We are still dealing with the basics. Lean doesn’t call for a separate quality process. In fact, quality is inbuilt every step of the way. For example, if you forget to add a modifier for that second procedure you performed on John Smith today, the person submitting the charges (or the system) must correct it. It also implies that they must understand what you are doing clinically. Similarly, if your colleague is doing a follow-up on your patient at the hospital, she must check what you did. Why is this important? Lean mandates that quality be controlled at source. From my days in MBA operations classes, I remember an image that showed a dollar bag that increased in size with the stage in which the error was detected – the farther away from its source, the bigger the dollar bag. The dollar bag meant increasing cost to the firm.
In order to pre-build quality into every step of the process, the team must be trained at a minimum on the before and after steps. If I’m posting payments, I need to know how to submit charges and how to follow up with insurance companies on pending balances. In smaller practices where one individual does everything, this may be a given. You must therefore prepare this individual for the process before billing (e.g. front desk management, clinical support) and after billing (e.g. patient follow-up, quality surveys) – considering billing itself as a complete process.
Cross training has the underlying key benefit of the getting process beyond specific individuals. I hear this all the time (especially in small practices): Mary knows this, Mary does that, that and that, Mary talks to insurances, Mary also talks to my patients, Mary manages my EOBs…you get the idea. My question often is: what happens when Mary goes on an extended vacation? I usually don’t get an answer back.
The situation is a little different but as common among larger practices. People tend to operate in silos. What I hear there is: Mary does that, Jane does this, Tracy sits here and it’s been that way for 15 years. My question here is not when someone goes on vacation (they have that figured) but how is quality controlled and how the group manages employee attrition if it were to occur?
The answer lies in cross-training. It makes the process independent of individuals and their specific skills. It also makes what is normally assumed to be specialized skills not so specialized. This allows the practice to make correct decisions without being held ransom by individuals (if such a situation were to arise). It also brings focus to the process. If a new member joins the team, she’s trained on different aspects of the process and her specific process. Cross-training becomes the norm. More important, it encourages the organization to constantly learn and motivates staff to strive for self development and growth.