Redesigning Of The Clinical Processes Enhances Digitalization

Monday, February 10, 2020
Digital Health

Today's health systems face the Silver Tsunami caused by the aging population and the rise of chronic diseases. Addressing the rising demand is a challenge for established processes and the healthcare workforce across the continuum of care. As a result, the cost of care explodes, and current staff shortages even increase further. 

Healthcare is an established industry that can benefit from further digitalization of the established processes. Digitalization, together with technological advancements, could help to lift the pressure of the healthcare workforce. Healthcare employees become more and more tech-savvy and value the digitalization options that can help: 

  • increase the quality of care,
  • increase compliance,
  • increase Patient Experience,
  • increase staff satisfaction, and
  • reduce operational costs.   

Digitalization may decrease the face time with a patient

Intensive care units (ICU) are technology-rich by nature. The combined bedside devices connected to a single Patient on an ICU can generate up to 200 data1 points per second. Still, some hospitals use paper documentation. The introduction of an electronic patient record could enable automated charting of all bedside device data. Let's assume the nurse to patient ratio remains the same. Nurses could benefit from the efficiency increase by automation of essential documentation tasks.

In daily practice, I often witnessed the opposite. Instead of the nurse spending more time with the patient, I observed her spending more time documenting than before. The reasons can be manifold and relate to cumbersome user interfaces, gaps in device interconnectivity, or poor onboarding of nurses. Another aspect is related to far advanced clinical documentation activities beyond their status quo to fulfill current Quality Assurance guidelines better or maintain double documentation instead of fetching statistics out of the electronic documentation2. The introduction of electronic documentation requires a holistic approach of the entire inpatient workflow to consolidate and redesign purposefully established processes.

Electronic Calculations could be misleading

An important metric in measuring hospital efficiency is the Lenght of Stay (LOS) for a given diagnosis. Best in class hospitals have applied active discharge management by triaging the inpatient cases in the emergency room. This proactive approach helps bed managers to plan procedures based on current and predicted bed capacity. The anticipated LOS, once shared, can also guide caregivers across the continuum of care. During an inpatient episode, the criticality and thus the required hospitalization days may change the considered LOS up or downwards. How could new insights be shared with the bed manager?

Increasing the quality of care demands a holistic approach to the entire inpatient workflow

One solution is a transparent LOS indicator in the Hospital Information System (HIS) on all patient and department screens. A German General Hospital3 decided to utilize the LOS indicator in their HIS. First, they conducted a pilot in the two most significant departments for four weeks. After the feedback had been positive, the hospital management pulled in the remaining department heads. Although some department heads raised some concerns, all were open for the experiment. Within two weeks, four departments pulled out of the test.

Two main reasons have been identified:

  • Specific differences in discharge workflow that, e.g., require seamless outpatient support for geriatric patients to avoid unnecessary readmission.
  • Delayed or missing information that was not digitally available at the doctors' round. 

The speed of implementation kept a positive spirit. The agile approach highlighted challenges and allowed adjustment of the plan. 


The two cases described utilized digitalization for enabling automated documentation and decision support. Those system advancements require process adjustments relevant to the entire healthcare workforce that typically works in shifts around the clock. Processes are often related to patient journeys that may overspan departments. Increasing the quality of care, compliance, and staff satisfaction successfully demands a holistic approach to the entire inpatient workflow across the patient episode. As in any process improvement program, the team needs to be taken on the change journey, involved early for capturing their needs and supported in achieving their goals. 

Successful process improvements may not always directly reduce operational costs. They should at least reduce caregiver stress, become visible to the patient, and thus increase their experience positively. Positive patient experience will lead to better outcomes and happier staff. Happier staff can reduce staff fluctuation significantly and create operational savings.  

1 - Celi, Leo & Mark, Roger & Stone, David & Montgomery, Robert. (2013). "Big Data" in the Intensive Care Unit.. American journal of respiratory and critical care medicine. 187. 1157-1160. 10.1164/rccm.201212-2311ED.
2 - Case Study UK Hospital.
3 - Case Study German Hospital Chain.