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Healthcare Process Improvement Strategies 101: What to Consider When Planning Initiatives

by | Jun 16, 2023

Recalibrating business processes in a medical organization is inevitable. Common motivations for healthcare systems and medical practices to reevaluate operations include: 

  • Financial challenges – Reimbursement levels and turnaround times do not meet expectations. 
  • Impeded growth – Potential to grow the patient base exists, but in its current state, the practice cannot accommodate more patients or providers. 
  • Process variation – The processes for identical business functions vary between location and/or provider, leading to a diminished ability to control outcomes. 

This article will guide you through the essential elements of healthcare process improvement planning, so you can be prepared to execute these initiatives with greater confidence. 

The Elements of Healthcare Process Improvement 

While on the hunt for process improvement opportunities, certain aspects tend to immediately come to the forefront. But keep in mind healthcare delivery is an ecosystem where overlaps occur, so it is beneficial to consider all the areas that need attention not just the ones that appear urgent at the time. Here are the key areas to focus on: 

  1. Clinical – Assessing and improving clinical workflows, care coordination, and treatment protocols to ensure the most effective, efficient, and timely care delivery. These activities can include “hand offs” during the various phases of the patient visit, effective communication between staff members and with patients, and ensuring that patients are fully engaged in their plan of care. 
  1. Operations – Leveraging technology, staff, and processes in a manner that enhances the value of administrative tasks. The appropriate application of all three in a coordinated manner can conserve resources, reduce errors, and create a greater return on investment for these areas. Tasks to optimize include appointment scheduling, intake and registration, billing, and documentation.  
  1. Electronic health records (EHR) system – Ensuring the EHR system supports providers and staff by automating workflows, capturing appropriate data to support clinical decision making and billing, and ultimately enhancing the quality of patient care. 
  1. Medical practice management (billing) software – Ensuring a seamless interface with the clinical data from the EHR, the application of robust billing edits, and the creation of smart workflows for the billing team. These elements – when leveraged properly – help ensure that claims are processed in a timely manner, are supported by appropriate documentation and coding, resulting in optimal reimbursement for the organization. 

Where to Start: Identifying Inefficiencies in Healthcare Processes  

The greater awareness you have of your current process inefficiencies, the better prepared you are to choose the best solutions. Outlined here are steps to gain a clearer picture of the challenges at hand. Depending on the process being addressed, some or all of the following may be utilized. 

  1. Gather data – Obtain the Key Performance Indicators (KPIs) relevant to the process you want to assess such as new patient appointment availability, no show rates, staff utilization, claim denial categories and percentages, clinic throughput and patient engagement scores. 
  1. Map it – By creating a visual representation or flowchart of the process, outlining each step, task, decision point, and identifying the owner of each, you can see clearly the relationship between staff, technology, and the process itself.  
  1. Flag all bottlenecks – Look for any areas where the process slows down so each can be resolved. Manual work, multiple hand-offs, absent data, or rework due to errors, are often the culprits. 
  1. Seek input – Though you have likely already heard plenty of feedback, there is always more to learn from your teams. Take the time to ask them questions that will better inform your approach.  
  1. Time observations – Monitoring the time it takes for each step helps to reveal where the most significant time and resource consumption occurs. These areas can potentially be streamlined or eliminated. 
  1. Know the error rates – It is not enough to know that errors are happening. There must also be data to comprehend the full impact of error occurrences and how the error rates compare to national benchmarks. 
  1. Benchmark with best practices – Compare your process with industry best practices or successful models from other healthcare organizations. Use this to identify gaps between your current process and the desired standards. 
  1. Evaluate technology – Finding where the manual work is occurring often uncovers technical limitations, training gaps, and outdated tools that hinder efficiency and accuracy. This provides a great starting point to explore opportunities for optimization or upgrades. 

Consider a EHR Gap Analysis 

Performing a gap analysis for an EHR system helps identify deficiencies in expected or required performance. This enables effective prioritization of time and resources to address problem areas, while leveraging system strengths to enhance efficiency, reduce errors, and streamline workflows. Address these four categories to improve the overall performance of your EHR. 

  • Functional gap analysis — During a functional gap analysis, the EHR team will analyze the EHR system by comparing it to the medical practice’s functional business requirements and identify gaps where particular functionalities are missing or not performing optimally.  
  • Workflow gap analysis — This analysis maps the current EHR related clinical processes and identifies bottlenecks and/or “pain points” within the EHR system, with an eye toward creating and optimal future state for clinical workflow.  
  • Security gap analysis — This analysis identifies security risks and vulnerabilities within the system and recommends remedial measures.  
  • Data gap analysis — A data gap analysis evaluates the quality and completeness of the data within the EHR system and helps identify those data elements that the EHR system cannot currently capture or that are missing altogether. 

This targeted approach ensures that the most critical issues are resolved promptly to minimize risks and enhance the overall performance of the organization. The approach outlined above can also be applied to Practice Management/Billing systems. 

Process Improvement Methodologies 

Once your organization has a fuller understanding of where the process improvement opportunities lie, you are well positioned to explore solutions. Consider some of the most common process improvement methodologies utilized by the healthcare industry: 

  • Lean Methodology Inspired by lean manufacturing principles, this approach focuses on eliminating waste, streamlining processes, and delivering value to patients. It encourages continuous improvement, empowers staff to solve problems, and promotes efficiency and quality. 
  • Six Sigma Using data and problem-solving tools, Six Sigma aims to reduce process variation and defects. It helps healthcare organizations identify root causes of errors, improve process stability, and enhance patient safety. 
  • Plan-Do-Study-Act (PDSA) This iterative method promotes continuous testing and learning as it implements change on a small scale, studying the results, and using the finding to refine improvements. 
  • Total Quality Management (TQM) TQM is a comprehensive approach that emphasizes customer satisfaction, teamwork, and continuous learning. It engages all healthcare team members in quality improvement, standardizes processes, and bases decisions on the data. 
  • Kaizen Kaizen fosters continuous improvement through small, incremental changes. It encourages employee involvement to empower frontline staff in making improvements in their daily work. Kaizen fosters a culture of learning, innovation, and problem-solving. 
  • Rapid Improvement Events (RIEs) Related to the Kaizen method are RIEs. These trial-based activities last a few days and are referred to as “Kaizen events” or “blitzes.” RIEs bring together teams to solve specific process-related problems.  
  • Business Process Reengineering (BPR) BPR challenges traditional workflows and leverages technology to radically redesign existing processes and achieve significant performance and outcome improvements. The objective is substantial gains in efficiency, quality, and patient satisfaction. 

It is important to note that healthcare organizations often combine and adapt these methodologies to suit their specific needs and challenges. The idea is to choose the right methodology or combination of methodologies based on your organization’s goals, resources, and readiness.  

By adopting the right blend of process improvement methodologies, healthcare organizations can drive positive change, improve patient care quality, and enhance overall operational performance. 

Take Care of the Now with an Eye on the Horizon 

Your organization gains the most benefit from process improvement initiatives when it both addresses its current state and lays the groundwork for an optimal future state. To achieve both, these are the bases to cover. 

Optimize the Current State of Operations  

Optimizing the current state of healthcare processes includes streamlining workflows, leveraging available technology, aligning staffing resources, and memorializing optimized current state workflows with published standard operating procedures (SOPs).  

  • Streamlining workflow analyzes current processes and identifies areas for improvement such as eliminating redundant steps, minimizing manual work, and reducing process variation. 
  • Leveraging available technology involves identifying gaps in current technology utilization to uncover opportunities for training, enhanced implementation, or upgrades to improve efficiency and effectiveness. 
  • Aligning staffing resources appropriately must ensure that the right staff are in the right position and that workloads are appropriately balanced. 
  • Memorializing optimized current state workflows by publishing them as standard operating procedures (SOPs) ensures that best practices are followed and that the outline of those practices are readily available as new staff members onboard. 

Develop a Pathway for Optimal Future State 

Developing a pathway for the optimal future state of healthcare processes includes the continued leveraging of data insights, developing a responsive business culture, and an evidence-based plan for patient retention. 

  • Data integrity – Without financial and operational reporting accuracy and consistency, you lack the key elements to make the right decisions now and in the future. 
  • Responsive business culture – Adaptability in response to changes in the internal and external environment is key. The structure of your organization should align people, culture, process, and technology to support growth and scalability, enhance business value, improve patient engagement, and expand market share.  
  • Patient retention – It costs more to bring in new patients than it does to retain current patients. Retention can be achieved through seamless access, engaging patients as partners in their plan of care, an empathetic staff, and responsiveness to patient feedback. 

Be Prepared for Challenges in Healthcare Process Improvement  

In spite of best efforts and intentions, process improvement efforts will likely be met with challenges. These obstacles can include: 

  • Resistance to change – Change can be met with resistance in any industry, and healthcare is no exception. Team members may resist process changes due to fear of the unknown, skepticism about the benefits, misinformation generated by the “rumor mill,” or concerns over workflow disruptions.  
  • Time constraints – The demands of the immediate work at hand can easily take priority over investing in efforts designed to create a better “future state”. 
  • Culture – Maintaining the status quo is often an element (although unwritten) of an organization’s culture. 

Overcoming these challenges requires effective change management strategies, including transparency (i.e., clearly describing the “why” behind the change), robust communication at all levels within the organization, identifying and engaging stakeholders early on, acknowledging and addressing concerns, and providing training and support.  

By fostering a culture of open communication and involving staff in the improvement process, healthcare organizations can mitigate resistance and create an environment for process improvement success. 

Summary: Planning Out Healthcare Process Improvement Initiatives 

Finding the right approach to address process improvement initiatives is a challenge countless healthcare organizations face. While efficiency focuses on streamlining workflows and creating maximum return on investment (ROI), patient-centered care emphasizes satisfaction and optimal patient outcomes. Healthcare organizations must continuously evaluate processes to ensure they are doing both.  

Engaging stakeholders, promoting a culture of innovation, seeking creative solutions, and embracing technology are key factors to overcome these challenges. By persistently striving for process improvement, healthcare systems can enhance patient outcomes, optimize resource utilization, and deliver exceptional care that meets the evolving needs of their patients and communities. 

Develop the Best Process Improvement Strategy for Your Organization with the Help of Experienced Consultants 

With so many layers of healthcare operations to consider, determining the best approach at the macro level down to the minutiae is tricky to say the least. Lean on our consultants to take the guesswork out of process improvement. With our decades of collective experience in countless healthcare settings and situations, we can map out the most effective plan to optimize your organization’s operations. Reach out to us to learn how our solutions will meet your greatest challenges. 

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