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Original Research: George R. Gamble, Adam O. Goldstein, and Rachel S. Bearman Implementing a Standing Order Immunization Policy: A Minimalist Intervention J Am Board Fam Med 2008; 21: 38-44 [Abstract] [Full text] [PDF]

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Search for workflow that works

Susan T Andrews   (8 January 2008)

Search for workflow that works 8 January 2008
Susan T Andrews, Family physician Family Practice Partners Send response to journal: Re: Search for workflow that works sta{at}familypracticepartners.com Susan T Andrews	As a family physician participating in a national research group focused on quality who has had success with improving influenza and pneumococcal immunization rates, I read with interest the laudible effort to improve patient health. What we've found over the past 4 years working to improve quality is that the knowledge of what needs to be done and the protocols are not what makes the difference. Changing workflow processes does. Offloading the work to nurses was central to our effort, but having automatic flags come up for the nurses at the time of the patient visit along with the protocol to be followed improved rates significantly. We also built into the progress note a very quick way for the nurses to document what they did. One click documented the vaccine was given, posted the charges for the immunization and updated the Health Maintenance flow sheet. Obviously, we have an electronic health record that permits us to set up these processes. Pearls for process change: make the process easy and quick, plus bring the information to the person assigned the task - don't expect them to go looking for it. Analyze what needs work, come up with a solution, implement it, then see if it worked. If not, look for another solution. The researchers gave staff knowledge and instructions, perhaps without the processes to make it easy to follow the plan. They did followup to see if what they did worked, a step often overlooked. Now, with some brainstorming, they're set to try another hopefully easy intervention, followed by analysis. We need to see more good studies like this one.