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Future Workflow: An Iterative Process Between Gap Analysis and Workflow Redesigns
Steven LeBeau
Walden University
Supporting Workflow in Healthcare Systems (NURS - 6421 - 2)
November 3, 2014
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Future Workflow: An Iterative Process Between Gap Analysis and Workflow Redesigns
Successful nurses in today’s fast paced healthcare environment have organized their
routines into a science. Some nurses have allowed room for change and seem to glide from one
change to the next without a problem. However, the majority of nurse’s deal with change at
different levels of acceptance while some nurse’s resist change to the bitter end. Why is change
so disruptive? According to Change Theory (2011) the author noted that Kurt Lewin’s
explanation for change is a dynamic balance between working in control and working out of
control. For example, technology forces will drive change in one direction while nursing forces
push in the opposite direction to maintain control. Furthermore, change causes a shift in
equilibrium that favors the intended change (“Change Theory,” 2011). The introduction of an
electronic health record (EHR) certainly qualifies as an equilibrium changer from a nurse’s
control point and forces staff to learn a completely new way of working that does not fit the
earlier controlled science routine mentioned above. The purpose of this paper is to develop an
implementation plan for an EHR system that will meet meaningful use requirements by utilizing
the revised gap analysis, updating the workflow diagram, and developing a use case analysis that
will identify conversion strategies and change management techniques that will attempt to
reestablish the organizations equilibrium.
EHR Implementation: The Migration Plan
The Institute of Jaw and Facial Surgery (IJFS) is an outpatient maxillofacial surgery
center in Canton Ohio. Very respected as an established leader in dental implant innovation, IJFS
has made an attempt to convert to computer charting before meaningful use requirements were
ever established but has reverted back to paper. The office has the infrastructure in place such as
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hardwired CAT5 lines to key offices, Wifi, and a server storage unit on location that a third party
IT worker performs maintenance on as needed. The staff is a very cohesive and friendly group of
workers that have been employed at IJFS for many years. The following will be my migration
planning and activating procedures that will guide the conversion from paper to a digital medical
office.
Major Gaps
Addressing the major gaps identified in the current workflow diagram involves not only
the conversion of documentation and hardware but also providing links to meaningful use so that
the system is fruitful for the owners with government incentives for their hard work. One major
finding from the gap analysis illustrated a much more technically prepared office then had been
first perceived. The solutions will involve updating hardware in the form of tablets and possibly
tower computers with monitors and an integrated Dynomap for the OR.
Another gap is during surgery the patient, the doctor and the assisting nurse occupy the
room with back-up availability at the push of a button. Blood pressure are taken at the start and
finish of each procedure. Evidence-based practice for conscious sedation procedures are wellestablished and would provide meaningful use data. Many of the new meaningful use procedures
that the staff have grown accustom to will need to change towards evidence-based practice.
Dennis et al., (2012) noted the first step in managing change is understanding factors that inhibit
change such as staff member’s debating with themselves, internally, about the cost of learning a
tough new skill and will it be a benefit over the existing practice. The push-pull equilibrium of
adding to the staff’s workload will require understanding by the physicians that more has been
added which equates into a change on both side of the OR table. Gruber, Darragh, Puccia,
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Kadric, and Bruce (2010) noted that integrating both clinical and financial information into one
system will link quality, efficiency, and reduce costs all while projecting the practice into the
new technology area.
Unfamiliar change can cause feelings of frustration and helplessness, especially when the
change is completely new to everyone with little experienced help. Therefore, the change agent,
as reported by Dennis, Wixom, and Roth (2012) becomes the champion for the staff and leads
the project team. Dennis et al. (2012) further noted that change management is extremely
important to provide the organization with employees that want to change and adapt. Providing
leadership and patience along with excellent communication skills will act as the glue that will
hold the change management process together. Very little time between patients is available
during the two visits I made to IJFS. Some of the workload such as charting, cleaning of
instruments, or ordering prescriptions are areas that the clerical staff and physicians can help
reduce some of the workload on the nursing staff. The use case analysis addresses the Happy
Path perfect scenario with no problems as well as giving a bird’s-eye view of all the interaction
between the user and the system (Dennis, Wixom, & Roth, 2012). Finally, the workflow diagram
illustrates the interaction between the user and the EHR system by providing direction paths of
communication and assignments and introducing the meaningful use objectives that each worker
is responsible for collecting.
Implementation Strategy
Conversion strategies introduce the staff to the project and addresses implementation
concerns such as how abruptly will the change be, how many organizations will be involved, and
how long will the implementation take (Dennis, Wixom, & Roth, 2012). Parallel-Module
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conversation package will fit the IJFS style of implementation well because the parallel style will
allow the old system and the new system to exist side–by-side during the implementation process
while the module conversion will allow for two distinctly separate systems to be introduced one
at a time (Dennis, Wixom, & Roth, 2012). Many reasons strengthen this package but a few
benefits that highlight the choice will be explained.
Justification of Strategy Selection
The parallel style is a gradual introduction that will allow the staff members time to
warm-up to the software and change in workflow. Leyland, Hunter, and Dietrich (2009) noted in
their paper the number one reason for EHR failures are tied to fundamental principles of the
staff’s cultural environment, professional procedures, fraternities and traditions that make
themselves most known. In other words, no amount of money or time will assist an organization
whose staff does not want the system to succeed. Parallel style is employee first consideration
instead of the direct conversation that is abrupt and sudden. Combining the parallel style with the
module conversion allows sections of the office to go live one section or module at a time. For
example, the upstairs surgical section could convert first to the EHR system over an assigned
number of weeks. This is valuable time for the design team to trouble shot problems with
workflow and screen usability. The combined system will allow for a back-up system during the
conversion with the existing paper system working side-by-side with the new EHR system for a
short time. Finally, the modular implementation operates as a pilot study and could involve a
change agent group such as a doctor, nurse, and manager team that would initiate the
implementation for the first trial run. Successful organizations find a way to make their
organizations goals, their employee’s goals as well. In the end, it will come down to good old
fashion respect for each other and the ability to communicate that to each other.
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Summary
Change is a dynamic balance between working in control and working out of control. The
staff at the IJFS is a very cohesive and friendly group that have been employed at IJFS for many
years. The conversion to an EHR system not only involves the documentation and hardware but
also providing links to meaningful. Communication by key stakeholders such as the physician
and mangers will hold an extremely important role in the success of the project (Gruber et al.,
2010). Combining the parallel style with the module conversion will allow sections of the office
to go live one section or module at a time. The combined system will allow for a back-up system
during the conversion with the existing paper system working side-by-side with the new EHR
system for a short time. Successful organization find a way to make their organizations goals,
their employee’s goals.
References
Change Theory. (2011) In Current Nursing. Retrieved from
http://currentnursing.com/backstage.html
Dennis, A., Wixom, B. H., & Roth, R. M. (2012). Systems analysis and design (5th ed.).
Hoboken, NJ: Wiley.
Enid, M. (2012). Understanding development methods from other industries to improve the
design of consumer health information technology. (Report No. 290-09-00023i-10).
Agency for Healthcare Research and Quality.
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Gruber, N., Darragh, J., Puccia, P., Kadric, D., & Bruce, S. (2010). Embracing change to
improve performance: Implementation of an electronic health record system. Long-Term
Living: For the Continuing Care Professional, 59(1), 28-31.
Leyland, M., Hunter, D., & Dietrich, J. (2009). Integrating change management into clinical
health information technology project practice. Privacy, Security, Trust and the
Management of e-Business, 89–99. Retrieved from the Walden Library databases.
Addendum Objects Below
Wk9VisioProjectLeB
eauS.vsdx
Wk11ProjLeBeauSP
art3.pptx
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