title: A Mixed-Methods Research Framework for Healthcare Process Improvement.
abstract: The healthcare system in the United States is spiraling out of control due to ever-increasing costs without significant improvements in quality, access to care, satisfaction, and efficiency. Efficient workflow is paramount to improving healthcare value while maintaining the utmost standards of patient care and provider satisfaction in high stress environments. This article provides healthcare managers and quality engineers with a practical healthcare process improvement framework to assess, measure and improve clinical workflow processes.
  
  
  METHODS
  The proposed mixed-methods research framework integrates qualitative and quantitative tools to foster the improvement of processes and workflow in a systematic way. The framework consists of three distinct phases: 1) stakeholder analysis, 2a) survey design, 2b) time-motion study, and 3) process improvement.
  
  
  RESULTS
  The proposed framework is applied to the pediatric intensive care unit of the Penn State Hershey Children's Hospital. The implementation of this methodology led to identification and categorization of different workflow tasks and activities into both value-added and non-value added in an effort to provide more valuable and higher quality patient care.
  
  
  CONCLUSIONS
  Based upon the lessons learned from the case study, the three-phase methodology provides a better, broader, leaner, and holistic assessment of clinical workflow. The proposed framework can be implemented in various healthcare settings to support continuous improvement efforts in which complexity is a daily element that impacts workflow.
  
  
  CONCLUSIONS
  We proffer a general methodology for process improvement in a healthcare setting, providing decision makers and stakeholders with a useful framework to help their organizations improve efficiency.
authors.affiliation: Center for Integrated Healthcare Delivery Systems, Department of Industrial & Manufacturing Engineering, The Pennsylvania State University, University Park, PA; Center for Healthcare Innovation, Education and Research, Department of Health Organization Management, Texas Tech University, Lubbock, TX; Center for Health and Humanitarian Systems, Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, GA. Electronic address: ndbastian@psu.edu.
authors.forename: Nathaniel D
authors.initials: ND
authors.lastname: Bastian
authors.affiliation: Center for Integrated Healthcare Delivery Systems, Department of Industrial & Manufacturing Engineering, The Pennsylvania State University, University Park, PA.
authors.forename: David
authors.initials: D
authors.lastname: Munoz
authors.affiliation: Center for Integrated Healthcare Delivery Systems, Department of Industrial & Manufacturing Engineering, The Pennsylvania State University, University Park, PA.
authors.forename: Marta
authors.initials: M
authors.lastname: Ventura
mesh_terms: D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D017146:Models, Organizational; D010371:Pediatric Nursing / Q000458:organization & administration*; D017064:Process Assessment, Health Care; D036301:Qualitative Research; D058996:Quality Improvement; D014481:United States
keywords: Healthcare management; Mixed-methods research; Pediatric care; Process improvement; Quality engineering; Workflow assessment