BIDH5000 Chap.3 Clinical Redesign and Evaluation
Clinical Redesign and Evaluation
Clinical redesign changes workflow, information and responsibility rather than simply adding a screen. This chapter maps the current state through actors, handoffs, waits, duplication, rework and workarounds. It then links the future state to a theory of change and a mixed evaluation using process, outcome, experience and balancing measures. The goal is evidence that can explain both success and failure.
Follow a representative case from trigger to resolution and document the real pathway rather than the policy version. A workaround can signal poor design, but it may also be the adaptation that preserves safety when formal workflow breaks down. Understand its function before removing it. Information fields deserve the same care. Low frequency alone does not prove that a field lacks value.
Ask which immediate care, communication, accountability, reporting or learning purpose it serves; whether equivalent information is complete and accessible elsewhere; and who takes on responsibility when it moves. The future state should specify what stops, what starts, who decides and how exceptions are handled.
A concise theory of change then connects resources and activities to altered work, near-term results and longer-term outcomes. Evaluation needs several evidence roles. Outcome measures estimate the intended result, process measures show whether the new pathway was delivered and used, experience evidence explains how people encountered it, and balancing measures detect displaced burden or harm.
Interpret sequences over time instead of choosing one favourable endpoint. Check relevant access groups and contextual changes before attributing an improvement to the intervention. When adoption improves without the expected outcome, revisit the mechanism. When outcomes move before adoption, investigate alternative explanations.
An explanatory evaluation supplies feedback that implementers can use rather than issuing a late verdict after decisions are fixed.
What this chapter covers
- 01
Current-state workflow mapping
- 02
Handoffs, queues and workarounds
- 03
Information retention, derivation and retirement
- 04
Future-state roles and responsibility
- 05
Process, outcome and balancing measures
- 06
Variation, equity and causal interpretation
Evaluate a redesigned referral pathway
- 2State the mechanism and select service outcomes that reflect the intended benefit.
- 2Add process and experience evidence that shows whether the workflow was adopted and why.
- 2Specify a balancing measure and a comparison or time-series interpretation check.
Key terms
- Current state
- The observed arrangement of work, information, decisions, delays and adaptations before redesign.
- Future state
- The proposed arrangement of roles, workflow, information and responsibility after redesign.
- Workaround
- An unofficial adaptation used to complete work despite a mismatch, constraint or failure in the formal process.
- Process measure
- A measure of whether the intended activities or workflow were delivered and used.
- Outcome measure
- A measure of the result the service or intervention intends to change.
- Balancing measure
- A measure that detects burden, risk or deterioration displaced elsewhere by an improvement.
Clinical Redesign and Evaluation FAQ
Why should redesign map workarounds?
A workaround may reveal poor design, missing information or unclear responsibility, but it may also protect safety. Understanding its function prevents the project from removing an adaptation that staff rely on before the underlying problem is repaired.
Can a low-use data field simply be removed?
Not safely. Check the decision, accountability, communication or future-learning purpose it serves, whether equivalent information is complete and accessible elsewhere, and how removal or relocation changes responsibility and downstream work.
What makes an evaluation explanatory?
It combines outcomes with process, experience and context. If results disappoint, the team can distinguish a weak mechanism from incomplete adoption, new barriers, external change or a measure that failed to capture the intended benefit.
How should unequal results be handled?
Investigate whether access, workflow, data quality or the intervention mechanism differs across groups. Involve affected people, adapt the service or alternative channel, and avoid scaling when a preventable disparity indicates harm.
Assessment move
Map one patient journey with actors, decisions, information, waits, handoffs and rework. Mark each workaround and ask what function it performs. For the proposed future state, write a short theory of change and choose one outcome, two process indicators, one experience question and one balancing measure. Explain what each pattern would mean and what action would follow.
This prepares both the project plan and questions about why the redesign should work. Revisit every information field and classify it as retained, derived, moved or retired, recording the downstream user and risk. Draw the future pathway beside the current one and circle every changed responsibility.
Test three result patterns: adoption rises without outcomes, outcomes improve before adoption, and the average improves while one access group deteriorates. For each pattern, state the most plausible questions, additional evidence and decision the team should take next. Add a contextual change log beside the measure chart so staffing, policy or capacity shifts are considered before the intervention receives credit or blame.
