Correct Workflow Inefficiencies to Improve Clinical Outcomes

By Madison Pittman

To achieve the best possible clinical outcomes, you need the right staff in the right place, performing the right tasks, at the right time. 

Easier said than done, right?  

Healthcare delivery is a complex process, with many variables. That’s why identifying and understanding patterns is so important. You can’t predict the future, but with an excellent understanding of patterns, you can greatly increase your ability to provide the right staff in the right place at the right time.  

According to Organization Workflow and Its Impact on Work Quality (Chapter 31), in Patient Safety & Quality: An Evidence-Based Handbook for Nurses, “understanding existing clinical workflow … provides a baseline to redesign systems and develop better processes.” Healthcare technology, including the Internet of Things and electronic systems that can track and analyze clinician workflow, provide invaluable data to clinicians and healthcare executives who wish to improve clinical outcomes in a fiscally responsible manner.  

Track Nurse Movement to Identify Patterns

A 2015 article in For the Record, a news magazine for health information professionals,  reported that nurses spend less than two hours of a 12-hour shift on direct patient care. A 2018 study found that nurses spent approximately 35% of their time in patient rooms (including isolation rooms) and 25% of their time on documentation.  

Electronic systems, such as the Clean Hands-Safe Hands hand hygiene system, have found that nurses spend significantly less time in isolation rooms, despite the fact that patients in isolation are often acutely ill. Data from one Clean Hands-Safe Hands client revealed that providers were 3.3 times more likely to visit patients in regular rooms than those in isolation rooms, and 4.2 times more likely to visit typical patients than those with C. diff infections.  

This data helped the hospital pinpoint areas where staff were not performing patient care in the way that leaders expected. By leveraging data, hospital leaders recognized that real-life clinical workflow did not align with planned practice. They were able to leverage data to both redesign the process and provide necessary insights. 

Decrease Time Spent on Non-Value-Added Activities 

According to the 2018 study referenced above, nurses spent approximately 10% of their time on delegable and non-nursing activities, “which could be used more effectively for patient care.” Other studies have found that nurses may spend 20% of their time on “non-value-added” activities, which are defined as “actions performed by nurses that do not benefit the patient and should not be necessary in the delivery of patient care.”  

Much of this time is spent tracking down supplies and equipment. At one hospital, Clean Hands Safe Hands data revealed that hand hygiene performance was significantly lower than expected (and desired) in rooms across the hall from the supply closet. A closer inspection of staff movement revealed that clinicians who had to go across the hall for supplies did not always wash their hands again upon re-entering the room. Moving necessary supplies (such as bed linens and clean towels) to patient rooms could decrease nurse time spent on non-value-added activities, improve hand hygiene compliance and increase the amount of time nurses spend at the bedside.  

Reimagine Workflow to Increase Nurse Time at the Bedside

According to the For The Record article, “when nurses spend more time at the bedsides, studies show that patients are less likely to fall or suffer from infections or other adverse outcomes. Additionally, medication errors decrease with nurses on hand, and patients report being more satisfied with their care.”  

It is difficult to overestimate the value of clinicians – Registered Nurses, in particular – at the bedside. As Linda Aiken, PhD, RN noted in her seminal 2002 study Hospital Nurse Staffing and Patient Mortality, Burnout, and Job Dissatisfaction, “registered nurses constitute an around-the-clock surveillance system in hospitals for early detection and prompt intervention when patients’ conditions deteriorate.” 

Aiken’s study found that the odds of patient mortality increased by 7% for every additional patient in the average nurse’s workload, which implies that consistent nurse presence is key to outstanding clinical outcomes. Indeed, additional research has found that “missed nursing care,” or care that is delayed, partially completed, or omitted (often due to understaffing) is correlated with medication errors, infections, falls, pressure injuries and patient readmissions.  

“In a post-COVID world, a big component of success, moving forward, will be to provide the best patient care as efficiently as possible,” says Chris Hermann, PhD, founder and CEO of Clean Hands-Safe Hands. Accurate data can help you ensure that the right providers are in the right places at the right time, providing the right care.  


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