CCPP Module 9, Section 1: Mapping the End-to-End Collaborative Workflow
Module 9: Workflow Design and Clinical Operations

Section 9.1: Mapping the End-to-End Collaborative Workflow

A deep dive into creating a visual blueprint of your entire clinical process, from the moment a patient is referred to the completion of their long-term follow-up. This is the foundational map for your entire practice.

SECTION 9.1

Mapping the End-to-End Collaborative Workflow

From a Series of Tasks to a System of Care: Building Your Practice’s Architectural Blueprint.

9.1.1 The “Why”: Beyond the Daily To-Do List

In every pharmacy you have ever worked in, your days were governed by a list of tasks. Check prescriptions. Counsel patients. Call insurance companies. Give immunizations. Answer the phone. Manage inventory. This task-oriented mindset is essential for getting through a busy shift. It is reactive, efficient for individual actions, and deeply ingrained in the culture of pharmacy. However, when you build a collaborative practice, this mindset is no longer sufficient. It is, in fact, a liability.

A clinical practice is not just a collection of tasks to be completed; it is a system of care to be designed. It is a complex, multi-stage journey that a patient takes with you and your team. Relying on a simple to-do list to manage this journey is like trying to build a house by just making a list of “buy nails, cut wood, install window.” Without a blueprint, you will have a pile of materials, not a functional structure. The work may get done, but it will be chaotic, inefficient, prone to error, and impossible to scale or improve in a systematic way.

This is why we begin this module with workflow mapping. A workflow map is the architectural blueprint for your entire clinical operation. It is a visual representation of every single step, every decision point, every handoff, and every communication that occurs from the moment a patient is a name on a referral form to the moment they are a stable, long-term success story. Creating this map is not a bureaucratic exercise; it is the single most important strategic activity you can undertake when designing your practice. It forces you to move from thinking like a task-doer to thinking like a systems architect. It is the process by which you transform your clinical vision into a tangible, repeatable, and optimizable reality.

The map you create will become your foundational document. It will be your guide for writing Standard Operating Procedures (SOPs), for training new staff, for identifying bottlenecks that are costing you time and money, for pinpointing safety risks before they cause harm, and for demonstrating your value to administrators and payers. In a world of checklists, a workflow map is a declaration that you are not just managing tasks—you are engineering quality.

Pharmacist Analogy: From a Simple “Mix” to Aseptic Compounding

Think about the difference between two common pharmacy tasks: reconstituting an oral amoxicillin suspension and compounding a sterile, high-risk parenteral nutrition (PN) bag.

Reconstituting amoxicillin is a task. You have a mental or written checklist: get the bottle, tap to loosen powder, add half the water, shake well, add the rest of the water, shake again, apply the label. It’s a linear sequence. If you get interrupted, you just pick up where you left off. This is the “to-do list” mindset.

Compounding a PN bag, however, is a workflow. It is governed by a detailed blueprint—the master formulation record and the aseptic processing procedures (your workflow map). Every step is codified and visualized. You have clearly defined zones (the anteroom, the buffer room). You have specific garbing procedures. You have a precise order of injection for electrolytes to prevent precipitation. You have required documentation at every stage (logging lot numbers, BUD calculations). You have handoffs between the pharmacist who verifies the order and the technician who compounds. There are critical quality checkpoints built into the system, like visual inspection and sterility testing.

You would never dream of making a complex PN with a simple to-do list. The risk of catastrophic error is far too high. You rely on a meticulously designed, visual, and repeatable system to ensure safety and quality. Your clinical practice is the PN, not the amoxicillin. It has too many moving parts, too many handoffs, and too high a risk of patient harm to be run from a simple checklist. You must apply the same level of process engineering and design thinking to your clinical workflow as you would to your most complex sterile compound.

9.1.2 Tools of the Trade: Choosing Your Mapping Medium

Before you can draw the map, you need to choose your paper and pen. The tool you use for workflow mapping can range from the incredibly simple to the technologically complex. The “best” tool is the one that allows you to think clearly, collaborate with your team easily, and make changes as you iterate. Do not get bogged down in choosing the “perfect” software; the act of mapping is more important than the medium.

Masterclass Table: Comparing Workflow Mapping Tools
Tool Type Examples Pros Cons Best For…
Analog / Physical Whiteboard, large paper roll, sticky notes, markers
  • Highly Collaborative: Excellent for getting a team together in one room to brainstorm.
  • Kinesthetic & Tactile: The physical act of writing and moving notes can stimulate creative thinking.
  • Low Tech Barrier: Anyone can pick up a marker and contribute immediately.
  • Flexible: Easy to erase, move, and completely re-configure ideas on the fly.
  • Not Permanent: The final map needs to be transcribed into a digital format.
  • Not Remote-Friendly: Difficult to collaborate with team members who are not physically present.
  • Can Get Messy: Can become disorganized without a strong facilitator.
 The initial brainstorming session. Getting all the steps out of everyone’s head and onto a shared surface for the first time.
Digital Whiteboards Miro, Mural, FigJam
  • Best of Both Worlds: Combines the flexibility of a whiteboard with digital permanence.
  • Excellent for Remote Teams: Allows real-time collaboration from anywhere.
  • Multimedia: Can embed documents, images, links, and videos directly onto the board.
  • Templates: Often come with pre-built workflow and flowchart templates.
  • Learning Curve: Can be slightly overwhelming for non-tech-savvy users at first.
  • Subscription Costs: Most have recurring fees for full functionality.
  • “Infinite Canvas” Problem: Can become sprawling and lose focus without discipline.
 The primary mapping and iteration phase. Ideal for teams who will build, review, and refine the map together over time, especially if some members are remote.
Dedicated Diagramming Software Microsoft Visio, Lucidchart, draw.io
  • Structured & Formal: Enforces standard flowcharting conventions (e.g., specific shapes for processes, decisions, etc.).
  • Professional Output: Creates clean, polished diagrams perfect for formal documentation like SOPs.
  • Integration: Often integrates with other software suites (e.g., Microsoft Office, Google Workspace).
  • Less Flexible: Can feel rigid and constraining during initial creative brainstorming.
  • More Time-Consuming: The focus on formal structure can slow down the initial mapping process.
  • Can Be Overkill: The level of detail may be unnecessary for a small practice’s internal map.
 Creating the final, official version of your workflow. The “version of record” that will be embedded in your SOPs and used for official training.
Clinical Pearl: The Hybrid Approach

The most effective process often uses a hybrid approach. Start with a physical whiteboard and sticky notes for a high-energy, all-hands-on-deck brainstorming session with your entire team (including support staff!). The goal is just to capture every single step, no matter how small. Then, transfer that raw material to a digital whiteboard like Miro for cleaning up, organizing, and remote collaboration. Finally, once the workflow is stable and agreed upon, use a tool like Lucidchart or Visio to create the final, polished “version 1.0” for your official practice manual. This approach leverages the strengths of each tool at the appropriate stage of the design process.

9.1.3 The Seven Phases of the Patient Journey: Your Mapping Framework

A patient’s interaction with your service is not a single event. It is a long-term journey that can be broken down into distinct phases. By mapping each phase separately and then linking them together, you can tackle a complex process in manageable chunks. We will define this journey in seven core phases. For the rest of this section, we will conduct a deep dive into the micro-steps, responsibilities, and potential failure points within each phase.

1

Intake & Referral

2

Initial Visit

3

Care Plan & Collab

4

Implementation

5

Monitoring

6

Billing

7

Transition/Closure

Phase 1 Deep Dive: Intake & Referral

This is the front door to your practice. A poorly managed intake process creates downstream chaos, frustration for referring providers, and a terrible first impression for patients. The goal of this phase is to efficiently and accurately gather all necessary information to schedule a productive first visit.

Masterclass Table: Deconstructing the Intake & Referral Phase
Micro-Step Key Actions Responsible Person(s) Tools & Data Needed Common Failure Points & Risks
1.1 Receive Referral Acknowledge receipt of referral from provider’s office (via EMR, fax, phone). Create a preliminary patient shell in your system. Admin Staff, MA, or Technician EMR inbox, e-fax system, phone line, patient scheduling software.
  • Lost Referrals: Faxes are missed, EMR messages are overlooked. Risk: Patient never gets seen, relationship with referrer is damaged.
  • No Confirmation: Referring office doesn’t know you received it and sends it again, creating duplicates.
1.2 Initial Triage Pharmacist quickly reviews the referral to confirm it’s appropriate for the service (e.g., correct disease state, meets inclusion criteria). Pharmacist Referral form, practice’s scope of service document.
  • Inappropriate Referrals Accepted: Wastes a new patient slot on someone you can’t help. Risk: Frustration for patient and pharmacist.
  • Slow Triage: A clinically urgent referral sits for days before being identified.
1.3 Data Gathering Admin staff requests and obtains all necessary records: recent provider notes, labs, hospital discharge summaries, current medication list from the EMR. Admin Staff or Technician Phone, fax, EMR record request functionality. A checklist of required documents is essential.
  • Incomplete Records: Patient is scheduled without key information, leading to an unproductive first visit. Risk: Wasted time, need for rescheduling.
  • “Record Chase”: Staff spends hours on the phone trying to get records that should have been sent with the referral.
1.4 Insurance Verification Verify patient’s coverage for your clinical services. Identify copay/coinsurance, deductible status, and if a prior authorization for the visit itself is needed. Admin Staff or Biller Payer portals, phone calls to insurers, patient’s insurance card.
  • Visit Not Covered: You see the patient only to find out their plan doesn’t cover pharmacist visits. Risk: No reimbursement, potential for a large bill for the patient.
  • Surprise Costs: Patient arrives and is told they have a large unmet deductible.
1.5 Patient Outreach & Scheduling Contact the patient, explain the service and what to expect, confirm their understanding, and schedule the initial consultation. Send new patient paperwork. Admin Staff or MA Phone script, scheduling software, new patient packet (digital or mail).
  • Phone Tag: Inability to reach the patient delays scheduling for weeks.
  • Poor Explanation: Patient agrees to the visit but doesn’t really understand what it’s for. Risk: High no-show rate.

Phase 2 Deep Dive: The Initial Consultation

This is the core clinical encounter where you build rapport, perform your comprehensive assessment, and establish a therapeutic relationship. A well-structured visit is the foundation of the patient’s entire experience. The goal is to leave the visit with a complete understanding of the patient’s medication-related problems and a clear set of collaborative goals.

Masterclass Table: Deconstructing the Initial Consultation Phase
Micro-Step Key Actions Responsible Person(s) Tools & Data Needed Common Failure Points & Risks
2.1 Pre-Visit Chart Prep Pharmacist performs a deep review of all gathered records. A preliminary problem list is drafted, and a “Best Possible Medication History” (BPMH) is constructed from EMR, fill data, and old notes. Specific questions for the patient are prepared. Pharmacist All records from Phase 1, state PMP/CURES report, medication reconciliation template.
  • “Going in Cold”: Pharmacist opens the chart for the first time when the patient is in the room. Risk: Inefficient visit, missed details, lack of preparedness.
  • Not Checking PMP: Missing critical information about controlled substance use.
2.2 Patient Check-in MA/Admin staff greets the patient, collects any completed paperwork, obtains vital signs, and confirms demographic/insurance info. MA or Admin Staff Patient paperwork, scale, BP cuff, thermometer.
  • Long Wait Times: Poor scheduling leads to patient frustration before the visit even begins.
  • Forgetting Vitals: Missing key clinical data points needed for the assessment.
2.3 The Clinical Interview Pharmacist meets with the patient. This includes building rapport, setting the agenda, performing the definitive medication history interview, assessing adherence, allergies, social determinants of health, and understanding the patient’s goals. Pharmacist Interview guide/template (e.g., SOAP), motivational interviewing skills.
  • Pharmacist-Dominated Conversation: The pharmacist “lectures” instead of listening. Risk: Patient shuts down, true barriers are not identified.
  • Med Rec Only: The visit is just a list verification and misses the “why” behind the patient’s medication-taking behaviors.
2.4 Goal Setting & Education Collaboratively establish 1-2 key, achievable goals with the patient. Provide targeted education on the highest priority issues identified. Use teach-back method to confirm understanding. Pharmacist Patient education handouts (in appropriate language/literacy level), SMART goal worksheet.
  • Goal Overload: Trying to fix 10 problems at once overwhelms the patient.
  • “Information Dump”: Providing too much education without checking for comprehension. Risk: Patient leaves confused and retains nothing.
2.5 Visit Wrap-up & Next Steps Summarize the plan, clearly state what will happen next (e.g., “I will be sending these recommendations to Dr. Smith”), and schedule the follow-up appointment. Pharmacist & MA/Admin Scheduling software, after-visit summary.
  • Unclear Plan: Patient leaves not knowing what they are supposed to do or when they are coming back.
  • No Follow-up Scheduled: The patient is lost to follow-up, and the entire intervention is wasted.

Phase 3 Deep Dive: Care Plan & Provider Collaboration

This phase happens immediately after the patient leaves. It is the critical “behind the scenes” work where you synthesize your findings into a coherent plan and communicate it effectively to the rest of the healthcare team. Your credibility and the success of your recommendations depend on the quality and clarity of your communication in this phase.

Masterclass Table: Deconstructing the Care Plan & Collaboration Phase

EMR, SOAP note template, CPT coding guide.

Micro-Step Key Actions Responsible Person(s) Tools & Data Needed Common Failure Points & Risks
3.1 Synthesize & Document Pharmacist documents the entire patient encounter in a structured format (e.g., SOAP note) within the EMR. A clear assessment and prioritized problem list is created. Pharmacist
  • Delayed Documentation: Waiting days to write the note, leading to forgotten details. Risk: Inaccurate record, billing delays.
  • “Note Bloat”: Writing a novel instead of a concise, actionable summary. Risk: Provider ignores the note because it’s too long.
3.2 Formulate Recommendations Based on the assessment, the pharmacist drafts specific, evidence-based, and actionable recommendations. Each recommendation should include a clear rationale. (e.g., “Recommend starting lisinopril 10mg daily for hypertension and proteinuria, per KDIGO guidelines.”) Pharmacist Clinical guidelines (e.g., ADA, ACC/AHA), drug information resources, formulary information.
  • Vague Recommendations: “Consider optimizing diabetes meds.” Risk: Provider has no idea what to do and ignores it.
  • Ignoring Formulary: Recommending a non-preferred drug that will be immediately rejected by insurance.
3.3 Communicate with Provider Send the documented note and recommendations to the referring provider via the most appropriate channel (e.g., route EMR message, secure email, fax). For urgent issues, a direct phone call is necessary. Pharmacist EMR messaging, phone.
  • Wrong Channel: Sending a non-urgent message via pager, or an urgent message via slow EMR inbox.
  • No Follow-Up: Sending the note and assuming it was read and acted upon. Risk: Recommendations are never implemented.
3.4 Await & Track Response Create a system to track that the recommendations have been reviewed and either accepted, modified, or rejected by the provider. This is a critical closed loop. Pharmacist or Technician EMR task list, spreadsheet, or other tracking system.
  • “Sent and Forgotten”: No system to see if the provider ever responded. This is the single biggest failure point in many collaborative practices.
Critical Failure Point: The Open Loop

The most common reason collaborative practice agreements fail in the real world is a failure to close the communication loop. You can have the best patient visit and the most brilliant recommendations, but if they are sent into the void of an EMR inbox and never acted upon, you have accomplished nothing. Your workflow map must include a dedicated step for tracking the disposition of your recommendations. This might be a shared task list in the EMR or a simple spreadsheet, but it must exist. For every recommendation sent, there must be a corresponding entry of “Accepted,” “Rejected,” or “Needs Further Discussion” tracked to completion.

9.1.4 Advanced Mapping: Using Swimlane Diagrams to Define Roles

Once you have all the steps mapped out, the next level of sophistication is to organize them by who is responsible for each action. This is where a Swimlane Diagram becomes invaluable. It’s a type of flowchart that visually groups tasks into lanes, with each lane representing a person, role, or department. This makes it instantly clear who does what and where handoffs occur.

This clarity is essential for efficiency and accountability. When processes break down, it’s often at the handoff point between two swimlanes. A swimlane map illuminates these critical interfaces so you can strengthen them.

Example Swimlane Diagram for the Intake & Referral Phase

ROLE: Admin / Technician

1.1: Receive Referral

Log referral, create patient shell, send confirmation to referrer.

Waits for Pharmacist Triage

1.3: Data Gathering

Request & attach all required medical records.

1.4: Insurance Verification

Verify coverage for CMM services. Check for PA needs.

1.5: Patient Outreach

Call patient, explain service, schedule visit per script.

ROLE: Clinical Pharmacist

Waits for new referral in queue

1.2: Initial Triage

Review referral for clinical appropriateness. Give go-ahead for data gathering.

Patient is being worked up by staff

Final Chart Review

Once scheduled, pharmacist does a final check to ensure all necessary data is available prior to the visit.