Clinical Workflow and Process Analysis
Clinical workflow and process analysis tests your ability to observe, map, analyze, and redesign care processes. Expect questions on current-state versus future-state mapping, appropriate artifacts, Lean and Six Sigma concepts, and how to measure whether a change actually reduced delay or rework.
Methods and artifacts
- Use contextual inquiry, shadowing, time-motion studies, and interviews. Observe actual work, including workarounds, exceptions, handoffs, and queues.
- Artifacts include process maps, swimlane diagrams, spaghetti diagrams, value stream maps, and BPMN notation.
- Lean defines value from the patient's perspective and targets the seven wastes: overproduction, waiting, transport, overprocessing, inventory, motion, and defects.
- Six Sigma's DMAIC (define, measure, analyze, improve, control) is useful when variation and defects dominate.
Analysis
- Distinguish cycle time, lead time, and touch time; identify the constraint or bottleneck.
- Handoffs are high-risk; standardize with SBAR, checklists, and explicit transfer of responsibility.
- Separate value-added from non-value-added steps. Do not automate waste.
Worked example
An ED triage process has 14 steps, three handoffs, and a 22-minute wait for bed assignment. Time-motion data show duplicate registration data entry. The team co-locates triage and registration and removes the duplicate field. Reasoning: the change targets a non-value-added step and a handoff, so predicted lead time falls. The team tracks lead time on a run chart and watches registration error rate as a balancing measure.
Traps
Mapping the written policy instead of real practice; omitting exceptions and rework loops; redesigning without frontline staff; measuring only after implementation, with no baseline.