Review, Reconcile, and Optimize Your Workflows : Advances in Skin & Wound Care

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Review, Reconcile, and Optimize Your Workflows

Hess, Cathy Thomas BSN, RN, CWCN

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Advances in Skin & Wound Care 31(12):p 576, December 2018. | DOI: 10.1097/01.ASW.0000549493.05305.16

The end of the year is a perfect time to reflect on processes implemented in the past year and look forward to improving processes in the new year. One key process is workflow optimization. Workflow is a set of chronological, organized processes and tasks designed to efficiently meet a goal through interaction with people and resources.

In healthcare, smart workflows are vital, especially when providers use electronic health records (EHRs). The goals when using an EHR are to drive accountability of care; distribute clinical tasks among the team; improve care coordination through smart, efficient workflows and compliant documentation; impart care coordination through evidence-based care models; maintain regulatory standards; and optimize reports to drive compliance.


Designing and mapping your process take time and dedication to understanding the clinical, operational, regulatory, and financial workflows occurring in your department. Understanding your role and how you document your process is key to capturing the process within smart workflows. The first step to map your process is to define the clinical goals through collaborative workflows. These steps may include:

  • Determine roles, responsibilities, and skillsets
  • Know documentation requirements for place of service and scope of practice
  • Support evidence-based care guidelines
  • Understand the National and Local Coverage Determination Policies to support work performed
  • Develop policies and procedures to ensure compliance
  • Reduce duplication of effort and documentation
  • Determine procedures to be completed by role
  • Develop order sets and templates
  • Employ patient safety, quality, and risk-reduction initiatives
  • Support continuity of care across the continuum
  • Develop an audit plan


Investing time and expertise in developing appropriate workflows is imperative. This investment can yield better patient throughput, improved clinical satisfaction, and improved department processes to increase efficiency, reduction of errors, and patient and staff safety.

For example, when a patient arrives for a visit in an outpatient wound care department, the patient interacts with administrative staff, clinicians, and providers. From the point in time when the patient enters the department, the patient has expectations to be met for the visit, hence the need for a patient workflow. In order to effectively evaluate and manage the patient’s flow, the department must operate from best practice clinical pathways and documentation standards, hence the need for a clinical workflow.


Developing smart workflows within a practice takes time and patience. It is important to choose a specialty EHR that is customizable, flexible, and adaptable to your practice as you manage clinical, operational, regulatory, and/or financial changes along the way. Ultimately, the smart workflow process can lead to maximized efficiencies, enhanced clinical and operational quality, patient safety, streamlined documentation, and improved care coordination. This author has provided a sample clinical pathway for venous ulcers to map the clinical documentation to support the provider and staff workflow. See the Supplemental Table,

Within a pathway, your workflows must be flexible enough to handle a quick change to hospital standards; insert a change based on evidence; and/or modify existing forms and workflows to guide policy, procedure, and documentation processes.

After you have designed your workflows based on the patient population seen in your department, remember to adapt workflows to:

  • insert pertinent questions upon the patient’s arrival for the encounter;
  • methodically choose the appropriate form to insert these questions;
  • prompt actions or tasks when certain answers are chosen;
  • streamline workflows for the staff and providers, ensuring review of all pertinent documentation and maximizing scope of practice(s); and
  • customize questions within existing documentation forms to meet the facility’s requirements of the mandate.


Optimizing workflow is the cornerstone to a successful business. Look closely at changes required to adapt to new technology, regulations, processes, and procedures in the year ahead and take the time to reconcile your workflows.

Wishing you a happy, healthy, and successful 2019!

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