It is amazing how much you can learn about how processes really work by talking to staff, physicians, patients and others involved in those processes. However, actually observing the workflow and how processes unfold can shine a bright light on what really happens — especially when it comes to patient care.

During my career I've had the occasion to ask for a process to be explained and am usually able to identify a few opportunities for improvement with the help of the subject-matter expert offering the description. I've also reached out to others, especially those who have responsibility for processes that intersect with or impact the one being explored. Here dependencies and limitations can be identified so that integration of one process with those connected to it can be as seamless as possible.

However, it really isn't until one observes how those involved in the process actually fulfill their roles and responsibilities that the depth of the challenge can be fully realized. In addition, inefficiencies and disruptions that are not obvious to the actors will stand out to a fresh set of eyes.

Healthcare organizations spend a great deal of time and limited financial resources training staff to comply with rules, regulations, policies, clinical guidelines, standards and protocols. Then we turn them loose to perform their jobs and over time the environment, other staff and the natural evolution of the work impact a worker's performance.

Pretty soon a complaint is received, an error or poor patient outcome occurs or the data's trend line is headed in the wrong direction. The first thing a leader asks is, "Why isn't the policy/standard/protocol/guideline being followed?" Then, they remind those around them that the topic was "just covered in orientation" or some other training event.

The problem is that real life and human habits get in the way, and the only way to know that a process is being completed as it should is to actually observe it and again, over time. Sustaining change over time requires attention over time.

For example, think about implementing a shiny new EHR system. After the initial training is over, do you simply clap your hands and say, "Well, glad that is over and we can get back to work." Of course not. The use of that system changes as individuals move through different jobs and each time an upgrade, a system fix or new functionality is rolled out.

It is the same for all of our human processes. New supervisors arrive on scene, subtle "fixes" make their way into the process and full workarounds get implemented without a full understanding of how those changes impact the entire system. In addition, staff may think they fully perform tasks while at the same time not recognizing the risk their "shortcuts" pose to outcomes.

How do I support staff? I engage them, ask questions and observe so that I can identify risks and make changes to keep them from having to experience an error, a poor outcome, a lawsuit, loss of their license, and possibly their job.

So, the next time you are making your rounds, stop and observe people as they do their work and ask questions in a nonthreatening manner. Learn more about the work being done, and see what you can see.