What Weekly Supervision Taught Me About New Workflows
When I directed a social services program, I led a team of eleven. Regular supervision is one of the most reliable ways to learn whether a new workflow has actually taken hold. The process described at a rollout meeting and the process a case manager follows on an ordinary Tuesday can be quite different, and only the second one reaches a client.
What follows is offered for anyone preparing to introduce a change to their own team.
Start with how the work is done today
Before adding a new step, it is worth finding out how the work currently gets done. The policy describes one route. Staff are frequently relying on sticky notes, personal contact lists, and informal channels to keep clients from being lost. Those workarounds are not resistance. They show where the official process falls short, and they were created by the people who know it best. It is worth asking to see them before replacing them.
I would also ask about the difficult cases: the referral that arrives with half its information missing, the appointment that cannot be offered within the promised timeframe, the client who cannot be reached, and the request that comes in at 5:40 on a Friday afternoon. A workflow that accounts only for the uncomplicated case will not hold up for long once it is in use.
Pilot with a specific question
Agreeing to pilot something is only a beginning. A useful pilot names what is expected to change and what will be observed. For example, one team might spend a week using a revised escalation path for referrals that have not moved within a set number of days, and track how many referrals needed escalation, whether the next owner was clear, and what additional work the change created. The Institute for Healthcare Improvement’s Plan-Do-Study-Act approach is built on this idea of learning something small and local before committing an entire program to it.
Fit the essentials on one page
A staff member in the middle of a busy afternoon needs three pieces of information: what to do now, who is responsible for the next step, and what to do when the usual path is not available. These belong on a single page with the name of an escalation contact, revised to reflect the exceptions the pilot uncovered. Long procedure documents tend to go unopened. When staff keep arriving at the same workaround after a new process goes live, the design is usually unfinished.
Listen for the cost of the change
A completion rate shows that a step was recorded. It says nothing about whether the step helped or what it required of staff. Supervision conversations often surface that difference. A common pattern is that staff describe a new process as working, then mention that they are now entering the same information twice. That second comment is the one to follow up on, and it is a good reason to report a measure of burden, such as duplicate entry, slower response times, or additional handoffs, next to the compliance figure.
It is equally important to tell the team what came of their feedback, including what changed, what could not, and the reasons. People tend to remain candid about a process as long as they can see their comments being used.
A test for durability
Once a change has worked on a small scale, the remaining task is to make it durable. That involves updating templates, naming the person who maintains the process, revisiting it when staffing or volume shifts, and giving new employees the one-page guide so they are not relying on colleagues’ recollections. A workflow is established when it still functions on a short-staffed Tuesday, with an unfamiliar case, in the absence of the one person who attended the original meeting. That is a fair test for any team.
Sources
- Institute for Healthcare Improvement: Testing Changes
- Institute for Healthcare Improvement: Implementing Changes
About the author
Sherry Sayari, MPH, is an Operational Standards Evaluator who has led population health, community outreach, and social services programs. More on the About page.
