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 process.

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 operation.

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 areas: 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, walk-in)
    • 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, deadlines
    • 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