Releasing Bottlenecks

Recently while discussing a problem a provider was having with a workload bottleneck, I was reminded of a scene in the movie “Pearl Harbor.” A nurse sits in a yard outside a hospital as it’s being flooded with wounded. She forces herself past the shock of the situation, and, in an environment that was probably like hell, she walks from stretcher to stretcher with a tube of lipstick making marks on the wounded. She was performing triage.

From time to time, we all have to deal with a bottleneck that chokes the workflow in one process and can affect others. But just like patients flooding a hospital, workload bottlenecks must be triaged. Triage breaks the workflow into smaller units of prioritized work and sets up a system that will enable you to survive a crunch.

This particular provider (larger than average) had problems with certificates of medical necessity (CMNs), so the company established a team of CMN specialists in the accounts receivable department to make the process — and its results — better. Of course, the desired result was to reduce days sales held.

Soon after the company made this investment in the team, the supervisor left, and the days held grew. When a new supervisor was selected, she knew the business and was dedicated to the company and her mission within it, but the problem was not resolved. In fact, it got worse. Days sales held grew to a very painful 42.

One of the first things the new supervisor did was to set a daily work plan for each member of her team. It was a very good plan, but there was still no reduction in days held. The problem was that the plan was good for normal workflow, but the situation in this company had grown into a crisis.

The new supervisor quickly realized that the company needed to triage the huge backlog of work it had. With that done, the team members temporarily suspended — not abandoned — their normal work plan, and for the next seven work days, they processed the easiest group of work. By getting all of this work out, the team felt like it had achieved a meaningful milestone and was eager to move to the next phase of complexity. To release bottlenecks in your organization:

• Recognize bottlenecks early Bottlenecks can demoralize staff and disrupt other departments. When a bottleneck gets large enough, it will require a crisis plan complete with triage in order to release it.
• Develop a temporary crisis plan to replace the normal work plan For business bottlenecks, triage should give the highest priority to the tasks that are easiest to clear. Triage will likely require the most skilled staff to prioritize the work and allow them to hand off work to less skilled staff. The crisis plan must keep current work current, so it may require a temporary reallocation of staff from other departments.
• Get the team onboard Any process, temporary or permanent, is performed better if employees feel ownership in what they are doing. It is even more important when a group has to operate in the pressure of a crisis situation. When the crisis is over, let staffers enjoy the victory.
• Measure often When we walk a path that is familiar and safe, we don’t look down often. However, when the terrain is unfamiliar and believed to have pitfalls, we check our steps more frequently.
• Avoid bottlenecks before they begin Manage to a clear set of performance measures. You should measure both throughput and quality for every position in the company.

Workflow bottlenecks occur when the environment changes but the process does not. Make continuous process improvement a part of your company’s corporate culture.

Wallace Weeks is founder and president of The Weeks Group Inc., a Melbourne, Fla.-based strategy consulting firm. He can be reached at 321/752-4514 or by e-mail at [email protected].