Summary:
A sample workflow chart is created based on the process of scheduling a followup appointment with a patient over the telephone. Each step of the process is then described and explained in full. The workflow process is found to be largely efficient, but recommendations are made to increase efficiency. The importance of workflow understanding by nurses lies in the ability to make changes based on that understanding, to increase the effectiveness of the process.
NURSING FLOWCHART – SCHEDULING FOLLOWUP APPOINTMENT OVER PHONE
For the purposes of this flowchart, I decided to choose a very simple task often asked of me in my nursing practice; scheduling follow-up appointments for patients over the phone. I chose this for the simplicity of the task, its more or less streamlined steps, and its ease in entering into a workflow diagram. It is important to understand the work flow of an activity, and in the case of follow-up phone scheduling, a workflow diagram allows for this better understanding.
The first step is to call the patient. This step is only performed by the nurse, and is used simply with a telephone. This must be done in the actual reception area, with the scheduling program or book at the ready to discuss potential openings with the patient. This is typically done during office hours, at a time when it is thought the patient might be home. The information required for this step is the patient’s home phone number. This is the simplest step, and merely allows the process of communication with the patient to begin.
The second step is dependent on whether or not the patient answers the phone. If the patient does not answer the phone, it is necessary to leave a voicemail message. In these messages, the nurse gives their name, the office they are calling from, and the purpose of the call (i.e. to schedule a followup appointment). If there is information that can be given over the phone to give added context, that is also stated. The contact information is repeated to the voicemail, and the nurse hangs up (thus ending the workflow cycle at that point). However, if someone does pick up the phone, the first step to take is to ask whether or not it is the patient speaking (using their full name for identification).
The third step is dependent on whether or not the patient is the person answering the phone. If the person on the line says they are not the patient that is named, the nurse’s next step is to ask whether or not the person available can be spoken to; if not, you may ask what a good time might be to call back, apologize for the inconvenience, and hang up. (If it is a wrong number, it may be necessary to look up the number by other means.) However, if the person does answer in the affirmative about their identity, you then give the information normally given on the voicemail in step two. In this step, the nurse must ask what times are good for the patient to come in, and cross-reference their suggestions with the schedule currently on file for their physician. If an opening is available, the appointment is booked; if it is not, the nurse tells the patient and they look for another time. Once a time is determined, the nurse repeats the appointment time, thanks the patient for their time, and hangs up.
The soundness of the workflow is typically measured by time and effectiveness; if a nurse can get through to a patient over the phone and schedule an appointment that fits with the doctor’s and patient’s schedules, that is an effective iteration of the workflow process. In instances where the patient is not available or not answering, the goal is to end the process as soon as possible while being courteous to the patient and informing them as best as possible of the need for a followup appointment (Shepard & Moseley, 1976).
For the most part, the workflow process for scheduling followup appointments is fairly straightforward, and does not take much time. However, improvements could be made in terms of keeping updated and accurate contact information. When calling a patient, it might be good to have several options available for followup appointments, to give them some existing openings so they do not have to scour through their own schedule (Kennedy & Hsu, 2003). This might make decision making and appointment setting faster and more streamlined.
It is incredibly important to understand the flow of an activity; in a hospital or other medical practice setting, efficiency is important, even down to the smallest thing. If a nurse understands every step of a process, they know how to troubleshoot it if something goes wrong. Furthermore, it is easier to study the process itself and determine areas for improvement at various points (Cornell et al., 2010). If nurses and other health care practitioners can keep a constant eye out for the technology and resources used in a workflow process, it is possible to exercise constant improvements and create a system that is more effective overall.
References
Cornell, P., Herrin-Griffith, D., Keim, C., Petschonek, S., Sanders, A. M., D'Mello, S., &
Shepherd, G. (2010). Transforming nursing workflow, part 1: the chaotic nature of nurse activities. Journal of Nursing Administration, 40(9), 366-373.
Kennedy, J. G., & Hsu, J. T. (2003). Implementation of an open access scheduling system in a
residency training program. FAMILY MEDICINE-KANSAS CITY-, 35(9), 666-670.
Shepard, D. S., & Moseley III, T. A. (1976). Mailed versus telephoned appointment reminders to
reduce broken appointments in a hospital outpatient department. Medical care, 268-273.
