For a public health department the size of LA County’s, complexity is expected. The county’s Department of Health Services (DHS) manages six hospitals and a sprawling network of clinics and community health programs, serving one of the most populous counties in the United States. Physicians come and go. Departments operate with different systems and different needs. Among it all, the demand for speed, accuracy, and compliance is unrelenting.
When LA County began working with Nintex, the goal was straightforward: Replace the manual processes that were creating delays and risk with digital, automated workflows that could move faster, close reliably, and give administrators the visibility they needed to manage at scale.
Five years later, the DHS automated more than 100+ process workflows and 150 forms across the organization — and the internal demand keeps growing.
Departments didn’t know about Nintex a few years ago. Now they call us directly. We’re known as the department of forms and automation, and that is very gratifying to see.
— Marcos Paiola, IT Manager, LA County DHS
The challenge: Manual processes bogging down a high-stakes environment
Before Nintex, many of DHS’s critical processes relied on paper forms, manual data entry, and sequential approvals that moved slowly through multiple layers of administration.
In a healthcare environment where speed has nearly as much direct patient impact as accuracy, those gaps carried real risk.
Two processes illustrate the problem particularly well:
Laboratory order management: In a network of six hospitals, physicians order lab tests — and then sometimes leave. Without a structured system for tracking who ordered what, who approved it, and whether it was fulfilled, orders could exist in an ambiguous state with no clear owner and no automatic notification when results were ready, leading to gaps in patient care.
Employee name changes: What sounds like a simple administrative request was, in practice, a multi-system expedition: A paper form, manual data entry, sequential approvals across several administrators, an IT ticket, and a confirmation loop back to HR. Every handoff was an opportunity for delay or error — and for legal name changes, where documentation accuracy matters, those errors had real consequences for employees.
The solution: End-to-end workflow automation with Nintex
For lab order management, Nintex now captures the entire process: Who ordered, who approved, confirmation of fulfillment, and automatic notification to all relevant parties, with records stored in the appropriate system. The loop that previously stayed open now closes reliably, every time.
For employee name changes, what previously required navigating multiple departments over days now takes just five to ten minutes. The employee submits their documentation digitally, Nintex automatically validates their identity against the network, routes approval through the correct chain, generates the IT ticket, and confirms completion back to HR — all without manual handoffs and with full audit visibility throughout.
That process used to take a significant amount of time. We streamlined it to about 5 to 10 minutes. You submit the paperwork, we get all your data, validate through all the HR layers, and then finally conclude.
— Marcos Paiola, IT Manager, LA County DHS
The same model has now been applied to use cases across the organization. DHS now runs more than 100+ automated workflows and 150 digital forms, spanning HR, clinical operations, and administrative functions. Every new automation implementation follows the same principle: Understand the process end-to-end, identify where the manual handoffs create delay or risk, and replace them with a governed digital workflow.
DHS has also established a centralized automation team that acts as the governance hub for all workflow requests across the department. Every automation request flows through this team, which analyzes the process, maps its connections to existing systems, and builds solutions that can serve multiple departments rather than creating redundant parallel processes.
What’s next: Scaling automation and introducing AI
LA County’s DHS is now focused on taking automation to the next level. Pola describes a goal set by leadership to make 90% of the organization’s processes fully electronic — an ambitious target that Nintex is central to achieving.
Looking ahead, DHS is exploring how AI capabilities within the Nintex platform can address two specific operational challenges: Real-time process metrics that surface automatically from the workflow, and intelligent escalation for processes that have stalled — enabling the system to identify idle approvals and take action without requiring IT to intervene manually.
What we’re looking for from AI is the ability to interject and take action on a process that is pending — move it left, right, back into the chain, finish it up. That’s what we’re looking for at the next level.
— Marcos Paiola, IT Manager, LA County DHS
Ready to see what Nintex can do for your organization? Request a personalized demo at nintex.com/request-demo.
