Long, complicated process led to employee non-compliance
The Issue:
One company that I worked for had a long, complex process for employees to follow. The position was in an referral management department with an insurance company. The agents had to verify the insurance was valid, and then compare what was being requested against the Millgram Standard of Care to see if the request was justified. They would either approve the request, deny the request, or submit the request to the Utilization Management department for further review.
That process is easy enough on its own, but this was for TriCare, the military insurance program, so there were different rules depending on if the request was for the military service member or their dependent, and if the request was being made to be seen at the on-base hospital or a civilian hospital. There were also several special rules for care requests in Alaska and Hawaii.
The company had 4 primary Job Aids that were all 80+ pages each that outlined every possible step in the process; one for the service member on the base, a different one for the service member off the base, one for the dependents on the base, and the last one for the dependents off the base. They were massive, overwhelming tomes. Employees did one of three things; they either ignored the guides completely because they were too long and complicated, or they printed them out and kept them on their desk, or the most ambitious ones memorized every step.
Our Quality Assurance metrics were not very good. This was further complicated by the fact that the project was new and changes were being made weekly to these job aids. Since there were many repeated steps in the documents, changing one part of the process meant making those changes in quadruplicate. Sometimes the team updating the documents forgot one of the documents. Sometimes employees were not aware that changes had been made and were still using the old documents. The frequent updates certainly did not help the QA situation.
This was all further complicated by management’s decision to bring in Six-Sigma Black Belts for each department to optimize the work flow, but they worked in compartmentalized ways which had the net effect of creating additional issues or omitting possible outcomes.
The Solution:
I realized that many of the steps within these documents were identical or rarely used. I took all of the documents and matched identical steps and created a single, condensed job aid. I then digitized this job aid and made it a website that displayed on our company’s intranet site. Now, the employees would only ever see a single step of the process at the time and only when that step applied to their specific case. For example; if they looked the member up and found their data then the program would completely skip over the entire process for what to do if you couldn’t find the member because it was irrelevant. It was now, essentially, a “choose-your-own-adventure” style document. This was implemented with free software and cost the company nothing other than manpower.
The Results:
Because this was now a website it also prevented employees from printing 320+ pages of documentation every week. Additionally, it forced them to use the same single reference, which meant that once updates were published the entire workforce would see those same updates immediately, in real time. The manpower requirements spent updating the process was significantly reduced because changes were no longer required in quadruplicate. And the QA scores for the department rose by 43% across the board.
While the QA scores are more difficult to assign a monetary value to, the company had 4 technical writers working on the job aids with an average salary of $45K annually. They spent 10 hours per week making updates to these specific documents. That was reduced to a single person who now spent 4 hours per week working on the updates. This part of the solution resulted in a savings of $40,491 the firs year alone. The resulting costs were only 10% of what was originally being spent to update these documents.