IT’S NOT INTUITION
By Rice, Lucas | |
Proquest LLC |
A lack of care with work measurement tools results in unintended consequences
Do you get all of your work done in the office? Are you focused on completing all of your tasks each day or simply putting in your eight hours and calling it quits? Let's look at it from another perspective.
Regardless of your answer to this question, what does your boss think is important? Or better yet, if you are the boss, what makes the impact on your bottom line? Almost certainly, the answer to this last question is that the employees complete the necessary tasks.
Perhaps it's also safe to assume you don't like to spend unnecessary time and effort working on that particular service or product. It's waste. You're wasting your time at work, pushing back expectations while potentially kicking that workload into your evening or weekend, which also causes your customers and end users to wait on you.
Then, there's the impact of increased operational costs, lost customers, reduced throughput, and the list goes on. As industrial engineers or simply improvement "gurus," this might seem almost intuitive; hence the reason "work measurement" isn't the subject of too many magazine articles and does not make the front page of the local newspa- per. You're too good for it. It's too easy. We do it all the time.
Amazingly, we don't. At least, we don't do it enough and with the degree of analytical rigor that justifies its placement in textbooks and its value in the work- place. Going back to Work Measurement 101, it's a concept of improving processes with a goal of reducing total time, unnecessary activities, and unnecessary resources in a system that subsequently should reduce costs, improve customer satisfaction, quicken turnaround times, and again the list goes on.
But many of you are taught this concept in academic training, a certifica- tion course or via a Web-based training session. Regardless of whether youÕre relatively new to the concept or youÕve sat through lectures discussing time stud- ies, ideally youÕll find value in looking a bit beyond the common interpretation of work measurement.
The doctor will see you now
Michael works in healthcare. HeÕs a physician with all the acronyms afforded to these highly trained medical profes- sionals. HeÕs like a number of physicians who run a small to midsize practice. He has a team of nursing professionals and administrative staff that support him in his daily clinical and resourcing (e.g., scheduling, billing) needs.
Lately, Michael has been inundated with complaints from his staff, ranging from reduced reimbursements as a result of documentation errors and implemen- tation of new regulations to concerns about the amount of time required to move a patientÕs case through the billing and reimbursement process. This billing and reimbursement process, shown at a basic level in Figure 1, is plagued with these challenges, causing MichaelÕs staff to work harder and faster. And we all know what happens in situations like this. Errors. Confusion. Delays. Turnover.
As you can see from Figure 1, patients enter this particular process, are evalu- ated for insurance coverage, examined, diagnosed, treated and processed out along with insurance claims. The submis- sion of these claims, however, is met with a process in and of itself, as can be seen in the last few steps. Granted, this is only an example process, so donÕt read too deeply into each step. Rather, the key is under- standing how the system or the process functions, staff roles and responsibilities, and the requirements placed on this staff via expectations and the operating envi- ronment, rules, regulations and other factors on the periphery.
Years ago at a conference, Michael heard about concepts that reduce time in systems and processes to improve throughput and ease staff workload. He decided to revisit the concept on the Internet. Forgetting many of the details, he double-clicks his browser icon, searches Òwork measurementÓ and discovers a plethora of information tied to the concept. And, like many of you (you know you do), he finds a wiki site. On this wiki site is a specific process under the appropriate header that he thinks might help him solve the prob- lems heÕs facing.
We all have found tremendous value in such rapid, informal research. And Michael discovers a four-step process that outlines the step-by-step framework for carrying out improvements with work measurement:
1. Discover and eliminate lost or ineffec- tive time
2. Establish standard times for perfor- mance measurement
3. Measure performance against realistic expectations
4. Set operating goals and objectives
Simple, right? All Michael has to do is find where lost time might be, estab- lish standards, measure against current performance and set goals.
He discusses the process with his staff, and they gather around a table to determine where they can improve the process. They discover Òlost timeÓ in a number of steps in the billing process. For one, the handoff of billing paper- work from one staff member to another takes a tremendous amount of time. So a standard is developed. Only one period of 24 hours is allowed between handoffs. It sounds good, so why not? The stan- dard is established, and performance has been measured. An entire day is cut from the process, and weÕve achieved a single goal of reducing time in this system or process. Is this it? Is this the best we can do?
Doctor, you removed a perfectly good organ
Hey, no oneÕs perfect. But, to avoid the repercussions that result from changing a process based on personal evaluations and a subsequent discovery of a scientific sounding Internet wiki, think about the problem and devise a method that will allow you to achieve the results you seek. That end state is the whole point, right? Let's offer Michael something a little more appropriate, perhaps a little more technical, and ideally much more mean- ingful.
We're all busy, right? So why change your research? Use it. Start with your "wiki-approved" process. Your four-step process now turns into a more robust and results-driven method. Take a look at Figure 2.
We've integrated a few key steps and even moved a few things around to make this a little more viable. First, setting key goals and objectives shouldn't be done at the end. You should know what you want to accomplish before you start. After you've discovered opportunities for improvement by analyzing the system or process for deficiencies (e.g., root cause analysis, sampling and hypothesis test- ing, data modeling and simulation), and after establishing standards that you deem acceptable, develop some potential solutions. Then you can measure and test those solutions through more analysis.
Obviously, the next task is for you to implement the most viable and defen- sible solutions, while communicating the potential results and original intent with those involved and affected. Last, improvement isn't static - it's cyclical. Once you're finished, and as the envi- ronment changes - such as technology improvements that you can't or don't necessarily control or regulations fed to you from higher powers - you're going to be forced to update your improvements. But why wait? Be predictive and continu- ously look for opportunities to improve and maintain a state of optimum perfor- mance.
Isn't it amazing how a little more consideration can make you think of ways not just to improve your system or process, but to make sure that you have a method of attacking potential problems with a more robust framework that aligns to your end-state goals and objectives? Now, that's not exactly all that you're here to learn. You can't just develop a new way of solving a problem and stop there - you have to use it, and use it wisely.
Doctor, do you know what you're doing?
Making the method better doesn't imme- diately make the problem better. For this example, the next logical step is relooking at the billing and reimbursement process to see how improvements might be made. However, before we jump in and use our new, modified process, let's see what has happened already.
As it stands, our favorite doctor has been hearing nonstop complaints about his practice's billing and reimburse- ment process. And, at this point, we've ignored the 24-hour improvement made earlier. Little does the doctor know that Mark, the employee who is responsible for delivering the billing paperwork, has made a little "efficiency improvement" of his own. At least his heart's in the right place - pun absolutely intended.
Instead of walking the documents to their destination as they are created, he thinks it's more efficient to group them together (i.e., batch them) and carry them down the hall once a week or so and place them on the front desk. As Mark figures, this keeps him from walking back and forth multiple times a week, and it could potentially save his team members a lot of repetitive work. Hey, it saves time and effort, right? Besides, no one has told him to do otherwise, so why should he worry?
Assuming that a reduction in the batch time could make the process more balanced, the team decides to imple- ment a two-day turnaround on Mark's batches rather than the current five-day turnaround. This is all based on the steps followed from the wiki site. In the first step, Mark and the team identified lost time in having a longer batch time. Then, they established a two-day turnaround to give enough flexibility to the activity of sending claims, simply assuming this was good enough. Then, they measured performance for a couple of weeks and decided that it worked fairly well.
Finally, they felt their goals and objec- tives were met and that they could continue to make the best of this new improvement. Immediately, the process seems to work a little better. This particu- lar step was a bit of a bottleneck. Figure 3 shows this in a tiny bit more detail.
Although the wiki method and subse- quent implementation of the team's improvement strategy made the team members truly think the change was beneficial, they didn't look far enough into the process. As discussed in Figure 4, reducing the batch size had its own unintended consequences. These kinds of impacts often are not foreseen by the inexperienced, and sometimes even experienced personnel miss them.
First, documents piled up because the turnaround time for sending claims exceeded the batch turnaround time. Simply, every couple of days the claims processer had additional files to work through. Thus, in reality, greater vari- ability was injected into the system, minimizing confidence in total system processing times. In addition, the staff member responsible for this step has seen an increase in total workload, also increasing confusion and stress. This has led to greater errors in first-time processed claims, leading to higher deni- als and rework later in the system.
In this case, little to no consideration was given to the end-state of the process beyond just "let's improve it." In addi- tion, there was minimal analysis (mostly qualitative) completed to justify the recommendation and solution as imple- mented. And the pain was felt following institutionalization of the new change.
Granted, many of you reading this may immediately find this example relatively simple. But is it? Did you consider all of the internal and external factors you should have when making an impor- tant decision regarding changes to your systems or processes? Do you really feel comfortable, and can you adequately justify each important decision you've made?
The doctor is prepared to see you now
The intent of this article is not to teach you how to improve one particular process, but rather to bring out your creativity and your ability to solve prob- lems by challenging not just the issue you're facing now or in the future, but also the methods you've so easily referred to as your "suite of tools" or "go-to tools." Just as you've seen, injecting some creativity and thinking about what you really need to accomplish up front will allow you to approach a challenge more effectively and efficiently. And this also allows you to ensure that you've addressed all critical factors - internally and externally - with the necessary level of analytical rigor.
Unfortunately, this is an article, mean- ing it's limited in length, content and complexity, and you should feel obligated to put forth more effort in your applica- tion of analytical work measurement methods, rather than thinking it's simple, thinking it's just intuitive, or thinking it is captured easily by technology.
Obviously, the physician wishes you well but can't let you leave without a prescription for things you should do to support the health of your organiza- tion, the systems and processes in which you're engaged, and also your own profes- sional health.
Doctor's orders:
* "This is all too easy." Don't get complacent with what you think you know or what you think is all- encompassing. Challenge everything. Challenge yourself. Be creative and develop not just an end-state that you seek to achieve, but the means to getting there effectively and efficiently.
* "More than just words." No one said solving problems is easy. Just like a student who won't pass social stud- ies without some degree of rigor, you have to do your homework. Don't stop short of feeling comfortable in your ability to justify your results and solu- tions.
* "I have a brain." Great. Use it. Whether you need more brainpower to spark added discussion and creativ- ity or find yourself wildly running in a number of directions, use the resources available to you.
* "When will it all end?" It never ends. The brain only stops when you're dead, so improvement shouldn't stop either. This is all cyclical, meaning you need to be creative more than once and chal- lenge methods and solutions more than once.
So what's all this talk about work measurement not being a popular topic? If a doctor needs it, perhaps we all do. d
Copyright: | (c) 2014 Institute of Industrial Engineers-Publisher |
Wordcount: | 2458 |
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