Document Accountability in a Crisis

On a normal day, you’re primarily in your office but today, you’re on the floor covering for someone who is out sick. Out the corner of your eye, you notice one of your staff carrying out a procedure using an outdated method. Didn’t he get the message? We talked about this at the staff meeting two days ago! You drop what you’re doing, pull the employee aside, show him the current procedure, and instruct him to use it going forward.

Later in your office, you have a moment to reflect. Who else didn’t get the message? Has anyone actually read the new procedure? Two hours and several conversations later, it’s obvious that everyone did not get the message. This means more follow-up to ensure that there are no downstream consequences. This also means another email to the staff and another reminder at the staff meeting tomorrow morning. Your Lean instructor would call this “rework” - the effort required to correct a defect in a process. What a mess.

Managing change across a department or across an Enterprise is hard work. During a crisis, the challenges are amplified. “Managing by walking around” (MBWA) is a proven management tactic. The broader your area of responsibilities, however, the more difficult and less practical this becomes. While manual reporting from various locations has value, it is still fraught with error and is oftentimes incomplete.

We’ve all adopted automated electronic solutions in our lines of work – electronic prescriptions, lab orders, patient instructions, EHRs and more. In fact, we wouldn’t dream of going back to a manual paper-based system in those areas. Document management should be on that list.

Consider all of the documents that have been updated in your facility during the COVID-19 pandemic: 

• Assessment protocols for Nurses and Providers
• Testing procedures for Clinical Laboratory Scientists
  
• Nasopharyngeal collection procedures for Phlebotomists and Lab Assistants
• Call back and critical value reporting for Client Services
• Dispensing and compounding instructions for Pharmacists
• Facility sanitation changes for Environmental Services
  
• New PPE requirements for nearly everyone
• Risk Management policies

Were they reviewed and approved through proper channels? What date did they go out? What version was it? Is the old version archived properly? Was the process Lean? Did your staff read their documents...and can you prove it?

Centralized document control creates a transparent, visible portal that gives everyone visibility, 24/7 access to documents, speeds up knowledge transfer and cuts down on finger-pointing. It also creates accountability that goes both ways and management especially loves a good audit trail. Knowing exactly who authored, reviewed, approved and then read each of those documents is critical. Having an attestation statement signed by each reader is priceless. You will know who is “getting the message”, and you’ll have another arrow in your quiver when it come time to hold people accountable.

Document control keeps your staff current which ultimately improves employee morale and reduces conflict. Most employees like to be informed and following up-to-date procedures and processes. They can get as frustrated as management when they aren’t aware of what process has changed due to the organization lacking a cohesive system for document management. Staff members don’t like being called out when they also would like to have followed the right procedure. Management also has clear information when consistently difficult staff members fail to stay current.

And finally, when an audit occurs, you can show the inspector exactly where you stand with policies and procedures, by location, department, and even by workstation and employee. For all parties involved, these types of automated systems make the entire inspection process more efficient and usually means fewer deficiencies.

No one joined the healthcare ranks to push paper. However, especially as individuals move into management, it becomes part of the job. Healthcare has regulatory requirements and training protocols that will always be part of the industry.

While tracking procedures and regulations is endless, you don’t have to be buried in piles of paper. Quality automated document control will take any organization to the next level. Automated document control means you can stop hunting down paper copies of documents that have to be replaced with newer versions and publish and archive those documents electronically instead. You can stop worrying about who has read what and gain the peace of mind that comes with real-time reporting. Get a handle on the adoption of new practices in your Enterprise with informative dashboards.

As we all push through this pandemic, we will all be reflecting on what went well and what we need to change as quickly as possible. We just had an unplanned, full-scale training exercise and got to see how our organization functioned under extreme pressure. Many of us are seeing the limits of our manual systems and realize it’s time to implement Lean processes like automated Document Control.

In the end, you will have significantly fewer headaches, a calmer management environment and more time to focus on what matters most, your patients.

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