HI580 Unit 3 Current Workflow Map Example

Written Twice Every Hour: A Unit 3 Current Workflow Map of a Labor Unit, Workarounds Drawn In

[Student Name]

Purdue University Global

HI580: Information Systems Design and Implementation

Unit 3 Current Workflow Map

[Instructor Name]

[Date]

Brackenridge Medical Center, its unit, staff and every count are composite; the sources cited are real.

Scope and Method

The map covers one labor admission from triage arrival to transfer to the postpartum floor. It was built from observation across three shifts, two days and one night, with a labor nurse, a charge nurse and the unit clerk, then checked with each of them. Studies of clinical workflow recommend observation over interviews alone, because people describe the process they intend rather than the one they perform (Unertl et al., 2010).

Lanes

Six lanes separate people from systems: the patient; the labor nurse; the charge nurse; the obstetric provider; the unit clerk; and systems, drawn as two tracks, the central monitoring station and the electronic record. Separating the systems makes double entry visible, because the same information crosses from the nurse's lane into each track at different times.

The Main Path

1. Patient arrives at triage; unit clerk registers her in the record.

2. Labor nurse applies monitors; the tracing appears at the central station.

3. Obstetric provider evaluates; decision diamond: admit or send home.

4. If admitted, clerk changes status; charge nurse assigns a room and nurse.

5. Labor nurse completes the admission assessment on paper at the bedside.

6. Every 30 minutes in active labor, the labor nurse interprets the tracing and writes it on the bedside worksheet.

7. When time allows, usually once an hour, the labor nurse walks to the central station workstation and types the worksheet entries into the record.

8. Decision diamond: epidural or not. If yes, anesthesiologist documents in the anesthesia record; the nurse notes it on the worksheet.

9. Second stage: nurse documents pushing on the worksheet; entries are typed after delivery.

10. Decision diamond: vaginal or cesarean delivery.

11. Delivery: the nurse records birth time from the wall clock on the worksheet; the clerk creates the newborn record from a phone call.

12. Recovery: nurse completes delivery documentation in the record.

13. Transfer to postpartum: clerk completes transfer; the paper worksheet goes to health information for scanning.

Every interpretation on this unit is written twice, and the second writing is the one the legal record keeps.

Workarounds

Seven workarounds are drawn in a distinct shape and numbered:

1. The bedside paper worksheet, used for every interpretation in active labor.

2. Hourly batch typing at the central station.

3. Sticky-note tabs on printed tracing strips to mark segments for the next nurse at handoff.

4. Birth time taken from the wall clock, which differed from the monitor clock by up to three minutes on the day observed.

5. Newborn record created by the clerk from a phone call, sometimes twenty minutes after birth.

6. A personal notebook kept by one charge nurse to track which rooms had not charted in the last hour.

7. Night nurses printing the record's last page to review at the bedside because the workstation was in use.

Timing

On the shifts observed, a labor nurse with one active patient spent about 40 minutes per twelve-hour shift retyping worksheet entries. The delay between interpreting a tracing and the entry appearing in the record averaged 52 minutes and reached two hours during a busy night. The newborn record lagged birth by a median of 14 minutes.

Why the Workarounds Exist

Each workaround meets a real need the current setup does not. The worksheet exists because the record cannot be reached from the room. The tabs exist because handoff needs a pointer to a segment. The wall clock is used because no clock is shared. Process maps that show workarounds explicitly help a team see which needs a new design must meet, rather than simply removing the workaround and leaving the need unmet (Antonacci et al., 2018).

People, Process and Technology Together

The map is not only a picture of tasks. A sociotechnical view of health IT holds that hardware, software, workflow, people, organizational policies and the wider environment interact, so a change in one part produces effects in the others (Sittig & Singh, 2010). The labor unit illustrates this. The decision years ago to place workstations at the central station was a facilities and budget choice, yet it created a workflow of paper and retyping, which in turn shaped how nurses hand off care and how the legal record is assembled. The charge nurse's personal notebook is another example: a person filling a gap left by a system that cannot show who has charted recently. Any redesign that changes only the software will meet these same human arrangements, which is why the next units must design workflow and technology together rather than in sequence.

What the Map Shows for Design

Three points carry into the next units. Charting must be possible from the room. Clocks must agree across monitor, display and record. Newborn registration belongs at delivery, with the delivering nurse.

References

Antonacci, G., Reed, J. E., Lennox, L., & Barlow, J. (2018). The use of process mapping in healthcare quality improvement projects. Health Services Management Research, 31(2), 74-84. https://doi.org/10.1177/0951484818770411

Sittig, D. F., & Singh, H. (2010). A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality and Safety in Health Care, 19(Suppl 3), i68-i74. https://doi.org/10.1136/qshc.2010.042085

Unertl, K. M., Novak, L. L., Johnson, K. B., & Lorenzi, N. M. (2010). Traversing the many paths of workflow research: Developing a conceptual framework of workflow terminology through a systematic literature review. Journal of the American Medical Informatics Association, 17(3), 265-273. https://doi.org/10.1136/jamia.2010.004333