The top four challenges identified are:
1. Preparing for the transition to ICD-10 diagnosis coding
2. Dealing with rising operating costs
3. Preparing for reimbursement models that place a greater share of financial risk on the practice
4. Preparing for value-based payments
As the article pointed out, the challenges at this time seem overwhelming. The number of changes that physician providers and practices face seem to be the most intense and demanding in quite some time. The article then lists many resources that are available to MGMA members. These resources include webinars, books, and conferences.
At the root of solving the problems and challenges are employees, managers, clinicians and consultants engaged in designing and implementing new processes, new health information technology and new programs. Often the solutions come from executives and managers, sometimes with the aide of an outside consultant. This source of solutions is sometimes necessary. For instance, it will be necessary for a team of executives to direct the overall implementation of ICD-10. For a small physician practice this could be a physician and the office manager. Larger offices will include a broader representation of office staff.
One strategy that is often overlooked in creating the best solutions for the challenges is the engagement of front-line employees in identifying and implementing incremental improvements. That is, staff is engaged in continuous quality improvement activities. For example, management can ask staff to improve the training process for ICD-10 coding or ask the clinical staff what population level measures would best help them in improving the quality of care.
At the heart of engaging employees is a high performance idea system. Such a system encourages employees to submit ideas that will meet the goals set up by management. For example, management can ask employees to focus on finding ways to engage patients more. High performance idea systems generate and implement about 12 to 20 ideas per employee per year. As long as management makes clear what the foci of ideas are, about 95% of the ideas are implemented in the best practices.
Ideas focused upon improving the quality of care are introduced by staff during regular short meetings. These meetings may be once or twice a week or more often. Staff that meet once a week may want to meet for one-half hour. Not only are ideas for incremental changes introduced in these meetings, they are also adopted in the meetings. As long as a solution to a problem involves only those on the team, there is no need to seek higher approval for a solution. Rather the team leader gets the team members to modify and improve the suggested improvement if needed and then adopt it as part of each team member’s work. Such a strategy for adopting incremental changes suggested by front-line employees allows an organization to implement a great number of ideas each year from each employee. Implementation of ideas of improvement of care and work is not bogged down waiting for managerial approval.
Another key principle of using front line staff to continuously improve the quality of care and work in incremental steps is holding staff and management accountable for following through with the solutions. It is necessary for team leaders to see to it that new processes and solutions are adopted by affected staff. In order to do this, leaders will need to observe team members at work and also collect relevant data about the success of the solutions. Not all implemented ideas will lead to success.
Adopting this strategy to help a provider meet its challenges can be very difficult. Most of the time, the strategy of using front-line employees in a high performance idea system to implement solutions requires a dramatic culture change. Most healthcare providers, indeed most businesses, use management driven improvement. Management simply does not trust front-line staff to create and implement changes on their own without significant supervision.
Another inadequacy in using only management to create solutions besides their lack of trust in using staff is their limited point of view. Managers often are not engaged in the work of their staff; thus they are removed from the day-to-day work routines of their staff. This removal means that they will not be able to generate as many solutions to problems as the staff or to generate as effective as solutions, generally. Keep in mind, though, that management is responsible for directing the focus of creating solutions.
At one hospital where I was helping management and staff find a solution to problems associated with patient admissions, staff had been creating work around solutions to the problems they were facing in recording the number of empty beds available. Management had a software-based solution for this process. It simply was inaccurate. Admissions could never be sure exactly how many beds were available, often creating wait times for admissions of patients. I worked with staff and their managers to create a solution that was effective, accurate and simple to implement. Better yet, it was a very low cost solution.
Using staff to create solutions to difficult challenges is part of a lean healthcare program. This approach to providing the best care at lower cost has been adopted by the University of Michigan Healthcare System. In fact, they offer lean training conferences to other providers in Ann Arbor. (I attended one of these week long offerings and was greatly impressed; providers from all over the world attended the conference). The adoption of this approach has helped the University Healthcare System become recognized by Becker’s Hospital Review as one of the 100 best hospital systems in the United States in 2014.
I am sure that the challenges that you as a provider face seem overwhelming. The challenges listed in the MGMA survey are just a few of the many. Some of the challenges may be unique to your practice site. Engaging staff in providing solutions has been shown to be an effective tool in overcoming the challenges if the process of engaging the staff uses the principles set forth in lean programs and as I have discussed.