1. Choose Effective Leaders and Champions
Work flow redesign cannot happen without leaders who understand and can drive the need for change. Leaders chosen must establish a clear and compelling vision and be able to articulate the need for process redesign, in terms that those doing the work can understand and embrace. Leaders should be able to speak reliably about the operations of the medical group in order to establish the credibility of the initiative and should have a clear understanding of the inherent challenges that will need to be addressed if the group is to achieve desired results. Effective leadership is critical to addressing and removing obstacles that arise during the redesign process.
2. Make the Case for Redesign
Work flow redesign requires transformative change. Given that change is often intimidating and disruptive, it is critical that all involved understand why the status quo is no longer viable, how the process will work, and what the redesign process is going to achieve. Most importantly, the case for redesign needs to answer the question “what is in it for me” so those involved have a reason to buy-in. Buy-in at all levels of the organization is necessary if lasting change is to occur.
3. Clearly Define Goals, Critical Success Factors, and Baseline Performance Metrics
Do not begin to redesign work flows until there is consensus regarding the expected outcome of the redesign initiative. Without clearly defined goals and agreement around what success looks like, it will be difficult to evaluate if the redesigned work flows are having the desired impact. Goals should reinforce the case for redesign and provide further context for the work that is to take place. It is also beneficial to identify the critical factors for success so they can be integrated into the process and help guide the redesign efforts. Lastly, baseline performance metrics must be established and will serve as the basis by which to gauge the effectiveness of the changes implemented.
4. Create Cross-Functional Teams
Given the interdependence of all work flow processes in medical group operations, the redesign team should be cross-functional and cross-disciplinary; that is, include representatives from each of the areas that will be impacted by the work flow changes or will provide tools to assist in streamlining work flows (e.g., clinical staff, physicians, front office staff, information technology, human resources). Team members need to be content experts to ensure that the new work flows meet the needs of their area. Also, it is important that they have credibility within their area of expertise so they can serve as champions for the new work flows. Engage staff and physicians from multiple locations in order to ensure that the newly designed work flows can be adapted and applied across all sites.
5. Describe Your Ideal State
To facilitate creative thinking, create a vision and description of the ideal state before work is started on the actual redesign of the work flows themselves. Rather than building on the current state, start with a clean slate so that the ideal state is not reined in by current practice. Using the current state can often limit thinking and build in biases based on what people think is or is not achievable. Allowing individuals to think beyond what is possible today will break the barriers of traditional thinking and assist in pushing the envelope to achieving the ideal future state.
6. Create a New Work Flow that Drives Performance to the Ideal State
Mapping the current state is the starting point of the redesign work itself. The current state map identifies waste, duplication, bottlenecks, rework, and inconsistencies in the current process. The gap between the current state and the ideal state provides direction on changes needed in work flow and the challenges and obstacles required to be resolved in order to create a new work flow that successfully achieves the desired goals. Processes should be mapped in as much detail as possible to ensure that all eventualities are considered.
7. Revise Staff Roles and Responsibilities to Fit the New Work Flow
Redesign of work flows may require that staff roles and responsibilities be re-configured. As the work flows are modified, job descriptions should to be reviewed to identify if changes need to be made to reflect these changes in tasks or responsibilities. Specific performance expectations related to new tasks should be included in the job description to facilitate accountability.
8. Implement, Measure, and Refine
Upon agreement of the redesigned work flows, implementation begins with the development of the action plan which includes steps, assigned accountabilities, and a timeline. The action plan should address training requirements, the development of new tools, equipment needs, and detailed implementation of the processes themselves. Consider initially implementing the revised work flows in one or two pilot sites. Then refine work flow processes based on the performance to metrics before rolling it out throughout the organization. Choice of pilot sites is important to the success of the redesign process. Characteristics of an ideal pilot site include: an appetite for change, willingness to be flexible, and strong physician and administrative leadership at the pilot site level. Pilot implementation of new work flows should last for at least three weeks before any significant changes to new processes are made. Setting a three week target allows staff and physicians the time to adjust to the changes and ensures that changes are not made as a result of a reluctance or fear of change but are based on performance to identified metrics and end-user feedback. A performance dashboard should be established prior to implementation with ongoing tracking of defined measures and opportunity for end-users engagement and feedback. Daily huddles should be held to track progress and identify issues requiring resolution.
9. Communication Throughout the Design Process Is a Must
When embarking on workflow redesign, you cannot communicate enough. Physician and staff will be nervous and uncertain about what redesign means for them, and communicating at each step of the process can build support and a comfort level with the changes. Also, it is helpful to utilize a variety of communication methodologies, both written and verbal, to address the differences in how people hear and learn. Depending on the size and complexity of the redesign process, consider creating a regular newsletter to keep people informed of progress. Provide an opportunity for physicians and staff to ask questions and receive feedback through regular meetings. As the new work flows are implemented, the use of dashboards to monitor and track progress can be very helpful in building momentum.
10. Celebrate Success
Change is hard work and implementing new work flows can be very stressful for all involved. Therefore, it is important to celebrate success. Create opportunities for short term wins and celebrate as they are achieved. This lays the groundwork for creating a culture of continuous learning and improvement which is critical for long-term survival in a changing environment.
Ms. Corneliuson is a senior manager with GE Healthcare Camden Group and has over 14 years of healthcare management experience. She specializes in physician integration strategies, practice assessments, operational improvement, care and workflow redesign, and compensation arrangements. She is the co-author of The Governance Institute’s signature publication for 2012, Payment Reform, Care Redesign, and the New Healthcare Delivery Organization. She has a strong background in physician practice management with experience in medical foundations, provider-based clinics, and specialty hospital settings.