Dirk Stanley on Clinical Workflow


Dirk Stanley, MD, CMIO, UConn Health

It’s been a while since my last post, but today I thought it was finally time to write again. What inspired me was a discussion at work about a concept I’d like to describe as the “spaghetti-bowl workflow.”

Many Informatics professionals spend time untangling these ‘spaghetti-bowl’ workflows, optimizing them, and making them look like the “after” category. But how exactly do they do this?

In short, it’s helpful to have a solid recipe for making great, predictable, build-once “gourmet-style” clinical workflows that make everyone happy — including patients, clinical staff, regulatory/compliance, finance, and IT. After all, good workflows are like good food; they should be healthy and nourishing, and taste (feel) great.

If it’s a cupcake you want, then it’s helpful to follow the cupcake recipe.

Experienced people in #Informatics and #HealthIT might know the recipe for gourmet changes that satisfy all the stakeholders and don’t result in unexpected outcomes that need rebuilding, but this recipe is not commonly written anywhere. So for clinical education purposes, I thought I would share a version of the change recipe that I think works pretty well.

This is a slight variation on the “8 steps to workflow happiness” that I usually teach clinical staff, the first time I introduce the concept of following a recipe to achieve desired outcomes:

Eight Steps to Workflow Happiness

  1. Conception/analysis/prioritization/project approval
  2. Planning
  3. Drafting/building
  4. Testing/vetting
  5. Final approval
  6. Educating
  7. Publishing/go-live
  8. Monitoring/support

While the eight steps above make a good introduction, the earlier gourmet recipe fills in more details. It also highlights the importance of detailed analysis work before even scoping or planning a project.

Sometimes clinical staff (or clinical IT staff) can be surprised to learn the basics of project (and workflow) management. While it might at first seem daunting, it’s important to remember a few things:

  • Learning a good workflow change recipe (the basics of project scoping, planning, and execution) is vital to building solid, predictable workflows that meet all the right needs: Clinical, financial, and legal/compliance.
  • It’s not hard to learn (and is actually kind of fun once you know it!)
  • For small projects, you don’t need to make elaborate efforts for each step. Just being aware of each step will help you avoid pitfalls.
  • It will make you a better informaticist, clinical project leader, and clinical workflow designer.
  • It will help you work quickly with IT analysts, to build the desired workflows you’re looking for.
  • The investment in analysis and planning time will usually more than pay for itself in not having to troubleshoot or rebuild workflows after your go-live.
  • Skipping one or more of those steps, or doing the steps out-of-order, may lead to unexpected outcomes in your desired project or performance improvement initiative.

What these recipes do raise, however, is a common clinical informatics question: Who exactly should be responsible for each step? The IT analyst? The clinical staff? The regulatory and finance staff? The project manager? It’s helpful to start with your IT and Informatics teams, look at each step, and discuss who would be the optimal person to do each step, before you bring the discussion to additional stakeholders for buy-in.

Remember, planning, and planning ahead, are vitally important to success. These recipes can help you do that.

I hope this generates some good discussion with you and your analyst and informatics teams, before you tackle your next project. If you have any feedback, thoughts, or favorite change recipes, please feel free to share them in the comments section below.

Best of luck with your upcoming clinical workflow changes!

This piece was written Dirk Stanley, MD, a board-certified hospitalist, informaticist, workflow designer, and CMIO, on his blog, CMIO Perspective. To follow him on Twitter, click here.


Dirk Stanley on Clinical Workflow