The Workflow Behind The Smiles: Patient Experience

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Today, industrial engineers, and I have a Master’s in Industrial Engineering, they’re changing their name to Systems Engineering. When you’re a systems engineer, and you start talking about improving systems, basically, what systems engineers do, is they replace every word that is “systems” with the word “workflow”, because as soon as you start talking about workflow, you’re starting to talk about actual sequences of things. There’s all kinds of tools to help you improve those workflows.

What’s the relationship to patient experience? Folks are developing mobile apps for patients to interact with, and folks are coming in and doing, kind of, sophisticated “Charm Schools” for the folks that are interacting with the patients. I’m going to talk about this back-end stuff, but let’s start with probably the most famous, and prevalent, and popular definition of patient experience, from the Beryl Institute. “The sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” If you drill down on each of these four areas, Beryl also defines those.

Let’s take a look at the stuff in the middle here, the organization’s culture to influences patient perceptions. That culture is made up of vision and values, with then inform the attitudes, and demeanor, and training, and behavior of that front-line staff, interacting with the customer or the patient. The perceptions, that’s the other half, that’s the patient reacting, saying, “I recognize this, I understand this, I remember that.” Those are the smiles.

The systems is the rest of that definition. The sum of all the interactions across the continuum of care. If you drill down and grab the description of interactions, and the description of continuum of care, from the Beryl Institute, put them together, you get this. The orchestrated touch-points of people, processes, policies, communications, actions, and environment, before, during and after the delivery of care. The key word here is “orchestrated.” Orchestration is a very important word, it is a important part of the terminology of the workflow, and the workflow technology industry.

One way to understand orchestration is to contrast it with choreography. Orchestration implies some sort of central workflow conductor. You’ve got the conductor up there, they’re waving their want, and everybody is kind of doing what they’re told to do. In software, that’s often a workflow engine, which we’ll talk about in a little bit, but they can also be a human, a human care coordinator, who is facilitating these workflows. Choreography is about distributed workflow control, so there is no conductor, it’s like a jazz ensemble, and everybody has a set of, kind of, workflow rules in their heads, and they’re watching each other, and they’re doing a kind of a dance.

Modern workflow systems tend to be hybrids of orchestration and choreography. Some are very much toward orchestration, but they still have some choreography. Some are very much about peer-to-peer choreography of workflows.

Take me to the next post in this series: Health Information Technology’s “Workflow Wall”: Patient Experience.

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