The Workflow Technology Prescription: Patient Experience

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Over the last couple of decades, I’ve noticed that whenever there’s a big, sort of, societal problem, someone will eventually get around … The problem is called “X”, and someone will write a book called The “X” Prescription, how are we going to solve the problem. I often tweet this picture of The Workflow Prescription. What is the workflow prescription?

Let’s start with what is workflow. I have seen literally hundreds of definitions of workflows, over the two or three decades that I’ve been interested in the topic. I have seen definitions that would span two PowerPoint slides and used tiny font. The very simplest is simply, a series of steps. I like this definition, it’s mine, and it is workflow is a series of steps, consuming resources, that’s cost, and achieving a goal, that’s benefit.

Let’s break it down. Series of steps, tasks, activities, so they’re called different things. If you’re an anthropologist, and you go into someone’s home, and you are diagramming their life flows, and they create process maps when they’re trying to understand how folks, for example, are using various products. They may not call them tasks, they may call them activities.

Consuming resources, or costs. These costs are not just the healthcare system’s cost, but these are the patient’s money, attention, and time costs.

Then you’ve got goals, these are the benefits, costs and benefits. Workflows exist in an economic environment. When that economic environment changes, the workflows need to change. However, there are many reasons why it’s difficult to change healthcare workflows, in the ways that would maximize the ROI, maximize the benefit/cost ratio.

By the way, process and workflow are often used synonymously, not always, and the meaning is usually clear, from context.

That was workflow, what is workflow technology? Generally, informally speaking, any technology that intentionally facilitates workflow is workflow technology, but narrowly, technically, if you’re a workflow professional, a workflow technology person, workflow technology involves models of work. These models of work are executable, meaning a computer program can look at that model and execute it just like some computer code, just like an if/then or case statement. The models can be of work or workflow, workflow tends to be sequences of things, work tends to be hierarchies of goals. Consultable means these models can be understood and consulted by a human, so that you can look at it, and inspect it, and say, “Oh, I see what the status of this task is,” or, “I see what needs to change in the design of the work or the workflow.” Consultable also means by the computer, because even if it’s not executing the model, the computer may use some model of work to interpret, for example, analytics.

These models can usually be visually represented. In the business process management industry, you have lots of systems that allow you to draw workflow diagrams, and you turn a crank, and an application comes out. Instead of writing Java, C# and MUMPS code, you draw the workflows. Workflow technology also includes calendar systems, where non-programmers are creating rules, that are running against the calendars, to route messages and escalate, and also dynamic checklists. Checklists are big in healthcare, but if you implement those checklists in such a way that all of the items are smart, and they can detect which things have to occur in a different order, that’s an example of workflow technology, too.

What’s the difference between workflow technology and information technology? Information technology certainly influences workflow, every piece of software has “workflow”. My mother, who was an English teacher, drilled into the difference between affect and effect. Affect means to influence something, maybe positively, maybe negatively. Some software makes workflow better, in healthcare, some software does not. Workflow tech is intentionally designed to effect workflow, that is, it drives workflow, it pushes tasks to the right person, checks to make sure that they’re done, and so forth. It’s kind of like Jean-Luc Picard, in Star Trek, saying, “Make it so.” That’s workflow technology.

Here’s another difference. Information technology in health IT often hardcodes workflow. What does that mean for workflow to be hardcoded? It means that, after you compile the program, in the software factory, back at the vendor, and then you send it out, and it starts to execute. All of it’s behaviors are already inside the program, they’re already compiled down. It doesn’t consult much in its environment when it executes.

Softcoded software, such as workflow technology, softcodes workflow, so as the program executes, instead of just consulting some value that’s hardcoded into the program, it reaches out into a database, or reaches out into the environment, and at run time, this changes the order of things, this changes the business logic. People who aren’t programmers, people who aren’t Java, C# folks, can change the workflow behavior after you implement the system. It’s important to get the folks in the workflow, the clinicians and so forth, involved in the design at all aspects, not just before you implement, but even after to implement it. In order for that to be true, the software has to softcode workflow, so that those changes can be tweaked after the implementation.

Take me to the next post in this series: Four Benefits Of Structured Workflow and Messaging: Patient Experience.

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