Let's jump back into the topic of workarounds.
In last week's post, I discussed some of the key reasons for developing IT workarounds in the healthcare environment. Along with some key thoughts on the potential impacts. What I'd like to do this week is dive a bit deeper into how to assess a workaround. I'll also touch on some operational processes for ongoing management.
There are two levels of workarounds within a clinic or health system:
Individual workarounds are those created by a single user or a small isolated group. These are usually created when the users believe there is no impact on others or on the end-to-end process. An example would be using a word processing application to type clinic notes ... and then cut-pasting them into the electronic health record (EHR). Or adding order details to a comment section instead of using a discrete field or using a separate order item. Individual workarounds may be the result of habit, personal preference, or an attempt to mitigate an issue. They are rarely communicated to users outside those participating. Unfortunately, sometimes even these individual workarounds have unanticipated outcomes.
Workarounds may also be present for larger groups of users belonging to a common role, or area. Many organizations make attempts to standardize workflows across areas. They may also adhere to a guiding principle that minimizes customization with an EHR. Thus relying on the standard configuration offered by the vendor for many tasks. For some end-user groups, these standardized tasks may not align with the area process flows. When this happens, group members might collectively agree to use a workaround. If their particular group is all aware of the process, they believe things should be fine - there is no need to mention the change to others. (The general idea may be one of “what they don’t know won’t hurt them” ….. except, in this case, it might.)
In many situations, it’s common for the discovery of a workaround to occur with unanticipated impact(s) - which should not be the case. Maintaining open lines of communication between end-users, IT, and leadership is important. Not only to reduce the risk of unanticipated impacts. But to continue forward movement in our goals in making applications more efficient and effective.
Evaluating a Workaround
When we identify the use of a workaround, it is critical that it be evaluated. This is to understand the impacts and too remedy or formalize the situation as required. Some questions you may want to ask are:
- Is the user/group performing the workaround to accomplish a previously defined workflow? If yes, is the correct workflow documented?
- Are the users knowledgable on the defined process?
- Why are they using the workaround? (For a list of key reasons please refer to last week's post.)
- Is the workaround by a single user/small group of users, or is it widespread?
- Is the workaround something that is in place only for a temporary timeframe? Or is it something that the users intended for long term use?
- Is the workaround with a standalone/single task, or does it trigger a series of workarounds?
- Does the workaround involve a single system or are there multiple systems involved?
Following these, assess the workaround to determine if it is favorable or unfavorable in the current environment. Some key considerations for this would be:
- Does the workaround result in improved efficiency when compared to the documented process flow?
- Does the workaround result in improvements to the patient care process? Or to patient satisfaction?
- Is there any policy or regulatory concerns with the workaround?
- Does the workaround create any technical issues?
- Does the workaround align with organizational goals and strategy?
An unfavorable workaround causes technical issues that cannot be overcome in a short timeframe. Or leads to downstream impacts that present risk to the patient care process or workflow efficiency. If your evaluation results in an unfavorable determination - The next steps should be deciding how to prevent the use of the workaround. An effort to educate users on the appropriate process should also be undertaken.
A favorable workaround shows improvements to process efficiency and/or patient outcomes. There are no policy or regulatory concerns, nor any technical issues with a positive workaround. Communicating this as an alternative/preferable workflow can be the next step. Along with updating relevant documentation. (Note: If all other factors result in a favorable outcome, but there are some technical issues ... it may be possible to collaborate with the IT staff and application vendors to have them resolved.)
The creation and use of workarounds can occur at any time. It is important to have operational processes in place that related to their discovery, use, and remedy. A few key processes related to workarounds that you may wish to consider:
- Notification – Have a safe process for staff to communicate the use of/desire for workarounds to leadership and/or to IT contact points. Follow up with a collaborative evaluation.
- Communication – Have a clear communication process to inform users of relevant information for workarounds. Such as timeframe and approved process steps. This is helpful for workarounds that are necessary due to a technical issue with the EHR or another application.
- Evaluation – Have a rapid process for evaluating workarounds. Include appropriate stakeholders to review all components. Make sure to include a process to roll out positive workarounds on a larger scale if appropriate. Ensure there are steps in place to remedy unfavorable workarounds quickly.
- Education – To go with the communication(s), have a process for educating end-users on the desired actions to take. As well as on any useful tips that may assist the workflow. (You may wish to incorporate this into existing training activities or to a one-off initiative depending on the situation.)
"The world hates change, yet it is the only thing that has brought progress." - Charles Kettering