Impact Insights

What About Workarounds?

Jolinda Sears

Remember your first Electronic Medical Record (EMR) installation project? Remember going into a room with the software vendors and “validating” your workflows? How comfortable were you that everyone understood what transpired? Does the vendor really understand the workflows? Are the workflows a true representation of what really happens?  Why is this so important?

Along with a few hundred other important details for a new EMR implementation, there are two crucial pieces of information you need to garner before build begins. First, an in depth understanding of departmental workflows; and second, verifiable knowledge of current workflow compliance.  A vendor can give you great software but, if what they design doesn’t do what you need it to, end users are going to come away frustrated and unappreciative of what is actually a very useful product.

Given a workflow chart, how many leaders can say, with absolute certainty, what the flowchart states is exactly what is being done consistently in their departments?  This is a great place to start when getting prepared for a new software installation. Pre-build optimization can be useful for an organization to identify and eliminate workarounds, or instances where staff is not following the organization’s prescribed workflows.

Direct observation and documentation is a way to pre-validate workflows that are in place. It allows for end user contact and input on how things are really done and day-to-day issues that arise with the current workflows. This is a perfect opportunity to identify present problems in your current practice.  You don’t want to install a new system around a broken process. Identify and fix, validate, then build.

Sometimes workarounds are so ingrained in a system they are no longer identified as a problem. It becomes “just the way we do it.”  It’s not perfect, but clinicians have learned to adapt and live with it. Identification of these processes may be difficult as these are the ones end users have carefully and creatively developed to make it work. They aren’t going to give them up easily either. In their minds, it may have been broken, but now it is “fixed” so don’t go messing with it!

These workarounds can be identified with a little “why” digging and careful listening to what the end users are saying. If it sounds odd, for example, “the front desk staff enters an order…,” start digging. Order entry and front-end desk staff doesn’t go together. Why is front-end desk staff placing orders when ordering is a provider function? Who is validating these orders? Why is it necessary to have the front-end desk staff do it? Keep asking questions until a clear understanding of why it happened and what the process should be is answered. Then, work can begin to optimize the process. This may require a workgroup of leadership and staff, a Kaizen event, a six-sigma project or a simple rearranging of assignments to accomplish the change, but the time and energy invested will be well worth it.

Workarounds are great optimization opportunities. Finding out why workarounds are happening, mapping out the best way for the process to work, setting the new course in place, then validating it as the correct workflow ensures new build can support the right workflow.

A focused effort upfront can make a world of difference during build and once go live is complete. New project analysts are excited and ready to work, but they are reliant on the information they are given to create the product. Being able to provide them with workflows that are standardized, effective and being used as designed is the best way to ensure the end product works for the end users.

 

Looking for more about our approach to clinical implementations? Find it here.

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