Monday, October 03, 2005

Chapter 20

IF THEY CAN'T GET IT RIGHT IN 100 TRIES, THERE MUST BE SOMETHING WRONG WITH THE PROCEDURE

Standard procedures are great for almost any work you do with other people, as long as you are willing to throw them out. When everyone has agreed on a way to do something, tested it, refined it, and put it in practice, the work can be done by anyone. Training and, therefore, the way the work is done are consistent. The output is the same no matter who does the work. Everything doesn’t fall apart because the person who does that work is sick, on vacation, or leaves the group or the company. Still, one of the most important things about maintaining standard procedures is being able to adapt them quickly to current conditions, which means reviewing, revamping, and recreating them when necessary.

A sure sign that a procedure needs to be reviewed is when the procedure makes it easier to make a mistake than to do something right. You can see this most clearly when you are training new people, but you can also see it with the people who are experienced in the procedure. If people make the same mistake over and over again, it could be because that is the most logical or intuitive way to do it. People can learn to do something illogically or counter-intuitively, but it is a constant struggle.

The medical office software we used for years required that you put in the guarantor information first. The guarantor was the person that the statement would be addressed to and the one who was responsible for the bill. The information sheet that we used to have people fill out also had the guarantor information first, to make it easier for us to put the information in the computer. But people often put in the information about the patient first. Apparently, that’s the logical thing for most people. So, we rearranged the form, because we got tired of trying to follow the arrows they drew all over the form when they realized they had filled it out incorrectly.

In that situation, we had to make it a little harder for ourselves, in order to make it easier for the patients. Usually, our software makes things easier for us. It has defaults so that the usual answer is automatically filled in, required fields that you can’t skip or default, filtered fields that require one of a limited number of answers, and pop-up reminders that some action is required when you enter certain data. In the beginning, I didn’t set those up, because they weren’t necessary if everyone did everything perfectly. Now, I use all the tools and techniques that my team and I can think of to make it easier for us to do it right.

Sometimes, we can think of a way to prevent mistakes in a certain procedure, such as making it a required or filtered field in the computer, but our software isn’t programmed to do that and having custom programming done would be too expensive for us. Then we have to set up checks or audits to make sure that the required information is entered correctly.

We also try to help people remember what needs to be done. We do that by letting them know each and every time that it is not correct. It is not a punishment and there is no penalty except that they have to correct the error. The person who is checking or auditing the work just returns it to the person who did it every time and so does anyone who notices a mistake when they go to add the next referral or claim. Even though we know it’s just an oversight, we don’t fix it for them. We don’t wait until there are a certain number of errors before we say anything. And we don’t tell them that they “always” make that mistake sometime after the fact.

When our efforts to make it easier for everyone to do it right fail or there is no method that will work for everyone, we make it the responsibility of the individual to do whatever will work for them. To figure that out, they have to know exactly what mistakes they are making, in what circumstances, and how frequently, and they need to know as soon as possible, preferably before they get into the habit of doing it incorrectly. People don’t usually enjoy being shown their mistakes (me, neither). But most people say they would rather know at the time, when it is just a small thing, when they can fix it, and when they can try to keep an eye out for it in the future, especially if someone tells them because they want them to be successful (me, too).

We tell people when they have errors or omissions, every time, at the time, and let them fix them. We are willing for people to make the same mistake or ask the same question 100 times. It hardly ever takes 100 tries for someone who is doing the work (and correcting the mistakes) to get it right. So, if the same mistake keeps happening over and over again, we start thinking about what is causing it. We think about alternative ways of accomplishing the goal and things we can do to make it easier to do the task correctly and harder to make the mistake.

When the same mistake happens over and over again, it is an indication that there is a problem with the procedure, not with the people.

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