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Performance monitoring obstacles examined
Benefits clear, means can be a mystery
By John Woerly, MSA, RHIA, CHAM, Senior Manager, Accenture, Indianapolis
Leading practice patient access professionals are keenly aware of the need to have a formal performance monitoring program in place. It has been suggested that organizations that have launched performance monitoring programs have realized significant improvements in data integrity, customer satisfaction, employee and overall process compliance, as well as lower employee turnover, lower absenteeism, and higher staff morale.
Even though these benefits appear clear, the exact means of realizing them remains a mystery to many managers. Many rush to implement a performance monitoring program, only to end up with inconsistent processes and an alienated staff. It is clear: An effective monitoring program is a challenge and one that must evolve in order to be sustained and worthwhile. So, what are the obstacles? The largest hurdles appear to be: overcoming staff resistance and encouraging acceptance of change; finding the time to actually monitor and provide feedback; ability to calibrate accurately; and investment in required resources (people, process, and technology/tools).
Even though these obstacles play a part in the development and implementation of a performance monitoring program, they are not undefeatable. Successful programs share similar methodologies and strategies.
Dedicated performance monitoring specialists
Although performance monitoring is typically the burden of busy supervisors, many successful programs are starting to use a different approach — employing dedicated monitoring specialists whose sole focus is on quality assurance (monitoring, looking at trends, analyzing, feedback, and training).
This scenario is typically seen in larger work environments, and especially in call-center settings. This approach ensures that performance monitoring is a priority and does not get lost in day-to-day operations. It allows the managers to focus on other essential tasks, such as staff forecasting and scheduling; incentives and recognition; and process improvements —- all leading to performance improvement and customer satisfaction.
The selection of monitoring specialists is essential to program acceptance and success. The best choice is not necessarily the employee with the most seniority, nor the employee who is the best performer. Specific criteria must be developed to ensure consistent performance. Focus on each candidate's problem-solving skills; ability to multi-task; knowledge of policies, procedures, and processes; attention to detail; listening skills; ability to work independently; and proficiency with coaching and providing feedback in a positive, constructive manner. Those with backgrounds in education and training may be perfect candidates.
Standardization
Even with the best monitoring specialists in place, a program may struggle to reach desired results. Primarily, the problem may be the lack of consistency in how monitoring sessions are conducted and reported. This can result in confusion and loss of faith among staff members in the overall program.
Formal standardization processes can be deployed to overcome these issues. Basically, standardization is the process in which variations in the way performance criteria are interpreted are removed. This can be done by conducting training sessions of the monitoring specialists by having all review the same data (copies of registrations, recordings of customer calls, etc.) and then rate the processes independently.
Open a dialogue about what was documented — similarities and differences in interpretation should be discussed in a group setting. General agreement on evaluation practices and interpretations should be reached. Ensuring consistency in scoring is the best way to combat staff perceptions of bias, favoritism, and unfairness. This is not a quick process, but one that requires continued effort and dialogue.
Selection of focus areas
All too often, we want to "save the world" and "do it all." It is important when developing a performance monitoring program to look at a number of focused areas, such as staff productivity, data integrity/quality, customer satisfaction, etc. It may be easy to develop criteria for a number of performance activities, but one must focus on those that have the greatest impact on the efficiency and effectiveness of the operation. Additionally, focus on those items that are easily defined and measured, while setting goals that are realistic, yet a stretch.
Staff involvement and empowerment
Encouraging staff involvement to create and shape a performance monitoring program will also generate greater enthusiasm, understanding, and commitment to the goals of the program. Solicit input on data criteria, definitions of errors, quality/productivity standards, monitoring methods, frequency of review, coaching/feedback, and training expectations. This will assist in buy-in and lessen fear of the unknown.
In the spirit of Total Quality Management (TQM) and Six Sigma, continued input will ensure a "living" vs. static program. Periodically surveying staff to measure program satisfaction and understanding and soliciting input in changing customer behaviors or expectations, etc., will provide vehicles for staff empowerment. Staff-led task teams may lend themselves to further process enhancements.
Allowing employees to listen to recorded customer sessions (i.e., recordings of patient calls during scheduling or pre-registration transactions, calls to payers, etc.) and score their own performance along with the monitoring specialist may assist in staff education by making the transaction "come to life." The call observation form (see form) provides a mechanism to document process methodology and outcomes. (Note: A similar contact form could be created for face-to-face registration activities.) This is followed by discussion of techniques used and coaching and feedback to recognize positive performance and to recommend further methods to enhance performance.
Technology
Although technology may rank third after people and process issues, it can play a critical role in a performance monitoring process. Automated monitoring tools will enable the monitoring specialists to easily capture and view what customers experience. Such call center technology may include: call recorders, interactive voice recognition, automated call distribution, and subsequent automated reporting. Registration technology may include: work queuing systems, exception reports from legacy or bolt-on systems.
Advanced telephony systems allow one to "follow the customer" by recording contact conversations, as well as computer activities, including data entry during the contact period. This allows the identification of staff performance issues, as well as technology and process issues. This is all done in an effort to enhance operational efficiency and effectiveness.
Communication and feedback
Performance monitoring cannot be done in a vacuum. The more results are shared with staff in an effort to enhance operations, not for punitive reasons, the better. Additionally, sharing the key data in "scorecards" with senior management and key process stakeholders (department heads, medical staff, etc.) will allow the entire organization to better understand customers' expectations and needs, but also increase awareness of the patient access department, and the level of service that it delivers.
When results are shared they must be presented in a palatable way, with measurement of key elements of the process. Additionally, these data may document customers' most pressing concerns and recommendations. The data can also demonstrate, through the quality assurance program, that the department can increase hospital revenues, reduce costs, and/or improve service. Patient access is in an enviable position to best capture true customer perceptions and experiences, and then use the data to further improve service delivery.
Summary
For many years patient access professionals have wondered, "How do we become viewed as an equal and important partner in health care delivery?" Data used correctly can drive change. We are in the best position to document service delivery data and customer communications. Demonstrating that we can use the data to drive proactive change in service delivery is powerful, and can be the differentiator that we are looking for.
[Editor's note: John Woerly is a senior manager with the consulting practice of Accenture (formerly Capgemini Health), focusing on patient access and health information management strategies. He has more than 25 years management experience with health care providers, including physician group practices, public health, and for-profit and university hospitals, and has served as enterprise director of patient access in a variety of settings, ranging from a large university hospital to a six-hospital system. He is a former member of the board of directors of the National Association of Healthcare Access Management, from which he received the President's Award and the Distinguished Service Award.]
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