Healthcare Process Management Guide

The healthcare industry is has one of the most complex infrastructures compared to other
global industries. Consider all the moving parts and transfer of data (as well as patient care)
across health systems starting with individual practices and prehospital care, through hospitals
and onto palliative care facilities. When healthcare process management works well, it’s a
finely tuned machine that lends to the treatment and recovery of patients and provides faster of
services to families through social and administrative services.

The secret of getting ahead is getting started. The secret of getting started is breaking
your complex overwhelming tasks into small manageable tasks, and then starting on
the first one. - Mark Twain

Outside of the patients, properly tuned processes give healthcare providers and workers the
information, connections, and resources they need to do their jobs.

But how often do those processes work? And how often do they work efficiently and as
intended?

1. Focused Quality Improvement – Fix Critical Processes First

When you step back and look at the larger picture of patient care, there are hundreds of
people, directly and indirectly, involved at some point during treatment, recovery, and post-
recovery. This includes clerical workers, prehospital staff, physicians and nurses, nurse aids,
administrative and billing, social services, physical therapists, mental health workers and more.

The more people you add, and the more data changes hands, the more complex and
convoluted the process becomes. This results in much slower processes and approvals. Much
of the work is created as a result of failing or inefficient processes.

Healthcare is made up of thousands of processes, and if you focus on the ones that are most
critical you can make a significant improvement. Rather than try to change everything, or
create quick fixes that add to the workload, look at it by the Pareto principle; 80% of your
results come from just 20% of the work.

Rather than patch the process, find the critical points and bottlenecks in the critical processes
that will have the most impact. Optimize them and focus on quality improvement at the source
of the issue.

2. Better healthcare process management starts with data

“In God we Trust, all others must bring data”

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 No matter what kind of healthcare process you’re trying to improve, it should be tackled by the
numbers. That’s how you evaluate and find the areas that need the most attention.

 Where is the most time being lost

 What causes the most delays in billing
 Where are the gaps in communication
 How is information moved between facilities
 What are staff response times for emergent and non-emergent issues
 What are patient satisfaction rates, how do they relate to processes
When you’re dealing with a complex health system, process changes have to go up the chain,
sometimes through multiple levels of leadership and even to a board. The most effective way
to enact change is to present the data.

This should include the data showcasing the current issues in workflow and efficiency, while
also showing some measure of data on the results (even if forecasted) that would come from
improved process management.

Use the numbers to sell the need for improvement, as the data can provide tremendous insight
into how more efficient processes will impact the bottom line, patient care, and communication
among staff.

3. Process management should focus on the process, not staff

“Cease dependence on inspection to achieve quality. Eliminate the need for inspection on
a mass basis…”

Improving process management in healthcare is about managing the process of care. Many
facilities in the industry took the wrong approach in recent years, and still do, by trying to
manage the physicians, nurses and other workers.

It’s naive to think that improving processes starts and ends with cracking a whip on your facility
staff, at any level.

Too many facilities get caught up in the audits, inspections, and performance of care staff and
physicians, and attempt to manage them. What really needs to be audited, managed, and
improved are the current processes.

The teams within the healthcare system at every level should be tapped to achieve this.
Because they work with those processes around the clock, they can provide the most accurate
insight into how those processes should be improved.

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4. Adoption of the new processes is critical
“Adopt the new philosophy. We are in a new economic age. Western management must
awaken to the challenge, must learn their responsibilities, and take on leadership for change”

According to Harvard Business Review, hospital administrators typically work from the
information that is most readily available to and trusted by them—namely, the line-item
expense categories on their P&L statements. Those categories, such as personnel, space,
equipment, and supplies, are attractive targets: Reducing spending on them appears to
generate immediate results. But the reductions are usually made without considering the best
mix of resources needed to deliver excellent patient outcomes in an efficient manner.

The administration also pushes physicians to spend less time with patients in order to
improve workflow efficiency and improve patient care in hopes of dealing with the rising costs
of providing care. But this is a backward approach.

Not only does leadership need to shift their focus to improving process management, which
can reduce treatment and administrative costs, they also need to lead their teams with better
training and updated employee onboarding when new processes are deployed.

The only way more effective process management can occur is when communication and
training happen from the top down, not laterally.

This approach eliminates the need for constant retraining, inspections, and audits of the
workflow by building quality and effective deployment into the process from the beginning.
Rather than having to cut line item costs or rushing treatment, the savings come through more
efficient practices throughout the entire system.

5. Constantly improve processes

“ Improve constantly and forever the system of production and service, to improve quality and
productivity, and thus constantly decrease costs.”

Simply put, healthcare process management is ongoing. It doesn’t stop. There are always
opportunities to refine and improve the way various departments communicate, share
information, and move the workload through the system.

Rather than auditing workflows only during bottlenecks, or only auditing performance of the
healthcare staff to see what’s broken so the order can be restored, a new approach is
necessary. Healthcare leadership, at every level, must empower staff with the ability to find
ways to improve the process.

A proactive approach like this will consistently reveal issues with process management and
provide opportunities to continually decrease operational costs while improving efficiency.

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6. Eliminate fear for improved deployment
“Drive out fear, so that everyone may work effectively for the company”

People naturally “fear” change. It makes us uncomfortable and it’s a barrier to improving
processes. Our gut reaction to fear and change is to reject it immediately and maintain the
status quo. This is one of the biggest challenges with implementing new and more efficient
processes. It’s especially true when you have older health care workers with tenure that are
used to “the old way of doing things.”

Part of improving healthcare process management needs to be improved training and

onboarding. Whether it’s an improved method of obtaining and processing labs or a more
complex process that involves new technology deployment (like EHR integrated tablets),
leadership needs to have a plan to eliminate the fear of change and make it easy for all staff to
adapt.

Even with an automated process, strategic training and onboarding are critical to the effective
deployment of new processes.

7. Break down barriers in healthcare process management

“Break down barriers between departments. People in research, design, sales, and production
must work as a team, to foresee problems of production and in use that may be encountered
with the product or service”

A complaint often heard among prehospital workers (Paramedics and EMTs) are hospital staff
that won’t provide a face sheet containing a patient’s personal information. This is despite the
fact there is a transfer of care taking place. That small interaction can waste several minutes or
more, acting as a barrier to progressing patient care and slowing down other processes that
would involve that same personnel.

Even in a unified healthcare system, there are barriers between departments and divisions that
can result from personal, cultural, technological and even geographic differences. People in
research, design, sales, and marketing, and down to clerical and direct patient care must work
as a team.

When leadership can get their individual teams working together with others, communication
improves. They’ll also be able to identify problems (and potential problems) in processes that
will ultimately lead to improvements being made.

“Put everybody in the company to work to accomplish the transformation. The transformation is
everybody’s job.”

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8. Stop seeking perfection
“Eliminate slogans, exhortations, and targets for the work force asking for zero defects and
new levels of productivity. Such exhortations only create adversarial relationships, as the bulk
of the causes of low quality and low productivity belongs to the system and thus lies beyond
the power of the workforce.”

It is unreasonable to expect perfection from any employee, regardless of the industry. This
expectation creates disconnect where the staff is no longer seen as humans, and instead
machines that must be fine-tuned to perfection. If perfection isn’t achieved then they are
defective.

This viewpoint punishes healthcare workers for poor performance when in many cases the
performance is tied directly to inefficient processes and workflows. That response impacts their
performance and only inhibits growth, further diminishing productivity in a still-broken string of
processes.

An organization’s bottom line is certainly going to take a hit, but it’s the patient that suffers the
most when care isn’t provided and managed effectively.