Hawaii hospital system develops smarter workflows by eliminating 'stupid stuff'

Doctor computer keyboard
Hawai'i Pacific Health streamlined its workflows and boosted morale by asking front-line staff to identify stupid documentation tasks. (Getty/jacoblund)

In an effort to get rid of tasks that just weren't necessary, Hawaii Pacific Health hospitals enlisted front-line staff in a battle against “stupid stuff.”

Turns out, they found quite a bit of "stuff" that was easy to fix and had simply flown under the radar for years. 

In an op-ed piece published in the New England Journal of Medicine on Wednesday, Melinda Ashton, M.D., executive vice president and chief quality officer of Hawaii Pacific Health, described taking the simple approach to combating burnout by taking a hard look at its documentation systems.

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

The project itself grew out of Ashton’s concern that staff was finding it easier to click through and ignore certain tasks in their documentation than to think about them.

RELATED: CMS promises to ‘restore the doctor-patient relationship’ with 2019 proposed rule

For example, nurses in the emergency department frequently found it easier to click “no” on a question about whether a patient had a suspected infection, even though their next action indicated they knew the patient actually had an infection.

Ashton also found that wasted time on pointless tasks was adding up. An unnecessary rounding row that took 24 seconds to fill out cost nurses a collective 1,700 hours a month across the system’s four hospitals.

Ashton was adamant that they not mince words.

“We were going to call it ‘administrative simplification’ for a while and I sort of pushed back and said, 'You know, I really think we need to be clear on this,'" Ashton said. "I just had a sense that calling it stupid stuff was going to resonate better.”

That instinct turned out to be on the money.

The team found more low-hanging fruit that presented an easy fix than they could have known about otherwise, she said. For example, a request for umbilical cord care assessment that persisted in the EHR for patients older than 30 days cost nurses unnecessary clicks every time they did a head-to-toe assessment of a pediatric patient.

“We had really good nurses who have been doing repetitive tasks for ten years who never mentioned them before,” Ashton said.

Since the team’s request specifically acknowledged the possibility that some administrative tasks were superfluous to the point of uselessness, the nurses apparently got the invitation they needed to point those things out.

RELATED: Stanford report urges medical practices to ‘junk the fax,’ focus on EHR training and workflows

Even in other situations where eliminating documentation requirements wasn’t an option, the hospital was able to investigate workarounds or beef up training to help doctors and nurses complete required tasks more efficiently, or at least to provide a better understanding for why it matters. All of that matters when it comes to morale.

“When people have given us suggestions and we’ve been able to fix it, we get rave reviews back, and it’s pretty minor stuff,” Ashton said. “But it’s nice to get that kind of feeling from front-line staff, that they made a difference—and they’re happy about that.”