The work (clinical care, administration, facility operations, marketing, etc.) performed by healthcare organizations must be well-organized to ensure efficiency, profitability, and most importantly the best possible patient outcomes. The particular work processes performed by different divisions in the organization are based on workflows, or the progression of steps required to complete the process. In a sequential workflow, a step must be completed before the next one is begun. In parallel workflows, however, multiple steps may be underway simultaneously.
Value-added steps in a workflow are those which contribute in some meaningful way by streamlining, advancing, or enhancing the process. They add value by improving the process itself. Non-value-added steps, by contrast, do not directly contribute to or add value to the process and should be considered for elimination. Remember that some steps are mandated or required by regulations or accrediting organizations and need to remain in place whether they add value or not.
The various steps, and direction in which the process flows toward completion, are depicted in a process map. For clear examples of different process maps and tips for creating them, consult Amanda Athuraliya's Easy Guide to Process Mapping.
There are several types of process map, each with a defined purpose. Swimlane maps, for example, assign individuals to lanes in the flowchart. The lanes clarify who performs what role, at any step or stage, in the larger work process. A value stream map helps identify non-value-added steps in a process. To learn more about them, read the short article "What Is Value Stream Mapping, and How Can It Help My Practice?" by Ziad Gellad and Theodore Day.
To understand workflows, consult as many flowcharts as possible. Be sure to notice how these diagrams use directional arrows and varying symbols and shapes for different elements in the process. The flowchart should make clear where the process begins and how exactly it proceeds at any particular moment.
The Workflow Assessment for Health IT Toolkit is a helpful resource for understanding, designing, and analyzing workflows. Be sure to review all the pages and links in this toolkit. You will find detailed and clear explanations of flowcharts, tools for creating them, and access to many full-text research articles on workflow analysis.
The AHRQ's toolkit (link above) contains a search engine on its Research page and provides links to additional studies at the bottom of the Flowcharts page. Note: The studies discoverable through AHRQ are outdated and, while good examples for learning about such analysis, should not be cited in your own work unless otherwise approved by your professor.
When searching in library databases, be sure to run multiple searches. Create a list of viable keywords to enter. Insert the Boolean operators AND, OR, and NOT between keywords to expand or narrow your search results. Remember that researchers may use a variety of terms to describe workflow analysis. Be sure to search using various terms such as workflow analysis; workflow design; or work processes. Remember that a database will search for individual words separately unless you enclose phrases within quotation marks: "workflow analysis" will yield better-focused results than workflow analysis.
Also, explore the subject headings used by a particular database to classify articles about workflow. In Health—EBSCO or PubMed, for example, you can run a search using the subject heading workflow; be sure to set the dropdown field to Subject Terms when searching by database-assigned subject. Your search query should look something like this:
If the results are too limited, consider searching with additional Subject Terms on closely related topics. Searching for the assigned subjects organizational efficiency and quality of nursing care together may return articles providing good background information on the value of improving workflows.
Flowcharts may be initially designed on paper, but should eventually be rendered using computer software. In Microsoft Word, or similar word processing programs, you can insert Shapes and connect them to make a flowchart, or for better results insert a SmartArt diagram that already expresses a workflow or hierarchy. Review the link below to learn how to make a flowchart in Microsoft Word.
The American Society of Quality (ASQ) has designed a workflow template for use in Microsoft Excel (see image below). To access it, click on the link near the bottom of the ASQ's WHAT IS A PROCESS FLOW CHART? page (linked below).
