HEALTHCARE OPERATIONS
Clinical Productivity
Daily productivity for registered dietitians, inside Elevra, the hospital operations platform at Compass Healthcare Digital.
The turning point
The daily record got one owner.
I was the lead product designer on the module, accountable for its requirements and design from the first workbook review to production handoff.
Daily productivity lived in shared workbooks that managers rebuilt by hand at month end. A workbook can record who changed a cell. It cannot say whose day it was, or which of two entries should govern, so the edit trail alone never settled who was allowed to correct it.
I built the record around the dietitian who owns the day, with manager approval and authorship kept as separate permissions. Submit and lock shipped. The correction path was proposed before pilot: the manager authorises a reopen, the dietitian changes the values, and both versions are kept. Day-level detail costs a wider table and careful handling of weekends and leave.
Edits collided
Concurrent edits overwrote entries, and the file could not say whose day it was.
The day was split
Dietitians covering several units logged in separate workbooks, so their full day never showed.
August14 workbooks
- 101_Aug.xlsx
- 202_Aug.xlsx
- 303_Aug.xlsx
- 404_Aug.xlsx
- 505_Aug.xlsx
- 606_Aug.xlsx
- 707_Aug.xlsx
Managers reconciled
Managers merged and checked each workbook by hand, every month, for hours.
Gaps stayed hidden
A missing entry stayed invisible until someone opened the file and looked.
The problem
The workbook recorded a value. It could not tell the manager who owned the day.
Daily productivity lived in shared Excel files, one per cost center and month, edited in circulating copies. Excel can record who changed a cell. Nothing in the workbook said whose day it was, or which entry should govern it. History alone did not establish who could correct the record.
Operating model reconstructed
Shared workbookTwo writers, one cell, one file per cost center
2:02K. Simmonsoverwritten4.5 hrs
2:41R. Dempseythe file keeps this one2.5 hrs
Owned recordTwo RDs, two records, one writer each
Kayla SimmonsRD, Inpatient adult
- Day
- Thu, 13 August 2026
- Hours
- 4.5
- Care setting
- Acute medical, 4 East
Revisions
- 5:10 PMSubmitted by K. Simmons, ownerLocked at submit.
- 2:41 PMR. Dempsey’s entry went to her own record
- 2:02 PMDraft created by K. Simmons
See it
Managers needed the missing day, not another percentage.
Recreated from the shipped workflow, not screenshotted. Switch surfaces, then expand either one full screen.
Where it came from
These are real screens from the shipped product, reconstructed for this site. Every dietitian, site and record shown is demo data.
From workbook to roster
A shared spreadsheet, then a day grid, then a roster ordered by what is missing.
My role
I defined the module and designed it end to end.
My responsibility
I worked out what a dietitian's day holds, who may change it once it is submitted, and what a manager sees when a day is missing.
I wrote the requirements and designed the dietitian and manager views.
| Record | Owner | State |
|---|---|---|
| Day entered | Dietitian | Submitted |
| Day missing | Manager | Follow-up |
How I worked
Started from the workbooks. The requirements came from how dietitians actually logged their days and how managers reconciled them by hand at month end.
Designed in two tracks. One version inside Elevra's existing design library for this release, and an unconstrained version showing where the module could go next.
Scoped the first release. It sat on Elevra's existing assessment forms, with census integration, leadership dashboards and AI-assisted entry held for later. The module went through stakeholder review and reached production.
Outside my remit
- Engineering build
- Implementation on Elevra's assessment infrastructure and the production release.
Elevra / Daily record
Rachel Dempsey
Registered dietitian, record owner
Give each day an owner.
The RD owns the daily submission. Managers inspect the same record.
Patient care setting
Start with the care setting
Outpatient adult
Nutrition clinic
Show the relevant fields.
Selected care settings determine which activity fields appear.
Rachel Dempsey / This week
Tuesday is missing
Make missing days visible.
Day-level exceptions show where a manager needs to look.
Evolution
One record supported different responsibilities.
The RD still owned the daily record. Managers could inspect its state and exceptions, but did not author the work on the RD’s behalf. Manager approval and RD authorship were deliberately separate permissions.
Access control standards and health information research describe separation of duties: authority is split so a restricted action cannot be carried out by one person alone.
The RD authors the dayA registered dietitian logs one day’s work here.
The manager reads the same recordThe same entry arrives here. Nothing is retyped.
Tue, Fri missing3 of 5 days
Recreated from the shipped product with a stand-in roster.
The evidence layer
Three decisions shaped what shipped.
Use the platform that already owns assessments.
Clinical Productivity became a workflow inside Elevra's existing Assessments infrastructure, not a new platform.
The pain was shared files, fragmented records, and manual aggregation.
Field audits of real spreadsheets found errors in at least 86% of the files checked.
Only show the fields this care setting requires.
Selecting a care setting is what creates its activity fields; an unselected setting has none to fill.
Most of the source schema is irrelevant on any single day.
Public-sector design systems show a related question only when an earlier answer makes it relevant.
What it cost
A shorter-looking form can still be incomplete: fields were missing from the polished interface.
Care setting
Activity records
Inpatient adultAcute medical, 4 East
Unit rule awaiting confirmation
Outpatient adultNutrition clinic, Suite 210
Inpatient pediatrics, Outpatient pediatrics: no fields
Flag only what a rule can explain.
The manager surface uses day-level status, with explicit rules for data-quality exceptions.
Managers were reconciling the monthly result by hand.
Studies of clinical decision support find clinicians override about half or more of system alerts, and some of those overrides dismiss warnings that mattered.
What it cost
Day-level detail creates a wider table and needs careful weekend and PTO handling.
Rachel Dempsey, Tue
Tue 4 Aug, nothing submitted
Ownership
Submitted records
I defined how submitted records could be corrected without transferring authorship. The manager authorizes reopening; the dietitian changes the values, and both versions remain in history.
Health record rules apply a similar integrity principle: an amendment is appended or linked to the original record rather than replacing it, and earlier versions stay in revision history.
Implementation scope: submit and lock shipped; the correction path was proposed before pilot.
Kayla SimmonsRD, Inpatient adult
- Day
- Thu, 13 August 2026
| Field | Submitted | Corrected |
|---|---|---|
| Hours worked | 4.5 | 3.5 |
| PTO hours | 0.0 | 1.0 |
Current submission, K. Simmons, Fri 9:21 AM
Correction history
Outcomes
Daily work became attributable and actionable.
What would prove it next.
A reminder sent is an action. A resolved expected submission is the result.
Reconciliation time per exception
- Comprehensive
- 2
- Limited
- 3
- Total time
- 3.5 hrs
- Draft
- Submitted
- Locked
One workflow, start to finish.
Logging, manager review, drill-down, and draft and locked states shipped together in one module.
- RDRachel Dempsey
- KSKayla Simmons
- BNBlessing Nwosu
Tue 11 Aug has no log. Flagged Wed morning.
What the next iteration settles first.
Field gaps beside the interface
Put the field-gap inventory beside the interface from the first review. A surface can look ready while required fields are still absent.
Policy before polish
Settle time units, edit windows, correction rights, and role switching before visual polish. The interface can display the answer; it cannot responsibly invent one.
Compare notes
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