Human-Centered Approach to Women’s Health Workflow Optimization

Poor software usability, complex intersystem dependencies, and the lack of sociotechnical integration of software systems within processes may contribute to suboptimal clinical and administrative workflows across a healthcare organization. Study of workflows in the context of the care delivery environment can be used to identify opportunities to improve workflow efficiency and inform workflow standardization. The Veterans Health Administration (VHA), the Office of Health Informatics (OHI) Human Systems Integration (HSI) team of human factors practitioners, and the VHA Electronic Health Record Modernization Integration Office (OEHRM IO) led a multidisciplinary team to execute a mixed methods approach (observation and interview) to identify opportunities to improve workflow efficiency and inform workflow standardization after the transition to VHA’s new Federal Electronic Health Record (EHR), Oracle Health Millennium. This work focused on Women’s Health. The data collection team documented clinical and administrative workflows, inefficiencies, variations, and pain points at two VHA Women’s Health clinics. The team analyzed the data and produced workflow diagrams (with activity completion times), a pain point prioritization quad chart, and workflow variation maps to support knowledge sharing, team alignment, and opportunity prioritization. Multi-disciplinary team collaborations resulted in action plans aimed at requirements gathering, iterative design, and implementation of solutions considering a variety of improvement levers (e.g., workflow redesign, training, Health IT infrastructure, directives, organizational structure, leadership, staffing, and facilities). A Women’s Health Workgroup team continues to address the prioritized backlog of Short/Long Term EHR, Non-EHR Technology, and Non-Technology opportunities to improve workflow efficiency and standardize clinical practice and administrative workflows. The combination of studying workflow in the context of the care delivery environment and multi-disciplinary collaboration resulted in a greater impact on workflow efficiency, continued improvement, and standardization at the enterprise level than either one of these parts (studying workflow in the context of the care delivery environment and stakeholder engagement) could have achieved alone.