and reformat the diagram.

Finally, for extra clarity, you can even name your procedures exactly what they are, for example:

  • Draft – Current State: How to cook good food.
  • Final – Current State: How to cook good food.
  • Draft – Future State: How to cook even better food.
  • Final – Future State: How to cook even better food.

If you have any tips you’d like to share for documenting or troubleshooting workflows, feel free to pass them along.

This piece was written Dirk Stanley, MD, a board-certified hospitalist, informaticist, workflow designer, and CMIO, on his blog, CMIO Perspective. To follow him on Twitter, click here.