Across each trade, digital applied sciences have proved to be highly effective instruments for streamlining processes and automating workflows. In healthcare, the introduction of Electronic Health Records (EHRs) was hailed as a groundbreaking treatment to the inefficiency of paper-based techniques. But as many healthcare suppliers have now discovered, digitizing a pointless or poorly designed course of could make it even tougher for staff to get their work achieved. The numbers are stark: a examine within the Annals of Internal Medicine revealed that docs in outpatient settings spend simply 27% of their day in face-to-face affected person care, whereas half of their time is consumed by EHRs and desk work.
This imbalance is a triple risk. It shortchanges sufferers, who’re disadvantaged of precious time with their healthcare suppliers. It fuels burnout amongst nurses and docs, who determine an extra of paperwork as the first trigger. And it’s costly — the U.S. healthcare system spends a staggering $1 trillion per 12 months, or 1 / 4 of whole expenditures, on administration.
While some are hopeful that generative AI will assist reduce by the paperwork, these predictions stay speculative. In the meantime, there’s a confirmed treatment for lowering the executive burden. This resolution doesn’t hinge on fancy algorithms however on a dedication to rooting out bureaucratic inefficiencies and simplifying work processes. Take the case of Hawaii Pacific Health (HPH), a non-profit system using 7,000 workers throughout 4 hospitals within the Aloha state.
The story begins in 2017 with Dr. Melinda Ashton, a pediatrician serving as HPH’s Chief Quality Officer. In her function, Ashton had grow to be more and more involved with the deluge of administrative duties that had been eroding the time medical workers may spend straight caring for sufferers. Across HPH there was a rising refrain of complaints about unnecessary busywork and ponderous techniques. Physicians and nurses had been significantly pissed off by the hours they spent every day mechanically clicking by the maze of on-screen prompts that popped up every time they wanted to replace a affected person’s care data.
The spark for change got here when a bunch of nurses determined to calculate the time they and their friends spent documenting the easy undeniable fact that that they had accomplished their hourly rounds. The workforce estimated that this perfunctory activity consumed 1,700 nursing hours per thirty days.
This revelation — the right image of the pointless friction that was vexing clinicians — pushed Ashton over the sting. With a mix of boldness and pragmatism, she proposed a radical thought to her C-suite colleagues: rally all of HPH’s medical workers in a marketing campaign to “Get Rid of Stupid Stuff.” The blunt title raised eyebrows amongst execs, and a few recommended blander phrases like “administrative simplification,” however Ashton stood her floor. It was essential to acknowledge the issue truthfully and be clear in regards to the intent to unravel it.
“Get Rid of Stupid Stuff” Suggestions
Get Rid of Stupid Stuff (GROSS) launched in October 2017. Clinicians had been inspired to determine something within the EHR that was poorly designed, pointless, or simply plain nonsensical. The submission type was easy and simply accessible on HPH’s web.
To create buzz, Ashton toured every of HPS’s 4 hospitals. She shared vivid examples of administrative absurdity and invited her colleagues to affix the marketing campaign.
Most of the early nominations had been for duties that merely made no sense. A nurse in adolescent oncology identified that for over a decade she’d been dutifully documenting “cord care” for her sufferers. The absurdity? Adolescents don’t have umbilical cords. A neonatal nurse flagged one other equally goofy activity: Having to examine three bins each time she modified a child’s diapers, indicating whether or not or not her tiny affected person was incontinent of urine, stool, or each.
Other nominations focused processes that had been obligatory however wanted a critical effectivity improve. For occasion, sufferers being discharged from the emergency division needed to digitally signal an after-visit abstract which was then printed out, scanned, and uploaded again into the system.
From Idea to Action
In the primary 12 months of the initiative, HPH workers submitted practically 200 ideas. These had been reviewed by two nursing leaders in Ashton’s division, each of whom had intensive expertise in IT and high quality enchancment. The GROSS core workforce developed a easy however efficient triage mechanism.
Simple fixes, like eradicating the “cord” immediate for sufferers who weren’t newborns, had been dealt with straight by the GROSS workforce. Ideas requiring additional overview and elaboration had been dealt with by pre-existing high quality and EHR working teams. These groups, representing completely different hospital areas, reviewed and prioritized the nominations. When a “stupid stuff” thought received the inexperienced gentle, the working group would invite the person behind the unique nomination to assist with the redesign.
In some circumstances, discovering a repair additionally meant liaising with medical teams that had completely different views on the deserves of a particular follow. Emergency Department physicians, for instance, most popular to fill out easy one-time prescriptions for antibiotics, whereas hospitalists, eager to forestall dosing delays, would usually choose for a recurring prescription, which took extra time to enter. It was as much as the working teams to determine these conflicts and design one of the best resolution.
A small fraction of submissions — roughly one in each eight — bumped into main regulatory or technological hurdles and had been judged to be “not possible at this time.” When this occurred, the GROSS workforce would write a response explaining why the repair wasn’t possible. The objective was at all times to acknowledge each nomination and be clear when the boundaries to a redesign appeared insurmountable.
A Broader Impact
The second 12 months of GROSS would yield one other 300 nominations. Out of all of the actionable concepts, about 10% concerned patently silly actions that might be terminated instantly; 15% flagged gaps in medical communication and assist for obligatory workflows; and the remaining 75% recognized redesign alternatives to enhance effectivity and effectiveness. In addition to saving hundreds of hours throughout HPH, the GROSS initiative additionally had an impact on the group’s tradition — principally by empowering frontline workforce members to problem the techniques and processes that make their work unnecessarily tough and inefficient. As Ashton put it in an article for the New England Journal of Medicine: “… there is stupid stuff all around us, and although many of the nominations we receive aren’t for big changes, the small wins that come from acknowledging and improving our daily work do matter.”
Other hospital techniques together with the Cleveland Clinic and the Mount Sinai Health System, have taken pay attention to Dr. Ashton’s work applied their very own variations of “Getting Rid of Stupid Stuff.” Seeing the potential to scale this strategy throughout well being care system, the American Medical Association (AMA) launched a GROSS module as half STEPS Forward, its signature follow enchancment program.
Frontline Initiative and Intelligence
Dr. Ashton’s particular person management and initiative had been key in Hawaii Pacific’s success. She didn’t mince phrases — she known as out the “stupid stuff” for what it was. But the true magic of the hassle was tapping into the ability of the group’s collective intelligence. Those at head workplace, regardless of how well-intentioned, aren’t on the entrance traces and might’t, subsequently, calibrate the true prices of bureaucratic folly. It’s the nurses, docs, and others within the trenches, who see the place the system falls quick.
Yet, concepts alone aren’t sufficient. Dr. Ashton and workforce succeeded as a result of they had been disciplined and deliberate within the follow-through. GROSS wasn’t simply an digital suggestion field — it was a system that filtered, prioritized, and executed promising concepts, working throughout departments and disciplines. The initiative produced significant outcomes — outcomes that enhance the lives of clinicians and sufferers in methods important sufficient to justify the laborious work of rooting out extra paperwork.
In the face of entrenched norms and processes, it’s straightforward to succumb to a way of helplessness, to simply accept the established order as an immovable actuality; it’s additionally straightforward to consider that expertise will resolve each drawback. Yet, the story of Hawaii Pacific Healthcare’s GROSS initiative gives a compelling counter-narrative. It’s a story that reminds us that with easy, good course of enhancements, we will, certainly, problem and reshape the operational techniques that bind us.
