Tools and Tips
If you are a typical home medical equipment provider, you spend a fair amount of time strategizing about how to stay ahead of decreasing reimbursement rates, competitive bidding threats and ever-increasing costs of operations. Implementing a formalized performance improvement program can help you put your ideas into action, reduce risk and waste, and improve the efficiency of operations, quality of care and profitability. If your company is a Medicare supplier, a performance improvement program can help you get ready for the mandatory quality standards that will be required of HME providers in 2007. Putting together a performance improvement program isn't as hard as you might imagine.
1. Plan, Do, Check, Act
The use of a standardized performance improvement model, such as Plan, Do, Check, Act (PDCA), helps you maximize the effectiveness of your performance improvement activities by guiding you through the proper steps. PDCA is a simple model that is easy to follow. You "plan" the improvement; "do" the improvement by putting your plan into action; "check" the results of the actions; then "act" by making the changes part of your new policy or process. If you find that the planned improvements did not materialize when you check the results of your action, go back to the planning stage and redesign the improvement using the information you gained to get more favorable results.
2. Use a Team Approach
Involve staff members and the leadership of the company to get the most out of your efforts. As the owner or general manager of a company, you may feel you know best when it comes to what performance improvement activities should be a priority. As a leader of your company, it is your job to ultimately make those decisions. Your staff members, however, are on the front lines of your business on a day-to-day basis. They can help you identify problems that may be the perfect target for performance improvement activities, and also provide invaluable assistance when it comes to brainstorming solutions that will work. Promote a culture that sends the message that performance improvement is everyone's job.
3. Focus on Priorities
You can't work on everything at once, so the organization's leaders will need to make critical decisions about performance improvement activity priorities.
At times priorities are obvious, but when competing interests arise, you can ask yourself a few key questions to help guide your decision making. Does the process impact a large number of patients? Is the process high risk or chronically problem prone? Does the process have a major impact on quality of care or the financial health of the organization? Answering these questions about each performance improvement activity you are considering can help you separate the wheat from the chaff when it comes to making decisions about priorities.
4. Establish Effective Data Collection Procedures
Effective data collection and aggregation is crucial. A well-developed gut instinct can certainly come in handy when you are running a business, but when it comes to performance improvement, you will get better results if you plan your activities and make decisions about revamping processes based on hard data. Choose specific indicators to measure the heart of the process you are attempting to improve, and then collect data on the measure before you start your performance improvement project.
Consider developing a set of core indicators that you monitor consistently — perhaps every quarter — such as customer satisfaction survey results, incident report logs and financial indicators. It is also helpful to seek industry-wide data so that you can benchmark your results against other companies. Trending the data with charts and graphs will help problem areas stand out. When data falls out of the threshold you have set for acceptable results, it's time for a closer look and perhaps a performance improvement project focus.
5. Implement Action Plans
Effective data analysis and implementation of action plans completes the process. Meet with key staff members on a quarterly basis and carefully review the data that has been collected. This is where decisions are made regarding priorities for performance improvement activities. Once it?s decided what the priorities are, the real work starts. Now it?s time to put together a team to complete and in-depth review of the process that has been chosen for improvement.
Creating a flow chart of the process — whether in a narrative or graphic format — will help to clarify the root cause of the problem and help to uncover any obstacles that keep the process from working more effectively. Naturally, it's important to interview each staff member involved in the process so that it can be completely understood from the ground up. Once you have identified the obstacles, it's time for a brainstorming session. What can be done to remove the obstacles and improve performance?
At times, the lack of a formalized process can be the main problem. For instance, if there is no defined company policy on follow-up timeframes for physician documentation requests, turnaround times are likely to be outside acceptable limits. In some instances, the root cause of the problem may be lack of employee training, or not enough staff members. Perhaps employees don't have the necessary tools, such as reference materials or software, needed to complete processes more efficiently. Many times it's a combination of obstacles that result in an ineffective or inefficient process. Don't rule out anything until you have looked at all the possibilities, and above all, keep the process you are revamping as simple as possible.
Once you have settled on a plan of action, put it in written form and then begin to focus on the implementation. This may mean you will need to develop a new form, new training materials or a new policy and procedure. It will almost certainly mean you will need to meet with staff members and review the revamped process with them so that they understand how the new process is designed to work. Be open to suggestions and alternate ideas as you implement the action plan; it's not unusual to have to tweak a process once it moves from an idea on paper to one that is practiced in real life.
6. Review the Process
Once you are satisfied that your action plan is viable, let the new process work for several months, then collect data again to provide objective evidence of the improvement. If you don't see the improvements you expected, it's time to go back to the drawing board and tweak some more. When you are satisfied with the results, monitor the process for another three to six months until you are sure that the improvements you implemented will be effective over the long haul. Then move on to improving other areas of your business.
Many home medical equipment providers shy away from performance improvement activities that seem complicated and time consuming. A formalized performance improvement program, however, can be simple and still very effective. In fact, if you resolve to dedicate as few as eight to 10 hours of staff member time per quarter to performance improvement activities, you are likely to see a huge pay-off on such a minor investment.
This article originally appeared in the November 2005 issue of HME Business.