HCIN 542 / Workflow Simulation Lab
As part of the project management plan assignment in HCIN 542: Systems Analysis and Design, our teams were required to participate in a simulation lab wherein we observed the process of patient flow from the time of entering the clinic until discharge. Throughout the simulation, we also observed the workflows of various clinicians, including the clerk, the nurse, and the physician. Additional waiting times in the scenario were identified to our team by the moderator.
The purpose of this lab was for our team to map patient flow through a clinic visit, understand how and why work is completed by specific clinicians, and to identify weaknesses and inefficiencies within the process. As we learned in the course, most processes are 90-95% non-value waste. Focusing on eliminating these wastes is a key component in improving hospital workflows and improving quality and service levels. Correcting patient flow inefficiencies can lead to fewer unnecessary process steps; better provider-to-patient ratios; and fewer waits, delays, and cancellations.
Our team identified several wastes in the workflow and created a value-added vs non-value-added timeline to map the value add transformations as the patient passed through the clinic. For the simulation scenario, we calculated approximately 15 minutes of value-added time to 60 minutes of waste and/or business-value-added time with a total value-added ratio of only 20%. After performing a root cause analysis of the wastes in the failed system, we found that most of the errors in the process were a result of a singular problem: patient identification error. To further illustrate how this root cause created a cascade of waste in the process, we created a cross-functional process map with ‘swim lanes’ distinguishing roles and handoffs of the different staff members. Within the swim lane process map, we highlighted all errors that resulted from the initial patient identification mistake.
Overall this simulation lab was a great opportunity for informatics students to visualize clinician workflows and analyze the effectiveness of each task. While not all failures in a system are related, there is often one root cause which leads to a large amount of subsequent errors. By mapping the experience of the patient in the simulation lab, we were able to critique the current state in order to make improvements.