Doctors Tallking, Walking Down Hall | Virginia Mason Institute

The Flows of Medicine

Virginia Mason Institute

Proper flow influences predictable and reliable processes

The experience of flow can be found in nature. A river, for example, has movement, a certain pace to it, a consistent manner. It elicits a soothing response in those who experience it and inspires a sense of serenity and calm. The goal of achieving flow is to achieve the same effect. This natural, seamless, and most efficient system can be replicated in health care so that the patient’s experience of care is one of ease, comfort, and is soothing at times of uncertainty. For the provider, flow eases the burden of work, so that the ability to find joy in their work returns and their personal life no longer suffers from the processes that keep them working late.

The flows of medicine serve as an important way of framing our work to transform and improve health care. Predictability and reliability are the qualities sought after in the pursuit of flow. Designing a reliable process, with mistake-proofing built-in to prevent errors, within each flow of medicine requires identifying where barriers lie along the way and the implementing the necessary counter measures to remove them.

The Flows of Medicine

VMPS Flows of Medicine™

Flow of patients

For a patient to experience flow is the overarching top goal in the delivery of healthcare. This includes a patient’s access to receive the highest quality care without delays or barriers or errors along the way.

Flow of family and relationships

Family and personal relationships are an important component of providing comfort and assistance to patients who are receiving care.

Flow of providers

Providers are responsible for the delivery of care to the patient. A provider in flow provides quality, efficient, and error-free care to their patient and is supported by processes to perform this critical work in a way that also benefits their well-being and joy of work.

Flow of medication

Timely and accurate delivery of medication is an important and essential component of medical care.

Flow of supplies

Medical supplies, such as bandages, gloves and hand sanitizer are a critical element of patient care and in providing a safe environment for all.

Flow of information

The flow of information is especially critical. The majority of poor processes are rooted in improper flows of information. It is absolutely essential that accurate information is delivered and made visible to the appropriate individuals in a timely manner, consistently.

Flow of equipment

Equipment is an important part of providing the best quality of medical care. This equipment requires proper maintenance, storage, training for use, and sterilization, for example.

Flow of process engineering

How processes are designed and implemented in an organization can lead to teams working in flow with level balance of skills, time and tasks. Poorly designed processes hinder effective teamwork and often causes breakdowns in communication or consistency.

Optimizing flow is a strategy that will improve access to care

Access to care is a perfect example of how flow impacts patients’ experiences and outcomes. Today patients face poor access to care because internal processes are causing waits and delays to being seen. This is the result of poor flow in most health care facilities. Clinics that are not in flow operate like a traffic jam.

Scenario: The cars on the freeway are not moving. The on-ramps have metering to limit the number of cars that can enter the freeway at a given time. However, with or without the metering, the car who enters the freeway from the on-ramp is immediately stopped in traffic. This is because the cars in the freeway are not moving in flow. In order for the car to seamlessly enter the freeway from the on-ramp the processes that are causing waits and delays on the freeway must be addressed and corrected. Perhaps it’s rooted in a poor flow of information to better assist drivers determine when to merge for an upcoming exit. Perhaps an accident has been caused by a speeding driver.

In a clinical environment, poor flow can snowball in a similar manner, causing waits and delays to build up, physician burnout, and mistakes to be made in medical care. A seemingly harmless process that is poorly designed can turn into a catastrophic event.

Meet “Patient A”

Patient A wants to see her doctor. She calls to schedule an appointment and the soonest availability is months away. She will surely feel better by then, she assures herself, but she takes the appointment anyhow. Months pass and Patient A is not feeling better. In fact, she is feeling much worse and now has additional issues she would like to address with her physician during her visit.

She arrives to the medical facility hopeful to finally have her anxieties put to rest and to receive high quality medical care. After checking-in at the front desk Patient A waits in a crowded waiting room for nearly three hours before being called back to an exam room. Once in the exam room Patient A waits for another hour before a medical assistant comes in to weigh her, take her vitals, and update her medical chart. Patient A then waits nearly another hour to see her physician who has fallen behind and is running late for all of his appointments.

The physician finally comes in to see Patient A and asks her about the issue she mentioned when scheduling her appointment. She explains that her symptoms have worsened and she now has some additional issues she needs treatment for, including needing a physical and some lab work. Her physician prescribes some medication for her symptoms, orders lab work and says that due to limited time, she will need to schedule a follow-up appointment for her physical, at which point she can have her lab results reviewed.

The patient exits and returns to the front desk to schedule her follow-up appointment. The next appointment is four weeks away. Frustrated by not feeling well, and not having any concrete answers, the patient reluctantly accepts the appointment heads to the pharmacy and plans to return the following day for lab work. By the time Patient A’s second appointment rolls around she has taken the day off of work anticipating to again wait hours for her care and heads into the facility where she experiences the same delays. Her physician reviews her labs with her and identifies multiple concerning results. The patient can’t help but think that if she had been seen by her physician sooner she would be healthier today.

Patient A’s experience and outcome should have been better

When a health care setting is operating in flow, every task and every detail has been designed with the patient at the front of mind. The staff have created a standardized, patient-centered approach that balances and optimizes the workload across the team, empowering staff members to complete each task in flow with one another, and without unnecessary or wasteful steps or processes that might otherwise negatively impact the patient experience.

Eliminating waste frees up more time for staff to complete their work, with fewer mistakes, and with less overall stress. The patient can easily obtain an appointment, is quickly checked-in and taken to an exam room, and receives the highest quality attention and care from each member of the health care team who are working, in flow, to capture their health information and medical attention needs. When the right care is delivered at the exact right moment the patient experiences a far better health outcome. Flow is essential to what makes the perfect patient experience possible, in any health care setting, every time, with zero-defects.

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