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Software's guiding hand

January 1, 2008
by K. Walter Keirstead, MSc (EE)
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Work flow technology doesn't take over care, but rather helps clinicians avoid mistakes

Few people in healthcare dispute the merits of best practices. After all, what possibly could be better than best practices? Would anyone want to render interventions using “worst practices”?

Yet in most behavioral healthcare agencies best practices are detailed in policy/procedure manuals gathering dust on shelves. No one refers to them because they are not readily available at the point of service. And even if someone looks them up, they usually are not written in a quick-to-read format. You could put best practice materials online, but that won't accomplish much—now you have readily accessible reader-unfriendly information.

The answer is to convert best practice narratives into administrative and clinical processes that a software system interprets to guide patients along care pathways. This creates a process that can be monitored, controlled, and evaluated. Staff members no longer need to worry what the next intervention is, who should do it, where, when, or how. If we raise the bar a bit by positioning checklists at major milestones along care paths (e.g., chart reviews), it becomes difficult to inadvertently skip steps, miss steps, perform steps in the wrong sequence, or perform steps using the wrong resources.

If you are doing the right things the right way at the right time, using the right resources, and properly documenting interventions, your chances of being noncompliant with best practices will be reduced. Thus, categorizing interventions as “transactions” and automatically auditing them (i.e., continuous quality management) certainly are feasible and do not require more staff and expense.

This does not mean a software system is running the entire healthcare service-delivery process. Instead, the software helps identify when corrective action is needed. Without software, you discover problems after the fact; with software, you ensure there will be fewer problems to address. Exception reports become a lot less important because there are fewer exceptions.

Software is a marvelous tool, but you can't detect problems far enough ahead to prevent them all. Statistical analysis can't predict every problem. You know the saying: “If you torture statistics enough, they will tell you anything you want to hear.” But flow graphs do have a predictive capability, as Admiral Hyman Rickover and others at the DuPont Company separately discovered in the early 1950s (i.e., the critical path method).

In healthcare we cannot easily assign durations to tasks that have uncertain outcomes, but we can report to managers on a minute-by-minute basis the “time remaining to a state of noncompliance” (e.g., “you will be noncompliant with the best practice in 12 hours”). Put a sufficient number of alerts at the right places on care paths and you can detect evolving problems and take action to prevent these from fully materializing. The resulting “executive dashboard” is a great improvement over statistical projections based on exceptions. The results are increased staff efficiency, greatly reduced administrative and clinical errors, increased throughput, improved compliance, and improved outcomes.

But the field's shift to software-managed work flows won't be quick and easy. New technology often takes 20 years or longer to fully deploy.

Using process control requires great attention to details. What you might consider easy is likely to be difficult to translate into a software system. No eventuality, however seemingly inconsequential, can be left out.

So if you want to improve your operations, take those best practices out of the books and use software to help you integrate them into daily practice.

K. Walter Keirstead, MSc (EE), is President of Infinity/Civerex, LLC; Managing Director of Civerex Systems, Inc.; and Vice-President of Jay-Kell Technologies, Inc. He has worked as a process control engineer, software designer, and management consultant with Fortune 500 companies prior to forming Jay-Kell Technologies in 1990. For more information, call (800) 529-5355.