Authors (including presenting author) :
Leung NH
Affiliation :
Medicine, Pamela Youde Nethersole Eastern Hospital
Introduction :
This project focuses on redesigning the form rack system in a medical ward at Pamela Youde Nethersole Eastern Hospital to support faster and more reliable access to clinical documents. The original rack had grown in an unstructured way over time; new forms were repeatedly added while others became obsolete after conversion to electronic versions or service changed, resulting in overcrowded slots, inconsistent placement and situations where staff could not find a form even when it physically existed in the rack. These issues led to interruptions in clinical workflow, delayed documentation and particular difficulty for newer staff who lacked familiarity with the informal arrangement. The core of the re-design was a clear, intuitive organization of forms by both clinical specialty and functional type so staff could approach the rack either by “which specialty?” or “what task?”. Specialties such as cardiology, respiratory etc. were allocated clearly defined zones, and forms were also grouped into functional clusters such as charting, checklist, referral etc. Certain forms were intentionally placed in two logical locations so that they remained easy to retrieve regardless of whether staff searched by specialty or by form type. In parallel, a dedicated contingency rack was established exclusively for forms required during CMS downtime, ensuring that paper versions are easily accessible in contingency situations. To enhance visual navigation and reduce cognitive load, a Rainbow colour coding system was introduced, assigning distinct colours to each specialty or major category and applying these consistently across index, labels and rack sections. This was complemented by a projecting sign labelling system, in which tab like signs extend outward from the rack to display the specialty or category name, allowing rapid identification of the correct section from a distance or at a glance. Individual slots carry clear printed labels indicating form names. There are also reminder cards that appear automatically when only a few copies remain in the slot. These cards alert the clerk for refilling by staff putting the cards to collection box, creating a proactive system that eliminates stockouts, distributes responsibility across all users rather than relying solely on clerks to monitor proactively, reduces clerk workload. An Excel based search engine lists each form with its hard copy location and hyperlinks to print electronic versions directly. This integrated, low cost redesign makes form retrieval intuitive, standardized and resilient.
Objectives :
To redesign the form rack system for intuitive access by clinical specialty and functional type, eliminating unfindable forms through colour-coded Rainbow system, projecting labels, and duplication strategies. To establish resilient form availability via contingency rack for CMS downtime, proactive reminder cards reducing clerk workload/stockouts, and Excel search engine for hard-copy locations/electronic printing. To improve workflow efficiency, staff satisfaction, and new hire adaptation in Pamela Youde Nethersole Eastern Hospital's medical ward through low-cost, sustainable reorganization.
Methodology :
Study Design & Objective: This quality improvement project employed a pre-post intervention design to systematically evaluate the impact of a standardized form rack reorganization on a medical ward at Pamela Youde Nethersole Eastern Hospital. The primary objective was to measure changes in staff-reported form accessibility, workflow efficiency, and overall satisfaction following the implementation of a visual management system. The single-group, pre-post design was selected for its feasibility within the operational ward environment. Participants & Setting: The study targeted 28 staff members who regularly utilized the form rack, including Advanced Practice Nurses (APNs), Registered and Enrolled Nurses (RNs/ENs), Clerks, and Ward Managers. Participation was voluntary. The project was reviewed and classified as a serviceimprovement. Intervention: The existing form rack was comprehensively reorganized using a multi-faceted intervention: 1) Visual Standardization: Implementation of a Rainbow colour-coding system with large, projecting labels for immediate visual identification; 2) Logical Structuring: Forms were regrouped by clinical specialty (e.g., cardiology) and functional category (e.g., referrals, assessments); 3) Centralized Excel-based form search engine. Survey Instrument & Data Collection: A purpose-developed, 11-item Likert-scale questionnaire (1=Strongly Disagree/Very Difficult to 5=Strongly Agree/Very Easy) assessed key domains: intuitive grouping, label clarity, glance identification, visibility, retrieval of infrequent forms, index utility, workflow disruption, ease of new staff adaptation, independent locating ability, overall efficiency, and satisfaction. Anonymous paper surveys were distributed. A high pre-intervention response rate was achieved (93%, n=26). The identical survey was re-administered 4-6 weeks post-implementation to capture sustained perceptions, achieving the same response rate (n=26). Qualitative comments were solicited via open-ended fields. Data Analysis: Due to fully anonymous data collection which prevented individual matching of pre- and post-responses, the two sets of scores were treated as independent groups. Pre- and post-intervention mean scores for each survey item were compared using independent two-sample t-tests, with statistical significance set at p< 0.05. Subgroup analyses examined response patterns across different staff roles and years of experience (0-3, 4-6, 7+ years). Qualitative remarks were reviewed for thematic context.
Result & Outcome :
The form rack reformation produced substantial, statistically significant improvements across all measured dimensions. Pre-reform surveys (n=26, 93% response rate of 28 eligible staff) revealed low satisfaction with the disorganized system, with mean Likert scores (1=Strongly Disagree/Very Difficult; 5=Strongly Agree/Very Easy) ranging from 1.77 to 2.46. Accessibility items performed poorly: grouping ease (2.15), labeling intuition (2.27), glance identification (2.19), label visibility (2.46), locating infrequently used forms (1.77—the lowest), and index effectiveness (2.31). Workflow disruption scored 2.31, new staff adaptation 2.27, and locating forms without someone help scored 2.27 (indicating frequent assistance needed), while overall efficiency (2.23) and satisfaction (2.19) reflected widespread frustration. Newer staff (0-3 years) averaged ~2.0-2.2 and frequently required assistance. Post-reform surveys (n=26, 93% response rate, collected 4-6 weeks post-implementation) showed all items exceeding 4.0, representing 70-146% improvements: grouping ease (4.54, +2.39), labeling intuition (4.62, +2.35), glance identification (4.35, +2.16), label visibility (4.73, +2.27), locating infrequently used forms (4.35, +2.58), index effectiveness (4.38, +2.07), workflow impact (4.12, +1.81), new staff adaptation (4.50, +2.23), locating forms without someone help (4.15, +1.88), overall efficiency (4.54, +2.31), and satisfaction (4.58, +2.39). Two-sample t-tests confirmed statistical significance for all items (p< 0.0001). Gains were consistent across roles (APNs, RNs/ENs, Clerks, Ward Managers) and experience levels. Newer staff improved most dramatically (~2.1 → >4.5), achieving parity with experienced colleagues. The Rainbow colour-coding, projecting labels, specialty/category grouping, reminder cards, CMS downtime contingency rack, and Excel search engine received strong praise. Qualitative feedback reinforced quantitative results: "systematic specialty search saves time," "spent less time searching forms," "easy to locate," "logical arrangement," and "workflow becomes more effective." One constructive comment (RN/EN 4-6 years) noted some high-use forms positioned too low, suggesting minor frequency-based optimization, but 25/26 post-responses were unequivocally positive.
