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Last month’s edition of Making Good Healthcare Better focused upon Business Process Management and identified five key components of it.  The first is identifying critical processes, the focus of this newsletter.

Why is it necessary to actively manage key or critical processes?  In order to thrive in a changing reimbursement and regulatory environment key processes need to be optimized and new ones implemented.  In a recent speech, the CEO of Metro Health, Mike Faas, located in Wyoming, Michigan, stated that in order to succeed his organization needed to form new partnerships with regional providers.  He stated that one goal was to keep patients out of the hospital and to treat them more effectively by primary care physicians.  Patient panels for physicians would need to almost double in size from the current average of 2000.  The best way to do this was to improve processes at the primary care site with teamwork and to establish better communications with partners.  I believe that this strategy will be necessary for most hospital groups.

The passage of the Medicare Access and Chips Reauthorization Act (MACRA) focuses on improved outcomes for patients and new payment options for physicians.  Eligible providers must choose one of two options in order not to have their reimbursements cut.  One way to do this is through quality reporting:  Merit-Based Payment Systems (MIPS).  MIPS will be based upon four measures—quality, efficiency, meaningful use of EHR’s and clinical practice improvement activities; all are process based.  The makeup of MIPS will be determined by May 1, 2016.  More than likely PQRS and VBPM, two current reporting processes, will be integral to MIPS.  MIPS will require that eligible physicians and their groups focus more on teamwork and manage and improve key processes. 

If management and improvement of key processes will increase in importance soon (the best providers and businesses are already involved in this) it will be necessary for us to understand what processes are and understand how to identify key processes.

I believe that the American Society of Quality has some of the best resources available for understanding and improving processes (I am a member).  As found in last month’s newsletter, they define Process as “A set of interrelated work activities characterized by a set of specific inputs and value added tasks that make up a procedure for a set of specific outputs.”  One of the best ways to see processes is to organize the activities of the process into a flow chart or, as used in Lean Healthcare, a value stream map.  Below you will find a very simple flow chart of checking in a patient at an outpatient clinic.  Not every activity is included in this flow chart, only the key ones.  It is not necessary to state every activity in a flow chart.  The level of detail in a flow chart is determined by its use.  The following one details the key interactions between the receptionist and patient.  Other steps that could be included would be the notification to providers that the patient has checked in and is ready to be seen.  Thus, the check-in process:

 There are many processes, many interrelated, at a site, whether it is a provider, manufacturing, or business site.  It is not possible to identify all of them in most circumstances.  For the success of a business it is necessary to manage and improve the critical ones.  After these are managed and continuous improvement implemented, less important processes can be focused upon.

How does one identify key processes?  I believe that one should use the following steps, which I will explain in more detail afterwards:

1. Form a leadership team to identify the key processes
2. Identify criteria that can be used to gauge importance of a process
3. Leadership seeks to understand basic steps of processes being examined
4. Decide which processes are critical and sort them by order of imporatnce

1.    

Decisions about critical processes need to be decided by the leaders and executives of a provider or business.  In order to manage and improve processes leadership must be engaged and be supportive.  Also, leadership is likely the only group aware of all the important processes at a site.  Thus, they must be initially involved in setting priorities.

In order to rank and prioritize processes some agreed upon criteria must be defined.  One criterion might be the cost of the failure to manage the process.  For example, if physicians and clinical staff do not keep up with their certification process, an outpatient clinic could fail.  If a food manufacturer does not insure the safety of its food by inspection it may be heavily fined.  Another criteria besides monetary costs could be the meeting of regulations.  For example, if banks fail to have adequate reserves they can be fined by the Federal Reserve.

It is necessary for each leader on the decision team to understand the basic steps of the processes under consideration.  If they do not, it will be difficult to prioritize the processes.  If a leader(s) do not know the basic steps he should go-and-see the process in action.

Lastly, all the processes under consideration should be ranked by the leadership team in order of importance based upon the criteria decided upon by the team.  The first ones should be focused upon.  A timeline for improving the management of the process should be set and a champion from the team identified to oversee its improvement and management. 

As you can see, identifying key process at a site is very important to the health of any business.  Failure to do so will lead to the loss of potential revenue and negatively impact customers and patients.  Identifying the key processes takes time and effort by leadership but is well worth the investment.  The steps identified will lead to an effective identification and prioritization of key and critical processes.