Protect your Organization with the 4 Pillars of Quality Testing

End-user workflow and application testing provides a systematic way to ensure people and technology (software applications, devices, etc.) work together to produce desired outcomes.

Testing processes are essential to protect healthcare systems and their investments from risk.  Quality workflow-based testing practices ensure technology supports rather than interferes with processes, handoffs are not missed, and transitions are seamless.

The 4 Pillars of Quality Testing

Documented and Communicated Test Plan

A test plan outlines how testing needs to occur, who needs to be involved, and what tools will be required.

A well-documented and communicated test plan serves as a cornerstone to successful testing.  It functions as a blueprint, ensuring everyone involved with a change or project is on the same page, reducing ambiguity and promoting clear communication. 

A guiding principle in developing a project test plan is alignment with the organization’s overarching testing strategy.  This establishes consistency and coherence across projects and initiatives, facilitating seamless integration of project objectives with broader organizational practices.

A test plan should operate in synchronicity with project management practices, including work planning, resource management, issue management, change control, end-user education, and change management.  By embedding testing considerations into these processes, the test plan becomes an integral part of project execution, rather than an isolated activity.

A robust test plan is comprised of five main sections:

1.  Testing Types and Terms:   This section defines the different types of testing necessary for the project, and the expectations associated with each type of testing.  There are various types of testing, such as unit testing, functional/system testing, regression testing, performance testing, user acceptance testing, and integration testing.  Depending on the size and scope of impact to the end users, either some or all types of testing may be required.
2.  Testing Requirements: Here, the workflows to be tested are outlined, along with the resources that need to be incorporated in the testing.  This includes human resources (positions or roles), application resources (software and systems), integration resources (interfaces and data exchange), and device and hardware resources.  Additionally, any vendor or regulatory requirements impacting testing should also be documented in this section.
3.  Testing Team Organization:  This section identifies the individuals involved in developing and conducting the testing, outlining their roles, expectations, and responsibilities within the testing process.
4.  Testing Processes: The management processes and expectations for the stages and phases of testing are outlined in this section.  The processes outlined should include scheduling, preparation, confirmation of readiness, execution, freezes and change control, issue documentation and tracking, and issue resolution.
5.  Testing Tools and Practices:  This section, which may be integrated with the Testing Processes section, specifies the different types of tools that will be used to manage and implement the testing process.  It clarifies the tools and practices that will be used to outline and track all the work steps required to prepare for and complete a round of testing, reserve and schedule testing resources (human, technical-hardware & devices, operational facilities/locations & rooms, vendors, etc.), create and maintain the test scripts, conduct and manage each test round, log and manage issues associated with each test round, and communicate status. 

Organizations should develop a test plan template, allowing for tailoring to meet specific project requirements.  Regular review and updating of the test plan template ensure that testing practices remain current and adaptable to evolving needs.

Ultimately, the value of a test plan lies in its ability to hold teams accountable and enforce organizational expectations regarding testing.  By defining tools, procedures, and standards, test plans promote consistency and repeatability, minimizing errors and ensuring reliable outcomes in the production environment.

Maintainable Test Scripts 

Effective testing of systems and processes hinges on the accuracy of test scripts.  It is essential these scripts accurately reflect actual end-user operational processes, incorporating technology seamlessly into workflows. Test scripts must include handoffs between people, departments, and organizations in the right order and with enough detail.  Further, specific actions and expected outcomes for each click or input should be included, for the script to make sense and confirm operational success.

Regardless of the type of testing that needs to be done, creating accurate test scripts isn’t easy.  The two biggest hurdles to having accurate test scripts are developing the test scripts and maintaining the test scripts.

If developed appropriately, and regularly maintained, test scripts are a great organizational asset.  Otherwise, they can easily become a financial, legal, and patient care liability to the organization.   Poor test scripts lead to situations where processes and technology are approved without being fully validated, leading to production issues, delaying efforts at the expense of the organization, increasing user dissatisfaction, and exacerbating provider and staff burn-out.

Often, test scripts are mere outlines residing in individuals' minds or desktops, leading to inconsistent testing outcomes. The absence of standardized, detailed scripts impedes testing and introduces variability in results; and essentially eliminates the ability to keep test scripts up to date as workflows evolve and change. 

Overcoming this challenge requires a concerted effort to document test scripts in a shared, accessible format, managed in a test script repository.  The following are steps for establishing a comprehensive test script repository.  Leveraging testing tools, such as TransIT, can streamline this process by converting workflows into test scripts and minimizing development efforts.

The Steps

1.  Identify Workflows:  This foundational step entails identifying major workflows across departments, delineating common scenarios, and engaging subject matter experts (SMEs) to capture and diagram detailed scenario narratives including hand-off processes and transitions. 
   • Tip:  Data and information surrounding the highest volume discharge diagnoses and the highest cost/revenue discharge diagnoses can be a good source of determining workflow scenarios.
2.  Create Scripts:  Once the foundational workflows are identified, develop short step by step workflow-based “module” scripts for each department, hand-off process, and transition workflow.  These modules serve as building blocks for longer integration and regression scripts, covering high-volume and high-revenue scenarios.  Tracking the utilization of workflows in each script facilitates comprehensive coverage and simplifies maintenance efforts when workflows evolve, and the scripts need to be updated.  An effective Testing Tool, such as TransIT, can auto convert workflow diagrams into starter test scripts and track workflow utilization, decreasing the script development and maintenance efforts.  For more information on how to write test scripts, see "Creating Integration Test Scripts: A How-To Guide".
3.  Enhance Script Consistency:  Detailing click-by-click actions and expected outcomes in test scripts ensures consistency across testing rounds, enables a broader pool of testers (often a constrained resource), and aligns testing with real-world end-user practices.  Incorporating mechanisms for testers to note script and workflow issues streamlines script corrections and updates, bolstering testing productivity and satisfaction.  Furthermore, it supports the development and maintenance of corresponding end-user education materials. 
4.  Utilize Test Scripts:  Use workflow test scripts to validate all operational process and technical changes – not just the big ones.  This ensures thorough validation and protects the organization from potential risks.  Regular use of these scripts also facilitates upkeep by enabling easy management of tweaks and corrections, thereby consistently reflecting real-world practices.

Maintaining accurate and up-to-date detailed test scripts is essential for safeguarding organizational investments.  By adopting a systematic approach to script development and maintenance, organizations fortify their testing framework as a valuable organizational asset.

Management and Coordination

Testing coordination is vital to ensure the appropriate level (degree) of testing is seamlessly integrated into every project, upgrade, and change initiative.  A designated coordinator plays a pivotal role in overseeing this process.  A testing coordinator confirms that:

• All necessary test scripts are current and prepared
• Testing events are scheduled in alignment with other organizational activities
• Testing resources are efficiently allocated
• Testing activities progress smoothly and meet their deadlines. 

Furthermore, the coordinator ensures that outcomes are systematically documented, tracked, and communicated.  The testing management plan serves as a blueprint outlining the coordinator's responsibilities.

In addition to overseeing testing activities, the coordinator also implements formal coordination processes to maintain consistency in how testing events are organized and reported across various projects.  This includes:

Change Control:  Managing changes that occur during testing to minimize disruptions and maintain the integrity of the testing process.

Education and Communication:  Ensuring that team members are informed about testing processes and their responsibilities, fostering accountability for following established procedures.

Issue Resolution:  Monitoring and ensuring project or change-related issues are resolved promptly, as well as addressing any script-related issues that may arise during testing.

To streamline these coordination efforts and alleviate administrative burdens, the use of a testing tool such as TransIT is indispensable.  Such tools provide essential support for managing and coordinating testing processes, allowing the coordinator to focus on strategic oversight rather than administrative tasks.

By implementing robust management and coordination practices, organizations can optimize their testing efforts, mitigate risks, and ensure the successful delivery of projects and changes.

Standard Practices and Tools

Establishing standardized practices and tools is essential for reliable, consistent testing and ensuring clarity throughout the testing process.

By setting clear standards, organizations can streamline the storage and maintenance of test scripts, as well as ensure uniform execution of testing events and activities.  This includes implementing a systematic repeatable process for testers to follow, creating a centralized repository for tracking testing-related issues, and establishing mechanisms for holding the team accountable for testing outcomes.

Robust tools such as TransIT, are instrumental for organizations to have an effective enterprise testing strategy and processes that establish testing as a fundamental aspect of organizational practice across all projects and changes.

A good testing tool should possess several key features:

• Cross-platform, vendor agnostic capabilities to accommodate diverse workflows and technological environments.
• Scalability to support testing efforts across projects of varying sizes, from minor changes to large-scale initiatives.
• Centralized storage of all test scripts, facilitating easy tracking, access, and maintenance.
• Generation of workflow-based test scripts derived from process map diagrams, enhancing efficiency and accuracy.
• Planning and management functions to support comprehensive coordination.
• Resource identification and scheduling options to optimize resource allocation.
• Automatic notifications to assigned team members to keep them informed and engaged.
• Integrated issue logging to ease documentation, communication, and resolution of testing related issues.
• Capability to flag script issues and identify areas requiring updates.
• Real-time test round analytics for tracking progress and status.

For further testing tool insights, see articles Maximizing your Testing ROI and Healthcare Application Testing – It’s Condition is Critical, and case studies such as Improving the Quality of Testing at Nicklaus Children’s Health System.

Conclusion

Effective testing provides a systematic way to ensure people and technology (software applications, devices, etc.) work together to produce desired outcomes as part of the end user workflow.

1.  A comprehensive test plan guides the testing process and fosters collaboration, enhances efficiency, and mitigates risks.
2.  Maintaining test scripts as essential organizational assets safeguards organizational investments and mitigates risks.
3.  Establishing robust management and coordination practices optimizes testing efforts and ensures the successful delivery of projects and changes.
4.  Standards of practices supported by tools set clear testing expectations and provide consistency in how all testing activities and events are executed. 

When you incorporate these four pillars of testing into your organization’s practices you improve testing accuracy, decrease the time and effort required for appropriate testing, and accelerate the testing process thereby protecting your organization and its investments. 

How MAKE Solutions Can Help

MAKE Solutions can help you establish the four pillars to achieve a quality testing process.  MAKE’s TransIT tool and Testing as a Service (TaaS) supports the unique challenges of complex end user workflow and technology testing. 

TransIT is the comprehensive solution for quality healthcare workflow and application testing; providing workflow development and tracking, the creation of modular test script, test round resource planning and scheduling, and test execution, along with integrated issue logging, script flagging, and dashboard tracking features. 

References

1. Gartner, Predicts 2023: Changing How Healthcare Provider Services and Operations Are Delivered, By Barry Runyon, Sharon Hakkennes, and Gregg Pessin, 5 December 2022.