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			<title>The Fundamentals of Process Improvement: A Lean Perspective</title>
			<link>http://www.hmetalk.com/forum/blogs/chriscalderone/18-fundamentals-process-improvement-lean-perspective.html</link>
			<pubDate>Sun, 28 Nov 2010 15:36:25 GMT</pubDate>
			<description>*By Chris Calderone, MA, MBA* 
 
*Operational efficiency* has become a commonly used phrase as HME providers figure out how to deal with declining...</description>
			<content:encoded><![CDATA[<div><div align="center"><div align="center"><font face="Arial"><b>By Chris Calderone, MA, MBA</b></font></div><div align="center"><br />
</div></div><i><font face="Arial"><b>Operational efficiency</b></font></i><font face="Arial"> has become a commonly used phrase as HME providers figure out how to deal with declining reimbursement and rising costs<i>. </i>Loosely translated, operational efficiency means that providers must be intensely focused on continuous process improvement in order to reduce the hidden costs associated with inefficient workflow and sub-optimal processes.</font><br />
<font face="Arial">Areas such as intake, billing, and distribution are often laden with workflow issues and waste. This means they also offer many improvement opportunities which eventually develop into focused process improvement projects. </font><br />
<font face="Arial">Many providers do not have trouble getting initial results with their process improvement work, the trouble lies in holding on to the results. Like a marathon runner, providers can hit a performance wall. Any initial gains begin to slowly slip as performance improvement fatigue sets in – “why tried that before, it did not work”. </font><br />
<font face="Arial">Our experience tells us that successful process improvement is largely a function of paying attention to a few basic fundamentals. Providers that consistently achieve results - and more importantly, sustain those results, are also able to avoid some of the common mistakes associated with stalled process improvement initiatives.  </font><br />
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<i><font face="Arial">Addressing the Fundamentals and Avoiding Mistakes:</font></i><br />
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<b><font face="Arial">1.      </font></b><b><u><font face="Arial">Changing things and not behavior</font></u></b><br />
<font face="Arial">In a typical manufacturing environment, nearly 97% of all accidents can be traced back to human behavior. Similarly, in most lean process improvement initiatives, failure is often tied to human behavior. People have a tendency to revert back to the old way of doing things. </font><br />
<b><font face="Arial">When working to improve a process, modification of the process is necessary so that it becomes difficult to go back to the old way of doing things. However, if you only change "things", then the "things" will get lost or replaced when no one is looking. You will be back to the old way of doing things in no time at all. </font></b><br />
<font face="Arial">The more leaders verify and follow-up, the more people will follow the new standard(s). <b>Failure to consistently verify adherence to standards on the part of leaders will yield a corresponding failure to follow the standards on the part of employees. </b></font><br />
<font face="Arial"><b>Simply put, if you want to encourage specific behaviors, you have to routinely verify the behaviors are actually taking place. </b></font><br />
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<br />
<br />
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<font face="Arial"><b><font face="Arial">2.</font></b>      </font><u><b><font face="Arial">Failure to incorporate standard work</font></b></u><br />
<b><font face="Arial">Standard work is one of the foundational concepts of lean thinking. Standard work involves different people approaching similar work in a similar manner. </font></b><br />
<b><font face="Arial">It is common for us to see ten people working in an intake area using at least six different methods for processing a new referral. This individuality often results in variation or waste - waste in the form of missing or inaccurate information, missed steps, errors, and the costly rework that always comes with errors. </font></b><br />
<b><font face="Arial">Standard work involves finding the one best way to carry out a process, documenting it, and then spreading that “one best way” to everyone working within the process. </font></b><br />
<b><font face="Arial">Intake and billing processes that consistently result in speedier cash collections and reduced pending revenue have one thing in common – they are lead by people that are obsessed with standard work and process consistency. </font></b><br />
<i><b><font face="Arial">Successful processes incorporate the five elements of standard work:  </font></b></i><br />
<font face="Arial"><b><font face="Arial">1)</font>      </b></font><font face="Arial"><u><b>Content</b></u><b> – define the specific steps and tasks that need to be carried out</b></font><br />
<font face="Arial"><b><font face="Arial">2)</font>      </b></font><font face="Arial"><u><b>Sequence</b></u><b> – knowing when each task needs to be completed</b></font><br />
<font face="Arial"><b><font face="Arial">3)</font>      </b></font><font face="Arial"><u><b>Timing</b></u><b> – knowing how long should each step or task take</b></font><br />
<font face="Arial"><b><font face="Arial">4)</font>      </b></font><font face="Arial"><u><b>Outcome</b></u><b> – understanding the expected results of the process</b></font><br />
<font face="Arial"><b><font face="Arial">5)</font>      </b></font><font face="Arial"><u><b>Who</b></u><b> – identifying who should be performing each step or task within the process</b></font><br />
<br />
<br />
<b><font face="Arial">3.      </font></b><b><u><font face="Arial">Ignoring basic project management principles</font></u></b><br />
<font face="Arial">Identifying improvement opportunities is one thing, actually getting the work of improvement done is quite another. It is common for providers to work on projects that never seem to get completed - projects get about 90% complete and they tend to stay there. </font><br />
<font face="Arial">A big part of process improvement involves assigning out work and tasks to others - task management is a crucial part of project success. A simple tool such as a project task tracker can be used to help manage and monitor assigned tasks. </font><br />
<font face="Arial">Project management also involves properly scoping the project.  It is important to place boundaries around the project – you have to identify what you will and will not address as part of the process improvement work. </font><br />
<br />
 <br />
<b><font face="Arial">4.      </font></b><b><u><font face="Arial">Under communicating </font></u></b><br />
<font face="Arial">Our research and experience tells us that when process or wide-scale organizational changes are made, leaders fail to communicate the nature of the change by a factor of ten. That means that when leaders do communicate a change, they typically do 1/9 of what should be done. </font><br />
<font face="Arial">A single e-mail or a quick staff meeting is not sufficient. Consistent messaging using different methods is important. Coaching others along the way can also be an effective form of communicating the importance of change. </font><br />
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<b><font face="Arial">5.      </font></b><b><u><font face="Arial">Not leveraging front-line leaders </font></u></b><br />
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<br />
<font face="Arial">Our experience reveals that successful processes (and successful providers) have strong and consistent front-line leadership. Front-line leaders are the team leads, coordinators, leads, and supervisors that are often close to where the process work actually takes place. </font><br />
<br />
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<font face="Arial">Processes that perform consistently well have leaders that are able to hardwire accountability into the process.  Leaders are readily available to help staff solve-problems in near real time – they are also focused on coaching their staff in order to help drive results. </font><br />
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<b><u><font face="Arial">Conclusion</font></u></b><br />
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<font face="Arial">Providers have to continue to find ways to drive down costs and improve efficiency. By applying basic process improvement techniques, providers will be able to avoid some of the more common mistakes associated with less than successful process improvement projects.  </font><br />
<br />
<br />
<font face="Arial">Front-line leadership, accountability, standard work, and project management are all essential components of sustained process improvement – each plays an important role in hardwiring the behaviors required for tangible and lasting process improvement.  <br />
</font></div>

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			<dc:creator>ChrisCalderone</dc:creator>
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			<title>New Live Webinar - Optimizing Front-End Operations With Lean</title>
			<link>http://www.hmetalk.com/forum/blogs/chriscalderone/14-new-live-webinar-optimizing-front-end-operations-lean.html</link>
			<pubDate>Mon, 26 Jul 2010 23:52:44 GMT</pubDate>
			<description><![CDATA[<TABLE border=0 cellSpacing=0 cellPadding=0><TBODY><TR><TD vAlign=top>All new for 2010- learn how to utilize effective and proven lean techniques...]]></description>
			<content:encoded><![CDATA[<div><TABLE border=0 cellSpacing=0 cellPadding=0><TBODY><TR><TD vAlign=top><font size="2">All new for 2010- learn how to utilize effective and proven lean techniques that can help to reduce errors, reduce costly rework, reduce waste, and improve financial performance in HME front-end operations. </font><br />
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<font size="2">It all starts in intake/customer service. Learn how successful providers leverage lean principles to improve workflow, increase efficiency, and improve process consistency. </font><br />
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<font size="2">This informative live webiner will provide you with <font color="#000">best practice examples</font> of how HME providers have successfully implemented lean techniques to help decrease rejected claims and improve sluggish cashflow</font><br />
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<i><font size="2"><font color="#482c1b"><b>August 26, 2010 1:00 PM EST - 2:15 PM EST </b></font></font></i><br />
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<font color="#000000"><font size="2">Can't make the date? </font><a href="http://us.mc11.mail.yahoo.com/mc/compose?to=chrisc@leanhomecare.com" target="_blank"><font size="2"><font color="#00007f">Contact us</font></font></a><font size="2"> for alternative dates and times. </font></font><br />
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<font size="2">Only $89. The fee includes handouts, live Q/A session, and all tools covered in the webinar. </font><a href="http://www.chriscalderone.com/Intro.html" target="_blank"><font size="2"><font color="#00007f">Click Here</font></font></a><font size="2"> for more information and to register. </font><br />
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<font face="Arial">Call us at 734.709.5487 for additional information.</font><br />
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			<dc:creator>ChrisCalderone</dc:creator>
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			<title>Thinking Lean: The Power of Standardized Work Practices</title>
			<link>http://www.hmetalk.com/forum/blogs/chriscalderone/2-thinking-lean-power-standardized-work-practices.html</link>
			<pubDate>Wed, 06 Jan 2010 12:58:27 GMT</pubDate>
			<description>*Thinking Lean: The Power of Standardized Work Practices* 
  
*By Chris Calderone, MA, MBA* 
  
Standardized work practices have long been in place...</description>
			<content:encoded><![CDATA[<div><div align="left"><font face="Arial"><font size="2"><font face="Arial"><font size="2"><font size="3"><b>Thinking Lean: The Power of Standardized Work Practices</b></font></font></font></font></font></div> <br />
<div align="left"><font size="2"><font face="Arial"><font size="2"><font face="Arial"><b>By Chris Calderone, MA, MBA</b></font></font></font></font></div> <br />
<div align="left"><font size="2"><font face="Arial"><font size="2"><font face="Arial">Standardized work practices have long been in place in many manufacturing businesses. The standard</font></font></font></font><br />
<font size="2"><font face="Arial"><font size="2"><font face="Arial">work practice concept is a part of the lean thinking approach to process improvement. Lean thinking is a</font></font></font></font><br />
<font size="2"><font face="Arial"><font size="2"><font face="Arial">quality focused concept that concentrates improvement initiatives within the workflow in an effort to</font></font></font></font><br />
<font size="2"><font face="Arial"><font size="2"><font face="Arial">identify and drive out waste and variability within processes. One of the most effective ways to drive out</font></font></font></font><br />
<font size="2"><font face="Arial"><font size="2"><font face="Arial">waste and improve process consistency is through the use of standardized work practices.</font></font></font></font></div><font size="2"><font face="Arial"><br />
 <br />
<div align="left"><font size="2"><font face="Arial">Many healthcare organizations and hospitals have focused on implementing standardized work practices</font></font><br />
<font size="2"><font face="Arial">as part of their lean programs and the results have been impressive – improved patient satisfaction,</font></font><br />
<font size="2"><font face="Arial">improved outcomes, and improved financial performance.</font></font></div> <br />
<div align="left"><font size="2"><font face="Arial">The concept of work standardization can be readily applied to an HME operation.</font></font></div> <br />
<div align="left"><font size="2"><font face="Arial">A few HME providers have achieved success with implementing robust work standardization methods. A</font></font><br />
<font size="2"><font face="Arial">mid-size provider realized a 10% decrease in pending revenue after it implemented standard work</font></font><br />
<font size="2"><font face="Arial">practices in its intake and customer service area.</font></font></div> <br />
<div align="left"><font size="2"><font face="Arial">Another provider saw their DSO drop by five days after implementing standardized work practices in their</font></font><br />
<font size="2"><font face="Arial">billing and reimbursement area.</font></font></div> <br />
<div align="left"><font size="2"><font face="Arial">A large medical supply company reduced the number of pick errors in their shipping operation by 7</font></font><br />
<font size="2"><font face="Arial">percent after implementing standardized work practices. The reduction in pick errors resulted in a direct</font></font><br />
<font size="2"><font face="Arial">cost savings as costly product re-ships were reduced as well</font></font></div> <br />
<div align="left"><font size="2"><font face="Arial">Standardize work practices are crucial to improving process results. In many instances, providers rely on</font></font><br />
<font size="2"><font face="Arial">multiple individuals to complete similar work within functional areas. Whenever a group of people work to</font></font><br />
<font size="2"><font face="Arial">complete similar work, they will often come up with very individual methods for completing that work when</font></font><br />
<font size="2"><font face="Arial">standard practices are not in place. Different people doing similar work in a very different manner will</font></font><br />
<font size="2"><font face="Arial">often yield different results.</font></font></div> <br />
<div align="left"><font size="2"><font face="Arial">HME providers have many processes that can benefit from a robust work standardization approach</font></font><br />
<font size="2"><font face="Arial">including intake, billing and reimbursement, documentation, and distribution, to name a few.</font></font></div> <br />
<div align="left"><font size="2"><font face="Arial">One way of creating standardized work is through the use of a checklist. A checklist is a tool that can be</font></font><br />
<font size="2"><font face="Arial">used to help guide staff in their daily work. A checklist typically includes all of the key requirements and</font></font><br />
<font size="2"><font face="Arial">tasks that must be completed in order to successfully complete work within a process. A checklist can</font></font><br />
<font size="2"><font face="Arial">help to ensure work is complete and accurate before it is sent on to the next step or next process. An</font></font><br />
<font size="2"><font face="Arial">ideal location to for a checklist is in the intake area. A checklist should briefly list all of the main process</font></font><br />
<font size="2"><font face="Arial">steps or tasks that are required to turn that referral into a successful claim.</font></font></div> <br />
<div align="left"><font size="2"><font face="Arial">There are many upfront tasks that must be completed upon initial intake – from the gathering of basic</font></font><br />
<font size="2"><font face="Arial">demographics to insurance information. Many providers have less than solid standard procedures and</font></font><br />
<font size="2"><font face="Arial">work practices in place. Getting it right in the front-end the first time can save costly rework on the backend</font></font><br />
<font size="2"><font face="Arial">of the operation.</font></font></div> <br />
<div align="left"><font size="2"><font face="Arial"><u>Tips for Increasing Standardization</u>:</font></font></div> <br />
</font></font><font face="SymbolMT">• </font><font face="Arial"><font size="2"><font face="Arial"><font size="2">Role clarification – make sure everyone within the work area understands his or her role, who does </font></font></font></font><font size="2"><font face="Arial"><font size="2"><font face="Arial">what, when, and how they should do it</font></font></font></font><br />
 <br />
<div align="left"><font face="SymbolMT">• </font><font face="Arial"><font size="2"><font face="Arial"><font size="2">Performance standards – ensure relevant performance standards are in place that reflect core </font></font></font></font><font size="2"><font face="Arial"><font size="2"><font face="Arial">process requirements</font></font></font></font></div> <br />
<div align="left"><font face="SymbolMT">• </font><font face="Arial"><font size="2"><font face="Arial"><font size="2">Draw a diagram or a “blue print” of the workflow for a specific area- for example, draw a process flow </font></font></font></font><font size="2"><font face="Arial"><font size="2"><font face="Arial">chart of the intake area that identifies how work flows through the intake process and briefly describe </font></font></font></font><font size="2"><font face="Arial"><font size="2"><font face="Arial">what happens at each step within the process – this is a good way to help others “visualize” the </font></font><font size="2"><font face="Arial">workflow because it is a simplified visual explanation that is more powerful than a descriptive </font></font></font></font><font size="2"><font face="Arial"><font size="2"><font face="Arial">narrative of the process</font></font></font></font></div> <br />
<div align="left"><font face="SymbolMT">• </font><font face="Arial"><font size="2"><font face="Arial"><font size="2">Implement checklists that list key process steps (in sequence) that must be completed before the </font></font></font></font><font size="2"><font face="Arial"><font size="2"><font face="Arial">work is passed along to the next step – for example, in an intake area, list each step that occurs from </font></font></font></font><br />
<font size="2"><font face="Arial"><font size="2"><font face="Arial">the moment the phone or fax rings and describe what must take place at each main step</font></font></font></font></div> <br />
<font face="SymbolMT">• </font><font face="Arial"><font size="2"><font face="Arial"><font size="2">Continually assess first-time-quality - which is a measure of how often work moves through key pr</font></font></font></font><font size="2"><font face="Arial"><font size="2"><font face="Arial">ocess steps and does not require rework – for example, measure the number of complete and </font></font></font></font><font size="2"><font face="Arial"><font size="2"><font face="Arial">accurate initial intake forms</font></font></font></font><br />
 <br />
<div align="left"><font face="SymbolMT">• </font><font face="Arial"><font size="2"><font face="Arial"><font size="2">Make sure clearly written procedures are in place – are they updated to reflect changing processes </font></font></font></font><font size="2"><font face="Arial"><font size="2"><font face="Arial">and are they consistently reinforced with the staff?</font></font></font></font></div> <br />
<div align="left"><font face="SymbolMT">• </font><font face="Arial"><font size="2"><font face="Arial"><font size="2">Don’t assume standardization won’t apply to certain areas- although an intake and billing work </font></font></font></font><font size="2"><font face="Arial"><font size="2"><font face="Arial">process may vary based on payer-specific requirements, generally, you can standardize more than </font></font></font></font><font size="2"><font face="Arial"><font size="2"><font face="Arial">you realize</font></font></font></font></div> <br />
<div align="left"><font size="2"><font face="Arial"><font size="2"><font face="Arial">Implementing standard work practices can help to reduce variation in process results. Typical forms of </font></font><font size="2"><font face="Arial">process variation in an HME operation include missing information at intake, incomplete CMNs,</font></font></font></font><br />
<font size="2"><font face="Arial"><font size="2"><font face="Arial">incomplete prescriptions, and missing insurance information – all of which lead to delayed and/or rejected </font></font><font size="2"><font face="Arial">claims.</font></font></font></font><br />
 <br />
<font size="2"><font face="Arial"><font size="2"><font face="Arial">Providers that implement more robust standard work practices will help to formalize the informal and</font></font><br />
<font size="2"><font face="Arial">create an environment where people approach similar work in a more planned, and pre-defined manner.</font></font><br />
<font size="2"><font face="Arial">Most people know what to do in their work area. The key is to get the people who are doing the same </font></font><font size="2"><font face="Arial">type of work to carry out that work in a more similar manner. Work standardization can help to optimize </font></font><font size="2"><font face="Arial">workflow, reduce errors, and increase process consistency.</font></font></font></font></div><font size="2"><font face="Arial"><br />
 <br />
</font></font><br />
<font size="2"><font face="Arial"><font size="2"><font face="Arial">Contact Chris Calderone at </font></font></font></font><font face="Arial"><font size="2"><font color="#0000ff"><font face="Arial"><font size="2"><font color="#0000ff"><font face="Arial"><font size="2"><font color="#0000ff"><a href="mailto:chrisc@leanhomecare.com">chrisc@leanhomecare.com</a> </font></font></font></font></font></font></font></font></font><font face="Arial"><font size="2"><font face="Arial"><font size="2">or at 734-709-5487 with questions or comments</font></font></font></font><br />
 <br />
<div align="left"><font size="2"><font face="Arial"><font size="2"><font face="Arial">about this article</font></font></font></font></div> <br />
<div align="left"><font size="2"><font face="Arial"><font size="2"><font face="Arial">©Copyright 2008 The Lean Homecare Consulting Group, LLC</font></font></font></font></div> <br />
<font size="2"><font face="Arial"><font size="2"><font face="Arial">© Copyright 2008 Lean Homecare Consulting Group, LLC </font></font><br />
</font></font><div align="left"><font face="Arial"><font size="2"><font color="#0000ff"><font face="Arial"><font size="2"><font color="#0000ff"><font face="Arial"><font size="2"><font color="#0000ff">www.leanhomecare.com</font></font></font></font></font></font></font></font></font></div></div>

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			<dc:creator>ChrisCalderone</dc:creator>
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