Identifying critical processes

Release last month of Better achieving good health care focused on managing business processes and identified five key components. The first is the identification of critical processes, the focus of this bulletin.

Why is it necessary to actively manage key or critical processes? In order to achieve a variable remuneration and regulatory environment, it is necessary to optimize key processes and implement new ones. In a recent speech, Metro Health CEO, Mike Faas, headquartered in Wyoming, Michigan, said that for the success of his organization, new partnerships with regional providers need to be established. He said that one of the goals is to keep patients out of the hospital and to treat them more effectively by the primary care physician. Patient panels for doctors should almost double in comparison with the current average of 2000. The best way to do this was to improve the process of primary health care with team work and establish better communication with partners. I believe that this strategy will be needed by most hospital groups.

Adoption of the Law on Access to Medical Assistance and Chip Reform (MACRA) focuses on improving outcomes for patients and new payment options for doctors. Eligible service providers must choose one of two options in order not to reduce their reimbursement. One of the ways to do this is good reporting: Merit Based Payment Systems (MIPS). MIPS will be based on four measures – quality, efficiency, meaningful use of EHR and activities to improve clinical practice; They are all based on the process. The MIPS structure will be determined by May 1, 2016. More than likely PQRS and VBPM, two current reporting processes will be an integral part of MIPS. MIPS will require qualified doctors and their groups to focus more on team work and to manage and improve key processes.

If the importance of managing and improving key processes is soon to increase (in which the best service providers and companies are already included), we will need to understand what processes and how we will recognize key processes.

I believe that the American Society for Quality has some of the best available resources for understanding and improving the process (I am a member). As found in the last month's bulletin, they define Process as "a set of interconnected work activities characterized by a set of specific inputs and value added tasks that form the procedure for a set of specific outputs." One of the best ways to see the processes is to organize the process activities into a flowchart or, as used in Lean Healthcare, a flow-value map. Below you will find a very simple diagnostic screening diagram for the patient at the outpatient clinic. Not every activity included in this flowchart is just key. It is not necessary to specify each activity in the flowchart. The level of detail in the flowchart is determined by its use.

There are many processes, many interconnected, on-site, whether it's a provider, a production, or a business site. In most cases, it is not possible to identify them. For business success, it is necessary to manage and improve critical ones. Once managed and implemented continuously, they can focus on less important processes.

How are key processes identified? I believe that the following steps should be used, which I will explain later in more detail:

1. Form a leadership team to identify key processes

2. Identify the criteria that can be used to assess the importance of the process

3. Leadership tries to understand the basic steps of the process being examined

4. Decide which processes are critical and sort them in order of importance

Decisions on critical processes must be determined by the leaders and managers of service providers or businesses. In order to manage and improve the process, leadership must be engaged and supported. Also, management is probably the only group who is aware of all the important processes at the site. Therefore, they must be initially involved in prioritizing.

In order to rank and define priorities, it is necessary to define some agreed criteria. One criterion can be the cost of a failure in managing the process. For example, if doctors and clinical staff do not follow the certification process, an outpatient clinic may collapse. If the food manufacturer does not ensure the safety of his food by examination, it can be severely penalized. Another criterion surrounding the monetary costs could be the fulfillment of regulations. For example, if banks fail to have adequate reserves, they can be penalized by Federal Reserves.

It is necessary that each leader in the decision-making team understands the basic steps of the process under consideration. If it does not, it will be difficult to determine the process priorities. If the leader (or leaders) do not know the basic steps, he should go and see the process in action.

In the end, all the processes under consideration should be ranked by the management team by relevance, based on the criteria set by the team. The first one needs to focus on them. A timeframe should be set up to improve process management and winners from a team that is determined to exceed its improvement and management.

As you can see, identifying a key process in a location is very important for the health of each company. Failure to do so will lead to a loss of potential income and negatively affect customers and patients. Identifying key processes requires time and effort by the management, but it is worth the investment. The steps identified will lead to effective identification and prioritization of key and critical processes.

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