Don't let performance improvement fatigue set in

Sunday, September 26, 2010

Operational efficiency has become a commonly used phrase as HME providers figure out how to deal with declining reimbursement and rising costs. Loosely translated, operational efficiency means that providers must be intensely focused on continuous process improvement in order to reduce the hidden costs associated with inefficient workflow and sub-optimal processes.

Areas such as intake, billing and distribution are often laden with workflow issues and waste. This means they also offer many improvement opportunities, which eventually develop into focused process improvement projects.

Many providers do not have trouble getting initial results with their process improvement work; the trouble lies in holding on to the results. Like a marathon runner, providers can hit a performance wall. Any initial gains begin to slowly slip as performance improvement fatigue sets in--"we tried that before; it did not work."

Our experience tells us that successful process improvement is largely a function of paying attention to a few basic fundamentals. Providers that consistently achieve results--and more importantly, sustain those results, are also able to avoid some of the common mistakes associated with stalled process improvement initiatives.

Changing things and not behavior

In a typical manufacturing environment, nearly 97% of all accidents can be traced back to human behavior. Similarly, in most lean process improvement initiatives, failure is often tied to human behavior. People have a tendency to revert back to the old way of doing things.

When working to improve a process, modification of the process is necessary so that it becomes difficult to go back to the old way of doing things. However, if you only change "things," then the "things" will get lost or replaced when no one is looking. You will be back to the old way of doing things in no time at all.

The more leaders verify and follow up, the more people will follow the new standard(s). Failure to consistently verify adherence to standards on the part of leaders will yield a corresponding failure to follow the standards on the part of employees.

Simply put, if you want to encourage specific behaviors, you have to routinely verify the behaviors are actually taking place.

Failure to incorporate

standard work

Standard work is one of the foundational concepts of lean thinking. Standard work involves different people approaching similar work in a similar manner.

It is common for us to see 10 people working in an intake area using at least six different methods for processing a new referral. This individuality often results in variation or waste--waste in the form of missing or inaccurate information, missed steps, errors, and the costly rework that always comes with errors.

Standard work involves finding the one best way to carry out a process, documenting it and then spreading that "one best way" to everyone working within the process.

Intake and billing processes that consistently result in speedier cash collections and reduced pending revenue have one thing in common--they are lead by people that are obsessed with standard work and process consistency.

Successful processes incorporate the five elements of standard work:

  1. Content - define the specific steps and tasks that need to be carried out
  2. Sequence - know when each task needs to be completed
  3. Timing - know how long each step or task should take
  4. Outcome - understand the expected results of the process
  5. Who - identify who should be performing each step or task within the process

Ignoring basic project management principles

Identifying improvement opportunities is one thing, actually getting the work of improvement done is quite another. It is common for providers to work on projects that never seem to get completed--projects get about 90% complete and they tend to stay there.

A big part of process improvement involves assigning out work and tasks to others--task management is a crucial part of project success. A simple tool such as a project task tracker can be used to help manage and monitor assigned tasks.

Project management also involves properly scoping the project. It is important to place boundaries around the project--you have to identify what you will and will not address as part of the process improvement work.

Under communicating

Our research and experience tells us that when process or wide-scale organizational changes are made, leaders fail to communicate the nature of the change by a factor of ten. That means that when leaders do communicate a change, they typically do 1/9 of what should be done.

A single e-mail or a quick staff meeting is not sufficient. Consistent messaging using different methods is important. Coaching others along the way can also be an effective form of communicating the importance of change.

Not leveraging

front-line leaders

Our experience reveals that successful processes (and successful providers) have strong and consistent front-line leadership. Front-line leaders are the team leads, coordinators and supervisors that are often close to where the process work takes place.

Processes that perform consistently well have leaders that are able to hardwire accountability into the process. Leaders are readily available to help staff solve problems in near real time. They are also focused on coaching their staff in order to help drive results.

Providers have to continue to find ways to drive down costs and improve efficiency. By applying basic process improvement techniques, providers will be able to avoid some of the more common mistakes associated with less-than- successful process improvement projects. hme

Chris Calderone is a managing partner at Lean Homecare Consulting Group. Reach him at