Methods to capture workflow

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In the process of implementing any new systems in the hospital, it is imperative to do workflow studies to determine the “as-is” (current state) and the “to-be” (future state) work processes of the healthcare providers. Two methods commonly used by project teams to capture the workflows are the time-motion study and the work –sampling study.

Time motion study basically means the study of what a person is doing and how long it takes to do it. It involves the investigator to follow the subject and record the temporal aspects of events (e.g. tasks) under evaluation. This method is also known as the stop ]watch method and is currently considered as the gold standard in performing a workflow study. It gives detailed description of the workflow processes of the healthcare provider. However, it is tedious and labor intensive and hence is more costly as well. The investigator has to keep up and follow the subject studied for long periods of time as well as capture as accurate as possible the time take to perform the action.

Work sampling on the other hand is counting how many times the action is done by the subject observed in a fixed time, for eg, how many times the physician looks to the computer screen in a 10 minutes consultation. This method can be directly observed, or the person him/herself can keep a log on it. This workflow capturing method can be non-reliable, especially if the person him/her selves have to logs in the data. Also this method may not be feasible if the person has to keep continually travel from one place to another, as the investigator will then have to keep following up with him/her. However, compared to Time-motion studies, work sampling does not introduce as much bias as time-motion studies, as the investigator does not shadow the user as much. As data from work-sampling studies are usually extrapolated, a larger sample size is required to get better data representation.

Irregardless of what method is used, a detailed mapping of the workflow is needed to ensure success in the reaching the goals of the change in process.

References 1) A comparison of time-and-motion and self-reporting methods of work measurement. Burke TA, McKee JR, Wilson HC, Donahue RM, Batenhorst AS, Pathak DS. J Nurs Adm. 2000 Mar;30(3):118-2

2) Modeling Clinical Trials Workflow in Community Practice Settings Sharib A. Khan, MBBS MA,1 Philip R.O. Payne, MPhil,1 Stephen B. Johnson, PhD,1 J. Thomas Bigger, MD,2 and Rita Kukafka, DrPH, MA1,3 AMIA Annu Symp Proc. 2006; 2006: 419–423.

3) A Comparison of Work-Sampling and Time-and-Motion Techniques for Studies in Health Services Research .Steven A. Finkler, James R. Knickman, Gerry Hendrickson, Mack Lipkin, Jr., and Warren G. Thompson.. Health Serv Res. 1993 December; 28(5): 577–597.

Submitted by Jo Nie Sua