GUEST COLUMN

Create core’ process to achieve seamless access

(Editor’s note: This is the second of a two-part series. The first part appeared in the October issue of Hospital Access Management.)

By Mike Monahan

Healthcare Resources Associates

Evergreen, CO

Jeff Jones

Stockamp & Associates

Lake Oswego, OR

Achieving seamless access management will require a change in the way we do business. Last month, we looked at the human resource issues in change. This month, we will examine the process changes needed to achieve the following scenarios:

• a patient arrives on the day of surgery and goes directly to pre-op;

• a patient arrives for an unscheduled magnetic resonance imaging and proceeds directly to the procedure room;

• a patient arrives for a clinic visit and is escorted directly to a treatment room;

• a patient arrives in an emergency department and after a prompt triage and check-in is moved directly to a bed.

Achieving this level of patient service — while simultaneously assuring payment for service — is the goal of every health care provider. It’s a goal that is seldom achieved. If delivering seamless access to care is a goal of health care providers, what should they do to achieve this goal?

Based on years of study and implementation, it is clear that two components are essential to creating seamless patient access:

A core process approach — integrating all functions of patient access into a single "core" process that is focused on patient service and payment for services provided;

A process-centered performance model — a comprehensive program that integrates improvements to processes, tools, organization and culture to create a high performance organization.

A single "seamless" process makes intuitive sense because this is the patient’s view of access. So what is the core process of patient access and how is it created? The access core process is made up of four primary capabilities:

• reservation and scheduling;

• information management;

• securing sponsorship;

• customer service.

All of the functions necessary to facilitate patient access to care can be attributed to one of these capabilities. (See the chart, inserted in this issue.)

To achieve seamless patient access, the four functions must be redesigned into one overall process. The individual work steps must be re-engineered to create optimal performance of a single function and streamline interactions between functions.

The re-engineering approach should focus on the following principles:

• determining the patient’s needs;

• converting from reactive to proactive environment;

• eliminating unnecessary and redundant tasks and hand-offs;

• minimizing work-in-progress (backlogs);

• establishing an environment of accountability.

Re-engineering patient access functions as one core process is critical, but will not deliver sustainable high performance results without the support of appropriate tools, the organization, and the staff culture. These key supporting capabilities are described in the process-centered performance model.

Process-centered performance model

Achieving sustainable, high-performance operations requires a comprehensive improvement approach centered on core process(es). This approach is driven by the re-engineering of processes supported by improvements in tools, organization and culture. (See the chart, inserted in this issue.)

The four components of the process-centered performance model are described below:

1. Process — the method by which work is completed. Re-engineering work steps, functions, and handoffs, as described above, create a proactive, accountable, patient-focused environment. The process redesign is the foundation and defines the necessary improvement to tools, organization, and culture.

2. Tools — anything used to facilitate work, including information and communication systems, processing guidelines, and resource material. Tool improvements can include simple modifications to existing information systems, major system implementations, creation of situation-based processing guidelines, and the development of on-line reference information. Tools enable core process(es) by prioritizing work, leveraging information and knowledge, and measuring performance.

3. Organization — the human capital to use the tools and execute the process. Organization improvements include new organization structures, reallocation of staff, and human resource policy changes. The structure, allocation and policies of human capital must be aligned with the core process to execute the work effectively and achieve a high level of performance.

4. Culture — the collective experiences, behaviors, expectations, and norms of the organization. Culture improvements can include reinforcement of quality expectations, incentive changes to reward important behaviors, and increased communication of organizational success.

There is no magic involved in achieving and sustaining high performance operations, and no shortcut.

Creating seamless access to care

The complexities of patient access for most health care providers require a comprehensive approach and solution. The number of care settings, the diversity of care, the unpredictability of patient volume and timing, breadth of organization coordination, and the changing requirements of payer contracts are only a few examples of the variables that must be addressed to create seamless patient access.

In addition to the complexity of the environment, there is not a single access solution that fits all health care providers. The core process approach and the process-centered performance model are the critical elements to creating a comprehensive access solution that can meet the requirements of a specific health care provider.

Creating seamless access to care can take multiple years and is difficult to achieve. However, the benefits of operational effectiveness, financial performance improvement, and strategic differentiation are enormous.

Besides being the right thing to do for patients, seamless access to care is a critical capability for success in an industry increasingly driven by expanding customer choice, pressures to reduce costs, changing payment requirements, soaring service expectations and aggressive competition for market share. Managing the human side of change can make the process less painful, produce fewer unintended consequences, and ensure the change is a lasting transformation.

[Editor’s note: Mike Monahan is managing partner of Healthcare Resources Associates in Evergreen, CO, a consulting and training practice that helps changing organizations deal with human resource issues; promotes health workplaces through enhanced leadership and management skills, and coaches individuals and groups for enhanced performance. Telephone: (800) 759-2881. E-mail: m2hra@aol.com.

Jeff Jones is a director at Stockamp & Associates in Lake Oswego, OR, a national health care consulting firm. He leads the practice group specializing in systems integration using seamless access systems. Telephone: (800) 260-0452.]