HEALTHCARE OPERATIONS
Clinical Productivity
Daily productivity for registered dietitians, inside Elevra, the hospital operations platform at Compass Healthcare Digital.
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
2:02Y. Tanakaoverwritten4.5 hrs
2:41R. Dempseythe file keeps this one2.5 hrs
Owned recordTwo RDs, two records, one writer each
Yuki TanakaRD, Inpatient adult
- Day
- Thu, 13 August 2026
- Hours
- 4.5
- Care setting
- Acute medical, 4 East
Revisions
- 5:10 PMSubmitted by Y. Tanaka, ownerLocked at submit.
- 2:41 PMR. Dempsey’s entry went to her own record
- 2:02 PMDraft created by Y. Tanaka
One RD. One day. One owned record.
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.
- Period
- August 2026
- Submitted
- 4 of 5 days · Tue missing
- Assessments
- 58 logged
- Read by
- Unit manager
One person owns the day. The manager reads the record rather than rebuilding it.
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.
Elevra / Clinical Productivity
One RD. One day. One owned record.
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 day
The manager reads the same record
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
Ownership
Approve the correction. Preserve the owner.
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.
Yuki TanakaRD, Inpatient adult
- Day
- Thu, 13 August 2026
| Field | Submitted | Corrected |
|---|---|---|
| Hours worked | 4.5 | 3.5 |
| PTO hours | 0.0 | 1.0 |
Current submission, Y. Tanaka, Fri 9:21 AM
Correction history
A submitted record can be corrected without becoming anonymously editable.
Outcomes
Daily work became attributable and actionable.
Shipped
The shipped module brought logging, manager review, drill-down, and draft and locked states into one workflow.
Actionable
The management view made individual missing days visible, giving follow-up a specific person, date, and record to act on. The AI layer remained in early testing, separate from the shipped workflow.
Next measures
Reconciliation time per exception, age of overdue expected submissions, correction turnaround, and false-positive reminder rate. A reminder sent is an action. A resolved expected submission is the result.
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.
More work