Vincent Blijleven1, Kitty Koelemeijer2, Monique Jaspers3. 1. Nyenrode Business University, Straatweg 25, 3621 BG Breukelen, The Netherlands; Department of Medical Informatics, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands. Electronic address: v.blijleven@nyenrode.nl. 2. Nyenrode Business University, Straatweg 25, 3621 BG Breukelen, The Netherlands. 3. Department of Medical Informatics, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
Abstract
OBJECTIVES: Mismatches frequently occur between information system (IS) dictated workflows and actual workflows of IS users. The resulting impeded workflows negatively influence the efficiency with which goods or services are produced and delivered to customers. Within a healthcare context, impeded workflows can additionally have a negative impact on the safety and effectiveness of care delivered to patients. METHODS: This study evaluates the impact of an electronic health record system of a large university hospital on workflows of healthcare professionals from a lean management waste perspective. Workflow mismatches were identified from direct observations and follow-up semi-structured interviews with physicians and nurses and assessed in terms of waste generated. RESULTS: In total, 241 manifestations of waste were identified and classified according to 8 types of waste. Furthermore, noteworthy relationships among the identified manifestations of waste were found. These include differences in frequency per type of waste, certain types of waste having a cascading effect, and waste proliferating as a result of mimicked and routinized behavior. CONCLUSIONS: The knowledge obtained from this study can support (re)design of IS to better match workflows which may subsequently lead to more safe, effective and efficient patient care.
OBJECTIVES: Mismatches frequently occur between information system (IS) dictated workflows and actual workflows of IS users. The resulting impeded workflows negatively influence the efficiency with which goods or services are produced and delivered to customers. Within a healthcare context, impeded workflows can additionally have a negative impact on the safety and effectiveness of care delivered to patients. METHODS: This study evaluates the impact of an electronic health record system of a large university hospital on workflows of healthcare professionals from a lean management waste perspective. Workflow mismatches were identified from direct observations and follow-up semi-structured interviews with physicians and nurses and assessed in terms of waste generated. RESULTS: In total, 241 manifestations of waste were identified and classified according to 8 types of waste. Furthermore, noteworthy relationships among the identified manifestations of waste were found. These include differences in frequency per type of waste, certain types of waste having a cascading effect, and waste proliferating as a result of mimicked and routinized behavior. CONCLUSIONS: The knowledge obtained from this study can support (re)design of IS to better match workflows which may subsequently lead to more safe, effective and efficient patient care.