By: Donna Demerjian, Ph.D., LCSW

When activating a new behavioral health facility, operational workflows play a pivotal role in ensuring efficiency, safety for staff and patients, and high-quality patient care. Workflows are sets of steps or tasks that are followed to complete a specific process. They define the sequence of activities, ownership for each task, and the tools or resources required to complete it. Comprehensive and streamlined workflows are essential in behavioral health facilities due to the complex patient care population and the safety and risk considerations for staff and patients.

While resources are often dedicated to the design and fit-up of a new facility, the development of workflows can frequently be an afterthought. This is often due to the belief that existing processes can easily be brought over or the idea that staff will “figure it out” once they are in the new space. The reality is that although processes themselves will likely only undergo a partial overhaul, changes to the environment, staffing, and incorporation of new and different equipment and technology impact operations.

There are several benefits to dedicating time and resources to develop well-defined workflows for a new behavioral health facility:

• Enhancing Patient Care and Experience – Workflows establish standardized processes that reduce the likelihood of errors and enhance the quality of care.
• Improving Efficiency and Productivity Through Lean Processes – Workflows streamline operations by clearly defining roles and responsibilities, eliminating unnecessary steps and potential bottlenecks, and reducing duplication of work.
• Facilitating Communication and Collaboration – Workflows facilitate communication and collaboration among the patient’s multidisciplinary care team, ensuring everyone is clear about roles, responsibilities, and timelines for deliverables.
• Supporting Compliance and Documentation – Workflows are developed to support compliance with licensing and regulatory requirements and provide valuable data that can be used for quality improvement initiatives.
• Enabling Continuity of Care – Workflows enable continuity of care by ensuring that information is smoothly transferred from one stage of care to the next and from one care provider to the next.
• Identification of Education and Training Needs – Workflow documentation is a key component of a comprehensive Orientation and Training program. By clearly defining new processes, educators are provided with materials that can be easily translated into a tool, checklist, or learning module.

Ideally, workflow planning should be included early in the behavioral health Transition and Activation Planning stages and rely on the information from Design Development and the Basis of Design documents. It is essential to allocate appropriate resources, including multidisciplinary team members, to ensure the workflows are developed according to the workflow timeline based on the construction schedule. While the concept of workflow planning may appear overwhelming, the following steps can make it more manageable:

• Include workflow planning in the initial stages of Transition and Activation planning. This allows plenty of time to develop and finalize the workflows before staff orientation and training take place so they can be incorporated into the staff training plan.

Pro Tip: At the end of each workflow planning session, provide the education team with a list of recommended training considerations.

• Develop a timeline for workflow planning. Workflow planning is a significant deliverable and often requires the input of an interdisciplinary team. Breaking the components into smaller, more manageable sprints enables the project team to tackle the work using fewer resources.

Pro Tip: Consider workflow topics that are predecessors to other workflows when developing the timeline.

• Focus on New and Different workflow topics. Use the information you have gathered during the project assessment and other discussions to prioritize workflow topics. Some common workflows for behavioral health facilities include:
  1. Access and Safety – Includes paths of travel and access for the client and staff, and safety features and protocols
  2. Restraint and Seclusion – Considerations include the integration with the code response workflows, compliance with regulatory bodies, communication among clinical team members, and critical incident reporting
  3. Patient Care Operations – Includes referrals, admissions, assessment, treatment and discharge flows
  4. Communication -Processes and devices used to communicate with clients and within the clinical team
  5. Risk Assessment – Processes and workflows to identify, mitigate, and manage risk factors in the Environment of Care, including the building, furniture, fixtures, and equipment (FFE), and people (staff, patients, and visitors).

Pro Tip: Create a workflow charter for each topic that includes purpose, objectives, deliverables, and stakeholders. Be sure to identify topics that are out of scope to mitigate scope creep.

• Leverage current-state processes to develop future-state workflows. There is no need to start from scratch, especially if something is working well. Use existing documents to provide a starting point for drafting workflows. Reviewing current policies and procedures, floorplans, new equipment lists, and stakeholder information provides essential information to support workflow planning.

Pro Tip: Gather a list of documents required to support workflow planning and add them to your document repository. Documents can often be leveraged by multiple workflows.

• Determine appropriate workflow deliverables. The deliverables are the outputs of your workflow planning. Depending on the topic, they may be flowcharts/process maps, matrices, maps denoting paths of travel, rooms, equipment, etc., updated policies and procedures, updated scopes of service, staffing plans, etc.

Pro Tip: Rather than showing up with a blank slate, draft deliverables before meeting with stakeholders to provide them with something to respond to. It is much easier to conceptualize something when there is something to review.

• Leverage subject-matter experts. You likely have a bench of subject matter experts within your organization who can support the workflow planning process. Consider team members from operations, IT, facilities, licensing/regulatory, etc. You can also consider external resources and consultants.

Pro Tip: Never be afraid to contact past projects or industry partners. We have found that people are excited to share the lessons they have learned and enjoy knowledge sharing.

• Pull it all together through a strategic plan. Develop and implement a strategic plan to develop, update, and finalize the workflow deliverables. Include the scheduling of any workgroups or planning meetings you will need. Also include a plan and timeline for developing, updating, and finalizing all workflow deliverables.

Pro Tip: Consider how information will be disseminated to the larger group of impacted stakeholders. Evaluate leveraging staff meetings, IFUs, and Townhall sessions to share new and exciting workflow changes to support change management.

In conclusion, workflow planning is essential to any behavioral health facility project. Workflows enhance patient care, improve efficiency, facilitate communication and collaboration, support compliance and documentation, and enable continuity of care. By investing in developing and optimizing workflows early in the Transition and Activation planning process, behavioral health facilities can significantly enhance their operations, the quality of care they provide, and the overall staff and patient experience.