Standardized work practices have long been in place in many manufacturing businesses. The standard work practice concept is a part of an approach to process
by Chris CalderoneE, MA, MBA

Standardized work practices have long been in place in many
manufacturing businesses. The standard work practice concept is a
part of an approach to process improvement called “lean
thinking,” a quality-focused concept that concentrates
improvement initiatives within the workflow to identify and drive
out waste and variability. And one of the most effective ways to
get rid of waste and improve process consistency is through the use
of standardized work practices.

Many health care organizations and hospitals have focused on
implementing standardized work practices as part of their
“lean” programs, and the results have been impressive:
improved patient satisfaction, improved outcomes — and
improved financial performance.

The concept of work standardization can be readily applied to an
HME operation, and some providers have already achieved success
with implementing robust work standardization methods. One mid-size
provider realized a 10 percent decrease in pending revenue after
implementing standard work practices in its intake and customer
service area. Another provider saw the company's DSO drop by five
days after implementing standardized work practices in the billing
and reimbursement department.

Standardized work practices are crucial to improving process
results. In many instances, providers rely on multiple employees to
complete similar work within functional areas. Whenever a group of
people work to complete similar work, they will often come up with
very individual methods for getting that work done when standard
practices are not in place. Different people doing similar work in
a very different manner will often yield different results.

HME providers have many processes that can benefit from a robust
work standardization approach, including intake, billing and
reimbursement, documentation and distribution, to name a few.

One way of creating standardized work is through the use of a
checklist. A checklist is a simple, common-sense tool that can
yield mighty results when it is used to help guide staff in their
daily work.

A checklist typically includes all of the key requirements and
tasks that must be completed in order to complete work successfully
within a process. A checklist also can help to ensure work is
complete and accurate before it is sent on to the next step or next

An ideal location for a checklist, for example, is in your
company's intake area. A checklist should briefly list all of the
main processes, steps or tasks that are required to turn that
referral into a successful claim.

There are many upfront tasks that must be completed upon initial
intake, for example, from the gathering of basic demographics to
insurance information. Many providers, however, have
less-than-solid standard procedures and work practices in place in
the intake department, but getting it right on the front-end the
first time can save costly rework on the back-end of the

Tips to Increase Standardization

Role clarification: Make sure everyone within the work
area understands their role, who does what, when and how they
should do it.

  • Performance standards: Ensure relevant performance
    standards are in place that reflect core process requirements.

  • Draw a diagram, or a “blueprint,” of the workflow
    for a specific area:
    For example, draw a process flow chart of
    the intake area that identifies how work flows through the intake
    process and briefly describe what happens at each step within the
    process. This is a good way to help others visualize the workflow
    because it is a simplified, visual explanation that is more
    powerful than a descriptive narrative of the process.

  • Implement checklists that list key process steps (in
    sequence) that must be completed before the work is passed along to
    the next step: For example, in an intake area, list each step that
    occurs from the moment the phone or fax rings, and describe what
    must take place at each main step.

  • Continually assess first-time-quality: This is a measure
    of how often work moves through key process steps and does not
    require rework. For example, measure the number of complete and
    accurate initial intake forms.

  • Make sure clearly written procedures are in place: Are
    they updated to reflect changing processes, and are they
    consistently reinforced with the staff?

  • Don't assume standardization won't apply to certain
    Although an intake and billing work process may vary
    based on payer-specific requirements, generally, you can
    standardize more than you realize.

    Implementing standard work practices can help to reduce
    variation in process results. Typical forms of process variation in
    an HME operation include missing information at intake, incomplete
    CMNs (certificates of medical necessity), incomplete prescriptions
    and missing insurance information — all of which lead to
    delayed and/or rejected claims.

    Providers who implement more robust standard work practices will
    help to formalize the informal and create an environment where
    people approach similar work in a more planned and predefined
    manner. Most people know what to do in their work area. The key is
    to get the people who are doing the same type of work to carry out
    that work in a more similar manner.

    Work standardization can help to optimize workflow, reduce
    errors and increase process consistency — and that can help
    put more dollars on your bottom line.

    With an MBA and a master's degree in organizational management,
    Chris Calderone is the founder and a principal of Lean Homecare
    Consulting Group, Jackson, Mich., which focuses on small- to
    mid-sized businesses in the changing HME environment. You can reach
    him at 734/709-5487 or through

    Sample Intake — New Referral Checklist

    1. Process receipt of referral: (fax, e-mail, phone,
      • Name
      • Address
      • Phone number
      • DOB
      • HT, WT
      • Emergency contact
      • Employer
      • Diagnosis
      • Social security number
      • Drug allergies
      • Advanced directives ___Yes ___No
    2. Process Rx:
      • Diagnosis noted on Rx
      • Equipment/supplies noted on Rx
      • Equipment/supplies appropriate for diagnosis
      • Oxygen Rx — elements of O2 Rx complete
      • Proper signature
    3. Process insurance:
      • Verify eligibility of primary
      • Secondary payer?
      • Determine deductible/co-pay amount
      • Inform of co-pay amount
    4. Prepare Documents:
      • Delivery ticket — load inventory, special instructions,
      • EOB
      • Estimate of patient cost
      • Print delivery ticket

    Sample Checklist

    Final Shipping Processing Point Checklist

    • Special Instructions Followed
    • Ship-To Address Verified
    • Ship-By Date Noted
    • Inspection Completed
    • Proper packaging, labeling
    • Paperwork placed in return bin
    • Back-Order Status Noted
    • Back-Order Status Communicated