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ShowcaseCase Study
Healthcare · Process Automation

Enterprise Workflow
Automation

How we replaced 12 manual approval processes with intelligent Power Automate workflows — recapturing 1,200 employee-hours per year and cutting approval latency from 3.5 days to 4.8 hours.

1,200Hours/Year Saved
94%Faster Approvals
12 → 0Manual Processes
$240KAnnual OpEx Saved

Client Context

A regional healthcare network with 14 facilities processed everything on paper — purchase requisitions, vendor onboarding, employee change requests, incident reports, equipment maintenance tickets, and compliance certifications. A single purchase order required 5 handwritten signatures across 3 departments, traveling via interoffice mail.

The average approval cycle was 3.5 business days. Rush requests took "only" 2 days — because an admin physically walked the form between buildings. During busy periods, forms were lost in transit at a rate of 8%, triggering duplicate submissions and reconciliation nightmares.

The organization had Microsoft 365 E3 licenses but was using only email and Word. Power Automate, SharePoint, and Teams were available at no additional cost but completely untouched.

Power Automate SharePoint Online Microsoft Teams Power Apps Adaptive Cards Dataverse Azure AD Power BI Embedded

Drowning in Paper

The client's operations team spent more time managing paperwork than managing operations. Compliance audits were particularly painful — finding a specific approval chain from 6 months ago meant rifling through filing cabinets across multiple buildings.

📋 Paper-Based Approvals

12 distinct approval workflows required physical signatures. Purchase orders, vendor onboarding, IT change requests, and compliance certifications all traveled via interoffice mail at glacial speed.

⏱️ 3.5-Day Cycle Time

Average approval took 3.5 business days. Critical purchase requests for patient-facing equipment were delayed alongside routine office supply orders — no prioritization mechanism existed.

📉 8% Loss Rate

Forms were routinely lost in transit between buildings. 8% of submissions required re-creation, adding frustration and duplicating effort. No audit trail existed for any approval decision.

🔍 Compliance Risk

Healthcare regulatory audits required proof of timely approvals. Finding historical records meant searching physical filing cabinets. Three audit findings in the previous year cited inadequate documentation.

Intelligent Workflow Platform

We built a unified approval platform on the Microsoft 365 stack the client already owned, digitizing all 12 workflows with intelligent routing, mobile approvals, and complete audit trails.

Step 1Power App Form
Step 2Auto-Route
Step 3Teams Approval
Step 4SharePoint Log
Step 5BI Dashboard

01 — Power App Intake Forms

Built responsive Power Apps forms for each workflow type. Dynamic fields adapt based on request category — a $500 supply order shows a simple form, while a $50K equipment request surfaces additional justification fields and auto-routes to VP-level approval.

02 — Intelligent Routing

Power Automate flows route approvals based on amount thresholds, department, and urgency level. Azure AD group membership determines the approval chain. Escalation triggers automatically if an approver hasn't responded within 4 hours.

03 — Teams Adaptive Cards

Approvers receive rich Adaptive Cards in Microsoft Teams with all request details, attachments, and one-tap approve/reject buttons. Approvals can be completed from mobile devices in under 15 seconds.

04 — Compliance Dashboard

Every approval action is timestamped and logged to SharePoint with the approver's identity, decision, and any comments. Power BI embedded dashboards provide real-time visibility into SLA compliance and bottleneck identification.

Power Automate Flow Architecture

The core routing engine uses a metadata-driven approach. A SharePoint configuration list defines approval chains, thresholds, and escalation rules — so the operations team can modify routing without touching the flow itself.

Power Automate Flow — Purchase Approval Engine
// Trigger: When an item is created in SharePoint // List: "PurchaseRequests" Trigger: SharePoint → "When an item is created"Action: Get Approval Config Filter: Category = triggerBody()['Category'] ↓ Condition: Amount > config['VPThreshold'] ├─ YesStart Approval (VP + Director) │ Approvers: config['VP_Group'] │ Type: "Everyone must approve" │ Wait: 4 hours → Escalate └─ NoStart Approval (Manager only) Approvers: triggerBody()['Manager'] Type: "First to respond" Wait: 4 hours → EscalateAction: Post Adaptive Card to Teams Card: Dynamic template with request details Buttons: [Approve] [Reject] [Request Info] ↓ Action: Update SharePoint Item Status: approval['outcome'] ApprovedBy: approval['responder'] ApprovedDate: utcNow() ↓ Action: Send Notification To: Original Requestor Template: "Your request has been {{outcome}}"

The metadata-driven approach means adding a new approval category takes 5 minutes — add a row to the configuration list. No flow modifications, no IT involvement, no deployment. The operations team manages their own workflow rules.

Measurable Impact

The platform was rolled out in 3 phases over 8 weeks. All 12 workflows were live within 2 months, and the final paper process was retired on day 60.

Metric Before After Improvement
Approval Cycle Time 3.5 days 4.8 hours ▲ 94% faster
Manual Processes 12 paper workflows 0 (fully digital) ▲ 100% digitized
Form Loss Rate 8% lost in transit 0% ▲ 100% reliability
Employee Hours Saved 1,200+ hrs/year Reallocated to patient care ▲ $240K value
Audit Findings 3 findings/year 0 findings ▲ 100% compliant
Additional License Cost $0 (existing M365) ▲ Zero cost
We were paying for Microsoft 365 for years and using it as expensive email. Garnet Grid showed us that the automation tools we needed were already included in our license. Our nurses used to spend 45 minutes a day chasing paper approvals — now they approve equipment requests from their phones in 15 seconds and spend that time with patients.
CO
Chief Operations Officer
Regional Healthcare Network — 14 Facilities

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