Business Process Simplification
by Debbie Day-Oliver
Business process simplification is improving the way work is done by providing value-added services which deliver the results necessary to transform and grow the business faster, better and cheaper than the competition.
As we enter the managed care marketplace health care facilities should take the same approach. Ask yourself these questions about how this concept applies to your HIM department:
What would the bottom line impacts be in customer satisfaction (e.g., the patient, the physician, other departments)?
What value added services could you provide that the 'customer' wants or needs but you have been unable to deliver up to this point?
From a budgetary/operational standpoint, would there be a positive impact?
Business process simplification (a.k.a. continuous improvement) builds on an understanding and simplification of the processes relative to a task to eliminate waste and improve the overall quality of the output. Generally, the areas focused upon include:
- elimination of waste (or non-value added activities)
- reduction of cycle time
- elimination of defects or disconnects within the process
- employee involvement (a 'must'!)
- continuous improvement (or 'there is no finish line')
Elimination of Waste
Ask yourself, or better still ask the employees within your department, 'why do we do ________?'. A common response might be, 'we've always done it that way'. Try to determine if other departments or areas are performing the same function with the same/different result or purpose.
Do you suffer the 'silo phenomena'? That's where each department exists within its own silo. Communication exists only at the higher levels (e.g., department manager to department manager). This instills in the staffs of all silos: an inability to communicate with those in other silos, a general consensus of non-accountability to anyone outside of the silo; and an unwillingness to look beyond the department for help with efficiency of any process.
Reduction of Cycle Time
How many processes become dysfunctional because of the cycle time involved? Following discharge of the patient, how long is it between the date of discharge and the date upon which the record is considered complete? How many staff members are involved in the completion process? Are any of the steps within the process duplicative or dysfunctional? Can you involve others outside of the department in creating a more efficient process?
Elimination of Defects or Disconnects
The first step in identifying a defect or disconnect is achieving an understanding of the process. An assessment of only the functions is insufficient. You must understand the process before you can begin to eliminate the dysfunctional attributes of the process and finally build an efficient process from which to progress.
Employee Involvement
Staff involved in the functions and processes must be the driving force behind the entire business improvement methodology. While you can expect 10% of staff to express negativity, 90% are with you! And won't the staff see it as a positive step as they work with you towards a common focus of improving departmental processes. They must be the ones who describe how the process works, identify the disconnects and suggest improved methods.
Continuous Improvement
As you complete your review of one process, continue on with the next! We all know that the health care industry is changing daily; so should the processes within the HIM department.
To be effective, the business process simplification or improvement methodology should not have start and end dates, but should truly be a continuous process. How can you begin your journey towards business process simplification? By process mapping.
What is Process Mapping?
Process mapping is a tool that allows one to:
- understand a process;
- simplify the process based upon that understanding; and
- through a multi-step methodology implement or eliminate processes that lead to full integration of a function.
A process map, often referred to as a cross-functional map, provides a pictorial view of how work gets done. The map provides all the necessary detail to understand the flow of information or materials. A process map may be used to understand how a product or service (e.g., an HIM function) is delivered to the customer (e.g., physician, patient, third party payor).
Maps might also be used to improve institutional performance by identifying and eliminating non-value added activities, identification of defects within a process or the reduction of cycle time (the amount of time from process start to end). Unlike traditional flow charts, the process map allows one to view cross-functional or inter-departmental activities necessary in the completion of so many activities within health care.
Measurable outcomes
Should you decide to pursue process mapping, what are some of the measurable outcomes you might expect?
First, you can fully understand the relationship between: your departmental divisions; your department and others in the facility; and, your organization and others. More importantly, if you are pursuing a change in process, the map allows you to identify who is impacted by the change, both intra- and inter- departmentally as well as from the customer level.
Second, process mapping allows you to identify all significant activities, the key activities targeted for improvement and the identification of the customer and what they value. Prior to revising a process or procedure, do we always identify completely who or what will be impacted by the change? If the revision has the potential for negative impact organizationally, should we proceed? If the customer-be it the physician, patient or other department-is no longer receiving a necessary service should the process be eliminated?
Third, the process map allows you to understand and agree, as a functional team, upon how the work gets done. It is much easier at this level of process revision to reach consensus than for one person, department or organization to proceed with a change in process without fully understanding the function. As a team, you can identify the critical measurements from which you can judge success. And, you can identify all systems improvement opportunities in your project scope.
Finally, the process map allows you to identify benchmarking opportunities and develop a path forward for continuous improvement.
Who are the Players?
Every simplification or mapping team needs to include specific people with designated roles. For your business process simplification strategy to be successful, you need a 'project champion.' This should be a senior manager who is willing and able to drive the hospital's involvement from the recognition of the need to change through to implementation of the improved processes.
Second, a coordinator is necessary to schedule mapping sessions, plan for the involvement of other departments and serve as the primary vehicle for communications.
And no mapping team would be complete without the team leader who will be responsible for selecting the team members (a critical task), participating in and leading all team meetings (perhaps serving as the 'scribe' as you map) and leading the implementation of revised processes and driving the results.
Developing the Team Charter
At your first team meeting, spend an appreciable period of time developing the team charter. Here are some issues to consider.
Task - What is it the team is to do?
Sponsor - Who has the resources to support the activity?
Purpose - Why are we doing this?
Membership - Is representation complete?
Deliverables - What is the proposed end-product?
Measure - How will we know if we're successful?
Ground Rules - Start/End times, attendance expectations etc.
Time Line - What are our milestones?
Two actual process maps are shown for your review. Prior to using process mapping software, the team mapped the process on large sheets of paper with vertical lines delineating individual or departmental lines, and using post-it notes for the functions. For each function which you map, you should complete two process maps; one for the 'is' process and one for the 'should' process.
The 'is' map on page 4 graphically demonstrates the flow of information from the Emergency Department (ED) through to the completion of charges by Data Processing.
The 'is' map shows us that, at a minimum, four separate departments and five staff members are involved in the process of creating/completing the ED documentation charge process.
Mapping the process lets us visually examine a somewhat cumbersome process. What is not demonstrated is the discussion, consensus and eventual design of a new process, which results in the creation of the 'should' map.
Again, the team concept plays a major role in continuous business improvement and is essential to the task of process mapping.
To summarize the revisions which occurred:
- The unit secretary was trained in CPT/ICD-9-CM relative to ED occurrences (this resulted in the removal of the 2 HIM staff from the loop).
- All questions relative to data completion would be processed at the site of service through the unit secretary eliminating the 'late' returns to the physician or nurse from the HIM coder.
- The chargemaster/chargeticket linkages between CPT and service code were tightened to eliminate as many 'noncoded' cases as possible.
- The abstracting function (for the ED only) was re-routed to the site of service.
- An ED specific performance measure was established to verify applicability and success of the process revisions.
This one rather simple example demonstrates how process mapping can contribute to identifying problems in process and how visualization can assist in developing more workable, efficient systems.