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Hospital leaders today are under extraordinary pressure. Staffing shortages persist, patient acuity is rising, and expectations for responsiveness, safety, and experience have never been higher. Nurses feel this pressure every day. Having spent 16 years at the bedside—and now working with hospitals across the country in my role at Ascom—I see these challenges firsthand.
Nursing workflows are no longer “nice to have” operational details—they’re strategic levers that directly affect patient outcomes, staff satisfaction, and financial performance.
This means how technology is implemented matters just as much as what technology is installed—and often determines whether it succeeds or fails. What defines a successful nurse call or clinical communication system today? I can tell you, it’s not lights, tones, or devices—it’s defined by how these tools support the objectives clinical workflows are built to achieve.
That’s where our Clinical Design Worksheet (CDW) comes in with our Professional Services team to drive quality and satisfaction.
What Is a Clinical Design Worksheet—and Why Does It Matter?
A Clinical Design Worksheet (CDW) is a structured, collaborative process of documentation used to design how nurse call and clinical communication systems will function in a specific care environment. It captures how alerts are generated, who receives them, how they escalate, and how staff respond—based on real clinical practice and data, not assumptions. This also applies to patient physiologic monitors, ventilators, IV pumps and the list goes on.
Too often, we see legacy nurse call systems that were installed “out of the box,” with little customization. The result? Over‑alerting, unclear accountability, alarm fatigue, and workflows that actively work against clinicians.
A CDW changes that dynamic. It ensures our Ascom Healthcare Platform technology is built around the hospital’s workflows, staffing models, and care goals—not the other way around. And, as hospital’s technology infrastructure becomes more complex, and as more devices integrate with our nurse call, software, or mobile devices the CDW takes on even more importance. Today, we see smaller hospitals integrating one, two or maybe three devices with nurse call and larger health systems integrating numerous devices and other technologies.
Ascom’s Approach Unifies Implementation
Our implementation process is intentionally rigorous to make sure workflows are scrutinized from the inception of a patient need to completion. From the earliest stages of the sales process, we require clinical participation to help us architect the right process for departments, units, and hospital-wide.
Our approach includes:
Our goal is making sure the system performs reliably in the real world.
Five Best Practices for Designing Effective Nursing Workflows
With more than 2,000 hospital customers in North America, we see, and we design a lot of CDWs. Several best practices consistently separate high‑performing organizations from those that struggle. The ones who are succeeding in meeting their goals do these five things well:
1. Engage the Right Clinical Leaders
“Nothing about me without me.” This principle is foundational. Workflow design must be led by clinicians who understand patient care at the unit level. This is not a facilities or IT exercise alone.
We see results when hospitals designate:
Technology decisions made without clinical ownership almost always lead to redesign later—often after problems emerge. When that happens, there’s added cost and time to a project, and you lose your passion for adoption.
2. Route for Accountability, Not Broadcast Alerts
We see this frequently across organizations. Decisions are made to send alerts to everyone. This is one of the most common causes of alarm fatigue. When everything goes to everyone, no one is truly responsible.
Effective workflows:
Sending the right information to the right person at the right time improves response times while dramatically reducing unnecessary interruptions.
3. Set Realistic Response Time Expectations
Unrealistic performance targets undermine staff trust and system adoption. Expecting every call to be answered in under 30 seconds is not clinically realistic—and clinicians recognize this immediately.
Best‑practice response targets are based on:
For example:
Right‑sized expectations support both patient safety and caregiver morale.
4. Practice at the Top of License
Well‑designed workflows ensure tasks are routed to the right role—not automatically to the RN.
Examples include:
This improves efficiency, reduces unnecessary interruptions, and helps clinicians focus on the work only they can do.
5. Reduce Alarm Fatigue Through Intelligent Filtering
Alarm fatigue is not caused by alerts—it’s caused by too many unnecessary alerts.
Ascom helps hospitals:
When devices “never stop ringing,” staff begin to disengage—often by silencing or not carrying them at all. Intelligent filtering restores trust in the system and the unit leadership for making needed changes.
Validate, Review, and Refine After Go‑Live
Workflow design is not static. We also conduct follow-ups as part of software maintenance agreements and quarterly business reviews.
At two weeks and again at 45 days, we hold additional follow ups as part of software maintenance agreement upgrades and quarterly business reviews.
This continuous‑improvement mindset is essential in complex clinical environments.
The Final Important Step: Documentation and Governance
Every CDW we create gets formally documented, signed, and retained by us, our partner and the customer. This official record serves as a guide to help us when a customer needs technical support or even refresher training. If customers make changes to the CDW, it’s crucial they document them in the CDW and send us an updated copy so we can best help them later.