Much of what we do, whether at work or in our personal lives, involves routine processes. For example, driving a car to shop at our favorite grocery is routine, not requiring much thought even though we focus on being careful. At work we may greet our customers or patients with routine greetings, although we try to be friendly. These routines do not require a lot of thought. Instead, our minds adopt patterns for these routines rather quickly as it saves a lot of energy, according to recent brain research. So, if most of what we do is routine, then we need to make sure that the patterns or processes involved in these routines are effective and customer- or patient-centered.
Before proceeding too far, let me define what a process is. According to the American Society of Quality (ASQ), a process is "A set of interrelated work activities characterized by a set of specific inputs and value added tasks that make up a procedure for a set of specific outputs." To illustrate this, I will examine a portion of the process of checking a patient in at an outpatient clinic. The input is information given by the patient-name, nature of visit and insurance coverage. The value added tasks are the questions from the person checking in the patient. For instance, "Do you still have the same insurance? May I see your card?" Doing this provides value for the clinic as it provides a means of billing for the services. The outputs are the recorded responses of the patient.
For the best outcomes that are predictable for both patients or customers and the provider or business it is necessary to understand the many processes at a provider site and effectively manage the processes. This function is called Business Process Management by quality professionals and was the focus of an article in the May, 2015, issue of Quality Progress, the flagship publication of the ASQ-"Process Primer".
Failure to actively manage the processes at your work site may have many unintended consequences that affect the bottom line. Let me return to the check in of the patient mentioned above as an example. Suppose the receptionist asking for the current insurance information of the patient finds out that the patient has just enrolled in Medicare. When asking for the insurance card the patient supplies his/her Medicare card. This seems fine but suppose the patient is in a Medicare Advantage program and, being new to Medicare, does not supply that card. Then, when the clinic files a claim, it will be denied and the billing staff will have to contact the patient to find out how to resolve the problem. This extra work is costly and time wasting. It could have all been avoided if the check-in routine included asking Medicare patients if they are using a Medicare Advantage payer.
According to the article "Process Primer" there are five pillars of Business Process Management (BPM):
1. Identifying top priority, critical processes.
2. Validating customer (patient) requirements.
3. Documenting the processes.
4. Developing process measurements.
5. Managing and improving the processes.
These pillars should be actively addressed and managed by site executives and leaders and staff trained to address them. Managing business processes requires training of staff and/or use of professionals who are experts in the field. Typically, quality experts trained in the use of lean six-sigma methodology or similar approaches are capable of providing guidance in BPM for a site. Many organizations provide training for staff in the use of the basic tools of lean six-sigma, including the Medical Management Group Association.
Identifying Critical Processes
There are many processes at a work site. It would take too much time and effort to identify and manage them all. Thus, it is necessary to identify which are most critical to patient and practice outcomes. These should be actively managed to insure optimal, predictable outcomes that satisfy the patients and customers. After the most critical processes are under control and producing predictable, effective outcomes, staff can move on to managing less critical processes.
Validate Customer Requirements
It is very important that customer needs are understood and being met. In healthcare, this approach is being patient-centered. Processes that directly impact patients, such as the provision of clinical care, must be focused on the needs of the patient. It is key that providers actively work to understand these needs. Other staff who have contact with the patient must also be patient-centered.
Not all customers are patients, though. For instance, the work of the billing staff has a direct impact on the financial health of the provider group; the customers of the billing staff are the office management and the rest of the staff. I would consider the processes that they use critical to the health of the provider organization. Thus, it must be managed so as to produce optimal outcomes.
Model the Processes
The current state of all critical processes need to be understood. One of the best ways to do this is to use mapping tools such as flowcharts, value stream mapping or software that allows the mapping of the details of a given process. According to "Process Primer", this includes people, systems, information, materials, tools and equipment, and documentation.
Develop Process Measurements
For a process to be managed key indicators must be identified and measured. At a clinical site these could include population level health outcomes, such as the average blood pressure of patients with diabetes. For billing it could be the number of claims in AR that are 60 days past due. Let me emphasize that it is not sufficient to have just one key indicator per process. Rather, measurements should be taken at various stages of the process to insure best management.
Manage and Improve a Process
Once key processes are identified, mapped and indicators are being measured as well as patient requirements identified the best providers will work to continuously improve the processes in order to insure ever better outcomes. This will provide ever-improving outcomes for patients and providers.
The best businesses and providers will be actively engaged managing and improving their processes. Although Business Practice Management is complex the time spent on it has a tremendous impact on the health of patients and the business of the provider. In the face of the changes in reimbursement to providers BPM is critical to the health of the provider.
