From Powerless To Powerful In Healthcare Through Workflow

[This post was inspired by the Healthcare Leadership (#HCLDR) tweetchat topic Powerful or Powerless in Healthcare.]

Set aside, for the moment, the issue of poverty and economics, when it comes to power in today’s society (where, simply put, often money is power, not knowledge). I will argue that the key concept to understanding what it means to feel powerful versus powerless is workflow: a series of tasks/actions/activities/experiences, consuming resources, achieving goals.

Consider engaging in a series of activities, say starting your car and driving to work. If at any point — trying open the door, trying to start your car, trying to put it in gear, trying to push the accelerator, trying to turn the wheel, trying to push the brake, and so on — what you do fails to achieve the result you desire, how to you feel? Powerless.

On the other hand, imagine you are captain of a starship. Your systems and people are incredible. Their processes and workflows are automatic, transparent, flexible, and always improving…. Every command you utter triggers incredibly sophisticated workflows that always achieve exactly what you wish. When you say, “Make it so!”, how do you feel? Powerful.

Powerfulness and powerlessness, in this workflow sense, are closely tied to a related psychological concept, “flow”, described in Flow: The Psychology of Optimal Experience, by Mihály Csíkszentmihályi, (whose graduate student I used to hang out with during medical school at the University of Chicago, by the way!).

From Wikipedia:

“In positive psychology, flow, also known as the zone, is the mental state of operation in which a person performing an activity is fully immersed in a feeling of energized focus, full involvement, and enjoyment in the process of the activity. In essence, flow is characterized by complete absorption in what one does. Named by Mihály Csíkszentmihályi, the concept has been widely referenced across a variety of fields (and has an especially big recognition in occupational therapy), though the concept has existed for thousands of years under other guises, notably in some Eastern religions.[1] Achieving flow is often colloquially referred to as being in the zone.” (Flow Psychology)


  • immersed
  • energized
  • involved
  • enjoyment

Another adjective that applies when you are in “in the zone” is that you feel “powerful”.

What is the connection between workflow (and workflow technology), in the prosaic sense usually invoked in healthcare and health IT, and feeling powerfully immersed, energized, involved, and full of enjoyment? Workflow is the concept that allows us to understand and design a series of experiences, experiences leading to feelings of powerfulness, instead of powerlessness.

What about that other sense of power (access to economic recourses), that I previously wrote about in Social Determinants of Health: Eat Your Beans? Or Speak Truth to Power?. This is the economic context of my definition of workflow: a series of steps/actions/activities/experiences, consuming resources, achieving goals.

The single most frequent and important reason that workflow fails is that at some step or other a necessary resource is unavailable. If you are poor, or otherwise lack access to necessary resources, your workflows suck and you feel powerless. On the other hand, if, at every step of workflow, all the necessary inputs are present, either due to your bank account or external agency, your workflows don’t suck. And you feel powerful.

How does all of this relate to empowering patients and providers?

Focus on their workflows. Focus on what they are trying to achieve. What steps will achieve it. And what resources each step requires to be a success.

@wareFLO On Periscope!


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