Presentation
Human-Centered Approach to Women’s Health Workflow Optimization
SessionPoster Session 2
DescriptionPoor software usability, complex intersystem dependencies, and the lack of sociotechnical integration of software systems within processes may contribute to suboptimal clinical and administrative workflows across a healthcare organization. Study of workflow in the context of the care delivery environment can be used to identify opportunities to improve workflow efficiency and inform workflow standardization1.
Veterans Health Administration (VHA), Office of Health Informatics (OHI) Human Systems Integration (HSI) team of human factors practitioners, and the VHA Electronic Health Record Modernization Integration Office (OEHRM IO) led a multidisciplinary team to execute a mixed methods approach (observation and interview) to identify opportunities to improve workflow efficiency and inform workflow standardization after the transition to VHA’s new Federal Electronic Health Record (EHR), Oracle Health Millennium. The approach was used for several clinical specialties, including Optometry, Audiology, and Women’s Health. This presentation will focus on Women’s Health. The data collection team documented clinical and administrative workflows, inefficiencies, variations, and pain points at two VHA Women’s Health clinics. The team analyzed the data and produced workflow diagrams (with activity completion times), a pain point prioritization quad chart, and workflow variation maps to support knowledge sharing, team alignment, and opportunity prioritization.
Multi-disciplinary team collaborations resulted in action plans aimed at requirements gathering, iterative design, and implementation of solutions considering a variety of improvement levers (e.g., workflow redesign, training, Health IT infrastructure, directives, organizational structure, leadership, staffing, and facilities). A Women’s Health Workgroup team continues to address the prioritized backlog of Short/Long Term EHR, Non-EHR Technology, and Non-Technology opportunities to improve workflow efficiency and standardize clinical practice and administrative workflows. Examples of specific pain points and workflow inefficiencies addressed with Health IT infrastructure intervention will be discussed e.g., lack of high-priority alerts, clinical recommendations not up to date, missing chart indicators, missing data fields, referral routing and interpretation issues, as well as environment issues (e.g., heating, ventilation and air conditioning, private versus public area).
User experience with EHR systems impacts health care provider and staff productivity and satisfaction as well as the quality of care provided to the patient2. Direct observation of end users (clinical and administrative) is an effective method to better understand factors contributing to suboptimal clinical and administrative workflows across a healthcare organization. In addition, interviews and multi-disciplinary team collaborations resulted in a variety of potential improvement levels (e.g., workflow redesign, training, staffing, etc.) as opposed to only leaning on Health IT changes to address pain points and workflow inefficiencies.
The combination of studying workflow in the context of the care delivery environment and multi-disciplinary collaboration resulted in greater impact on workflow efficiency, continued improvement, and standardization at the enterprise level than either one of these parts (studying workflow in the context of the care delivery environment and stakeholder engagement) could have achieved alone.
References
1. Zheng, K., Ratwani, R.M. and Adler-Milstein, J. (2020) ‘Studying workflow and workarounds in electronic health record–supported work to improve health system performance’, Annals of Internal Medicine, 172(11_Supplement). doi:10.7326/m19-0871.
2. Maddox, K. et al. (2023) ‘Lessons learned using rapid human factors methods: Condensed timeline with effective and impactful results’, Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care, 12(1), pp. 174–178. doi:10.1177/2327857923121040.
Veterans Health Administration (VHA), Office of Health Informatics (OHI) Human Systems Integration (HSI) team of human factors practitioners, and the VHA Electronic Health Record Modernization Integration Office (OEHRM IO) led a multidisciplinary team to execute a mixed methods approach (observation and interview) to identify opportunities to improve workflow efficiency and inform workflow standardization after the transition to VHA’s new Federal Electronic Health Record (EHR), Oracle Health Millennium. The approach was used for several clinical specialties, including Optometry, Audiology, and Women’s Health. This presentation will focus on Women’s Health. The data collection team documented clinical and administrative workflows, inefficiencies, variations, and pain points at two VHA Women’s Health clinics. The team analyzed the data and produced workflow diagrams (with activity completion times), a pain point prioritization quad chart, and workflow variation maps to support knowledge sharing, team alignment, and opportunity prioritization.
Multi-disciplinary team collaborations resulted in action plans aimed at requirements gathering, iterative design, and implementation of solutions considering a variety of improvement levers (e.g., workflow redesign, training, Health IT infrastructure, directives, organizational structure, leadership, staffing, and facilities). A Women’s Health Workgroup team continues to address the prioritized backlog of Short/Long Term EHR, Non-EHR Technology, and Non-Technology opportunities to improve workflow efficiency and standardize clinical practice and administrative workflows. Examples of specific pain points and workflow inefficiencies addressed with Health IT infrastructure intervention will be discussed e.g., lack of high-priority alerts, clinical recommendations not up to date, missing chart indicators, missing data fields, referral routing and interpretation issues, as well as environment issues (e.g., heating, ventilation and air conditioning, private versus public area).
User experience with EHR systems impacts health care provider and staff productivity and satisfaction as well as the quality of care provided to the patient2. Direct observation of end users (clinical and administrative) is an effective method to better understand factors contributing to suboptimal clinical and administrative workflows across a healthcare organization. In addition, interviews and multi-disciplinary team collaborations resulted in a variety of potential improvement levels (e.g., workflow redesign, training, staffing, etc.) as opposed to only leaning on Health IT changes to address pain points and workflow inefficiencies.
The combination of studying workflow in the context of the care delivery environment and multi-disciplinary collaboration resulted in greater impact on workflow efficiency, continued improvement, and standardization at the enterprise level than either one of these parts (studying workflow in the context of the care delivery environment and stakeholder engagement) could have achieved alone.
References
1. Zheng, K., Ratwani, R.M. and Adler-Milstein, J. (2020) ‘Studying workflow and workarounds in electronic health record–supported work to improve health system performance’, Annals of Internal Medicine, 172(11_Supplement). doi:10.7326/m19-0871.
2. Maddox, K. et al. (2023) ‘Lessons learned using rapid human factors methods: Condensed timeline with effective and impactful results’, Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care, 12(1), pp. 174–178. doi:10.1177/2327857923121040.
Event Type
Poster Presentation
TimeTuesday, March 244:45pm - 6:15pm EDT
LocationRhinelander Gallery
Hospital Environments