September 11, 2019
Is your practice experiencing a high number of front-end claim edits that relate to registration errors? Have patients complained about the phone tree or the clinical callback process taking too long? Is payment posting less efficient than it could be?
All of these issues point to a need for streamlining workflow and shortening task times by leveraging technology or eliminating forms or redundancies. To make improvements, start by documenting the workflow and processes that exist today. Here’s how.
1. Identify the workflows you want to streamline.
Create a simple list to get organized and ensure you don’t overlook anything. For instance:
Patient Services Workflows
• Schedule appointment
• Pre-Register / Offer portal
Payment Posting / Patient Balance Workflows
• Receive and post payment
• Process statements
• Follow up on patient balances > 60 days old
2. Choose your workflow mapping tools.
There is no right or wrong tool to use for documenting workflow, as long as you use a method that effectively captures every step, and that is easy to read, replicate, and use in workflow analysis and streamlining. Some people prefer to use individual sheets of copy paper or a legal pad. Others choose a sketchbook so all workflows are bound together. Some people prefer colored pencils or markers – others believe a black pen and a yellow highlighter is enough.
There are a number of workflow mapping software tools available as well. For those who prefer a final draft that is very tidy, you can first document workflows using paper (it’s easier when you are sitting next to a coworker, observing tasks), then enter it into the software later. But honestly, I think that for most practices, the pen and paper method is sufficient – assuming your handwriting is legible.
3. Assign process/task observer(s).
Workflow mapping is most effective when one person performs each task in the workflow and another observes and records it, and clocks the time of the steps that are in particular need of improvement. If one person tries to do all of these things, he or she will overlook steps, or not document completely.
The observer’s role is to watch and document objectively, ask clarifying questions so he or she can document tasks and steps accurately, and make sure that all tasks in a workflow are documented.
4. Observe and map each workflow.
The observer should watch his or her peers perform each task in the workflow, asking questions as needed. The map the observer creates should include:
• A brief description of each step in the process.
• The person or name of the role that performs the step or task(s).
• A note about any forms that are used as part of a task.
• The time it takes to perform the workflow.
• Any notes or ideas the observer has while watching the workflow.
Here’s an example:
Workflow for Checking in Patient
Front Desk Team (Mackenzie and Patty)
• Select/create a patient account in EHR
• Scan driver’s license and insurance card
• Update patient demographics
• Take the patient’s photo and apply to the account record
• Verify eligibility
• Collect the patient’s past balance and copay
• Click “check-in” / ready to be seen
Time: 1 – 4 minutes
5. Use visuals to make the map easier to review later.
Although it’s certainly acceptable to document workflows using a list like the one in the preceding step, your maps will be easier to read and analyze if you use a symbol system for the beginning and end of the workflow, steps in the workflow, and key decision points. Here’s a simple system to consider.
Oval – First and last step in a process.
Rectangle/Square – An activity or step in a process.
Diamond – A step where there is a decision point, such as if it’s a new patient you do one thing and if it’s an established patient you do something else.
Arrow – Shows that two steps connection, and the direction in which the workflow proceeds.
If you want to learn more about the details of process mapping, here is a useful resource. But for most practices, using the simple shapes above to create your maps will be sufficient. And remember, listing them as I did in step 4 is just fine too.
6. Review the maps and identify tasks and workflow sections to streamline.
Ask everyone on the team to analyze the maps and discuss ways to eliminate paper, use technology, or perform a task more efficiently. Often, a staffer who does not currently perform the tasks or process will have interesting and ideas because they are looking at the process with fresh eyes.
As you start to make improvements, revise the maps or task lists to reflect the new workflow, and use it as a training guide for current staff as well as new hires. Use the long task times the observer documented as a baseline for improvement.