Managing Business Processes
Routines are a large part of our daily lives at work and in our private lives. Even though we try to be careful, the act of driving to our favorite grocery store is a routine. Although we are friendly, we might use routine greetings at work to greet patients or customers. These routines don’t require much thought. According to brain research, our brains adopt these patterns quickly because it saves us a lot of energy. If most of our activities are routine, we must ensure that these patterns and processes are efficient and patient- or customer-centered.
Let me first define what a “process” is before I go any further. According to the American Society of Quality, a process is “A collection of interrelated activities that are characterized by a specific set of inputs and value-added tasks that make up a procedure in order to produce a specific output.” This is illustrated by examining a section of the process for checking in a patient at an outpatient clinic. Input is information about the patient, including their name, visit nature and insurance coverage. Value added tasks are questions that the person asking the patient is going to ask. For example, “Does your insurance still cover you?” Can I see your card? This is a great way to bill for services and adds value to the clinic. Outputs are the recorded responses from the patient.
It is important to be able to identify and manage the various processes at a provider’s site in order for the best results. Quality professionals call this Business Process Management. This article was published in Quality Progress May 2015 issue.
Ineffective management of your work environment can have unintended consequences. This could impact your bottom line. As an example, let me refer to the above-mentioned check-in of the patient. Imagine the receptionist asking about the patient’s current insurance information and finding out that the patient just signed up for Medicare. The patient provides his/her Medicare card when asked for their insurance card. Although this sounds fine, suppose that the patient is enrolled in a Medicare Advantage program, and does not have a Medicare card. When the clinic files a claim, it is denied. The billing staff will then contact the patient to solve the problem. This additional work can be costly and time-consuming. This extra work could have been avoided if check-ins included asking Medicare patients whether they use Medicare Advantage.
According to “Process Primer”, there are five pillars to Business Process Management (BPM).
1. Identifying critical, top-priority processes.
2. Validating customer (patient) requirements.
3. Documentation of the processes.
4. Measurements of process development.
5. Management and improvement of processes.
Site leaders, site managers and staff should actively address these pillars and manage them. Management of business processes requires staff training and/or the use of experts in the field. Quality experts who have been trained in lean six-sigma or similar methods are usually able to provide guidance on BPM for a particular site. Many organizations offer training to staff on the basics of lean six-sigma. This includes the Medical Management Group Association.
Identifying Critical Processes
Many processes are involved in a job site. It would be too time-consuming and difficult to manage all of them. It is therefore important to identify the most important factors that affect patient and practice outcomes. To ensure that patients and customers are satisfied, these should be managed actively. Once the most important processes have been managed and produced predictable, effective results, staff can then move on to manage less critical processes.
Validate Customer Requirements
Customer needs must be understood and met. This is a patient-centered approach in healthcare. Patients should be the focus of all processes, including the provision of medical care. Providers must actively seek to understand the patient’s needs. Patients must be centered by all staff members who come in contact with them.
However, not all patients are customers. The financial health of the provider group is directly affected by the billing staff’s work. For example, the office management and other staff members are their customers. The processes they use are critical to the organization’s health. It must be managed in a way that produces optimal results.
Modify the Processes
It is important to understand the current status of all critical processes. This can be done using mapping tools like flowcharts, value stream maps or software that allows you to map the details of a process. According to “Process Primer”, this refers to people, systems and information.
Measurements of the Process
To manage a process, key indicators need to be identified and measured. These indicators could be used at a clinical site to measure population health outcomes such as the blood pressure of diabetic patients. It could be the number 60-day-overdue claims in AR for billing. It is not enough to have one key indicator for each process. To ensure the best management, measurements should be taken at different stages of the process.
Manage and improve a process
Once the key processes have been identified and mapped, indicators have been measured and patient requirements identified, the best providers will continue to improve the processes to ensure better outcomes. Patients and providers will benefit from this.
Providers and businesses that are successful will actively engage in managing and improving their processes. Even though Business Practice Management can be complex, the time it takes to manage and improve the provider’s business has a huge impact on both the provider’s health and the providers’ bottom line. BPM is essential to provider health in the face of changes in reimbursement.