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Working Smarter, and Better

The road to workflow optimization is never easy, but there are a few best practices that can help smooth the way.

Jane Wilson, Executive Medical Director, Kingston Hospital NHS Foundation Trust

Kevin Fitzgerald, Director of Information Management and Technology, Kingston Hospital NHS Foundation Trust


At Kingston Hospital NHS Foundation Trust, we are always working to improve our practice.

In 2017, we undertook a large-scale effort to optimize our clinical workflows. As anyone who has implemented an electronic health system knows, even after the final deadline is met, the process is not over. There are always new functionalities to install, data to leverage and opportunities to improve. Our aim with this project was to make sure the system was providing value for all our end users and that we were truly serving the needs of our patients.

As a result of our efforts, in October 2017, Kingston Hospital became the fourth organization in England to achieve Stage 6 of the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM). In August 2018, Kingston Hospital became the first acute NHS trust in London to receive a rating of Outstanding by the Care Quality Commission for its effective leadership, commitment to patient-centered care and overall excellence. While we were proud to achieve these honors, we were equally proud of the coordination and effort it took to successfully execute the optimization of our system and the value it has provided for our caregivers. Our experience taught us about what it takes to achieve success in a large-scale workflow optimization. Here are five things we learned throughout the process:

1. Know your why

Establishing the driving purpose behind your optimization project helps keep your staff focused throughout the process. Your mission should focus on the big picture and ultimate benefits to the caregiver and the patient, not the IT aspects. For Kingston, our why was simple: Let’s give the clinicians the right information when they need it to better care for their patients. This led us to focus on simplifying and optimizing workflows since we received feedback that many of the workflows were too clunky. Knowing our primary motivations helped keep us on track.

2. You won’t get it right the first time

Keep going. The reality is that you should not expect to get everything right the first time around, and that’s OK. Adopting a mindset of continual optimization is key to improving and advancing your system. Kingston had an issue early on where some of our documentation metrics were lower than we would have liked. Because we’d been documenting on paper before, we didn’t have visibility into our performance, and once we had the metrics in front of us we realized we had work to do. Having the persistence to push through helped us improve our numbers and get to a place we feel good about.

3. Align your leaders

At Kingston, we have a unique reporting structure that has set the foundation for our success. We have a clinical systems IT program which means that, rather than technology standing on its own, we align it to the clinical team. Our Information Management & Technology (IM&T) director reports directly to the medical director. This helps keep conversations focused on what is best for the patient and for the organization, and that perspective flows into every project. Aligning your leaders in a way that supports your mission will make it easier to execute.

4. Focus on changes you can see

Making practical changes to the system that will make a difference to clinicians and patients will go a long way toward engaging end users in the change effort and gaining their support. Involve front-line doctors and nurses in the process – they are closest to the system and often know what changes will make the biggest impact.

5. Cultivate support

As with any large project, optimization requires support at all levels. Support from our clinical system supplier was immensely helpful. The change managers within our IT team also felt supported by leadership, and our IM&T director had regular conversations with them to ensure operations were running smoothly. Make sure top-level leadership is engaged and in regular communication with the change team so that they are aware of problems and can help solve them.