The Problem Is in the Procedure, Not the People

Even though everyone in call center/claims group probably made both of these mistakes more than 100 times, we knew that it was an indication that there was a problem with the procedure, not with the people.

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Understand the People

The provider pay-to address was something that could change from claim to claim, so we did need to pick that, but we requested and got an option added to our software so that the software displayed the locations in the claim, so that we could check to be sure the payment was going to the right place. Once we got used to looking at that new field, that mistake went down about 90%, but it is still a choice that a person has to make and we still get it wrong sometimes.

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Fix the Tools

It was obvious that the software should have been smart enough to pick the correct provider level once you put in the provider, since that never changed and remembering is something that computers do very well. We agitated for that change with our software vendor and eventually got it in an upgrade, since we couldn’t pay for custom programming. That mistake doesn’t happen anymore.

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If Mistakes are Too Easy to Make, They Never Stop Making Them

People got pretty good at doing what they had to do and, considering the circumstances, we did pretty well, but these mistakes were so easy to make, nobody ever really stopped making them, not even the people who had been there for years. New people really had a hard time. We figured out what would be needed to make it easier to do these tasks correctly.

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The Defects Are in the Tools, Not the People

The two most common mistakes we made in the call center/claims group were paying at the wrong level (we had four levels of payment, depending on the credentials of the provider) and paying the wrong provider location. It was easy to make mistakes in these areas. We had to choose the pay level in the second screen of the claim entry, while the provider level only displayed on the first screen, so we had to remember what it was when we got to that field. The provider address didn’t show in the claim at all. In order send the check to the right location, the person who entered the referral, days or weeks before, would have had to pick it correctly when they set it up. Since the referral didn’t always go to the same address as the claim check, this made paying the claim to the right location something you hoped for rather than knew.

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Make It Easier to Do Correctly Than to Make a Mistake

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.

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Let Them Decide How to Remember

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 have to rely on the individual to do whatever will work for them. For them to do that, 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).

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Let Them Fix Their Own Mistakes

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 them before we say anything. And, we don’t tell them that they “always” make that mistake sometime after the fact and not give them the examples.

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Set Up Checks or Audits

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.

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Use Tools to Help Them Do It Correctly

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 them whenever I can to make it easier to do it right. I use all the tools and techniques that my team and I can think of to make it easier to do it right.

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Make It Easier for the Person Doing It

The medical office software I 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 I 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 I found out that people want to give you information about the patient first. Apparently, that is the logical thing for most people. So, I rearranged the form, because I got tired of trying to follow the arrows they drew all over the form when they realized they had filled it out incorrectly, or having to correct the information I had already entered when I realized the name they had put down as the guarantor was really a kid and must be the patient.

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Make It Easier to Do It Right

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 to a lesser degree 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.

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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. 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, is 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 quickly to current conditions, and being willing to throw them out and start over when they don’t work.

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As Many Tries as You Need

You need to give those you teach many tries to get it right, as many tries as it takes for you to figure out how to teach them. And you need to let those you teach know that they have many tries to get it right, so they don’t get anxious about having to do it right the first time or the second time. One hundred is a good number. You know you will find the right way long before you get to the hundredth way (and you probably don’t know that many). They know they will learn it long before then. And, a year from now, when they have done it correctly 10,000 times, it won’t matter how many tries or how long it took them to get it right.

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What Works for Most Does Not Work For All

It may seem like it works in the opposite way, if you went to a public school like mine when you were a kid. It may seem like the teacher is only required to teach in a prescribed way, the same way for all students, and it is the student who fails if he doesn’t learn. Because that is what they say, the student failed. But the student does get another teacher or a tutor or special classes or special education, in recognition of the fact that that student can learn the same things, but needs a different way. So, I don’t think it is different. It’s just that our public schools have developed that way. They teach in a way that works for most students and only individualize the lessons when they have to. It may be an efficient way to get everyone through the required 12 years of school with the minimum possible expenditure of resources, but it stigmatizes and demoralizes those that it fails, instead of just acknowledging that no one-size-fits-all teaching could ever work for everyone. If your goal is to teach everyone who needs to know and is willing to learn, that philosophy of education will not help you achieve your goal.

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It Is the Teacher Who Fails

When there is a teacher and a student and something that needs to be taught by the one and learned by the other, it is the teacher who has the obligation to figure out how to make that happen. The student’s only job is to keep trying, to ask for help when they need it, and to look for another teacher if this one can’t help them. If nothing is taught and nothing is learned, it is the teacher who fails, not the student. The teacher fails if he doesn’t find the right method for the student. The student only fails if he gives up.

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Help Them Feel Confident

I was sitting with someone one day that I was training and she was having trouble remembering all the steps in the task I was teaching her. A few times, she even forgot a few that she had remembered previously. She turned to me with a disgusted look on her face. I thought of all the things I could say to her, but it seemed shortest and best to say, with confidence, “You know, this is going to seem really easy once you’ve done it a few hundred times.” She laughed and went back to practicing.

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They Will Use It Every Day

The things I was teaching them were things they were going to use every day. It wasn’t going to matter that it took them two days instead of one, or even if it took them a week to learn it. Once they had learned it, you wouldn’t be able to tell the difference between the way they did it and the way someone that had picked it up right away did it. I knew from experience, they were going to be just as fast and accurate and self-assured once they had done it enough. And even though I considered myself to be very smart (and still do) and even though I had been the one to teach them, I knew that it wouldn’t be long before they would be better at it than I was.

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Getting It the First Time is Irrelevant

After they thought they understood (or sometimes even before), we would get to the practice part. People often seemed to feel, like I had, that they ought to be able to do something that they had been taught the first time they tried it. But that was not the goal. The goal was to learn the skill, not to learn it the first time they heard it. There were always people that seemed to be able to do it right away. But that didn’t really matter. We weren’t testing for or offering prizes for that. It was irrelevant.

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Page One Bookstore, Saturday, November 7

The first Saturday of the month!

That's when Page One Bookstore hosts their local author book fair in the Brew Moon Cafe from 3:00 to 5:00 PM.

Page One is at the corner of Montgomery and Juan Tabo in Albuquerque, New Mexico.

I'll see you there!

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Take All the Blame

I took all the blame (and rightly so). “I’m so stupid,” they would say, “why can’t I get it?” “You’re not stupid, you’re very smart, look at all that you know,” I would tell them, “It’s just that sometimes I don’t explain very well, but let me go back and try explaining it a different way.”

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Hastings Tramway & Candelaria, Friday, November 6

Book Signing
Friday, November 6, 2009
5:30 PM to 9:30 PM

Hastings
12501 Candelaria Road NE
Albuquerque, NM 87111
(505) 332-8855

Local Authors!

David Corwell
Cloaked in Shadow
Dark Tales of Elves

Lela Belle Wolfert
Wishes in the Wind

Marianne Powers
Doing the Right Thing
and Achieving All Your Goals at the Same Time


Doing the Right Thing
and Achieving All Your Goals at the Same Time
www.mariannepowers.com

Be Calm and Happy

I learned that I had to calm way down myself. I had all the time in the world. I had nowhere else to be but there. They were the most important people in my life. This was the only thing on my mind. There was nothing I loved better than teaching them. I would be happy doing it forever, if that was how long it took. When they learned it, it was going to be the most fun thing they had ever done.

Doing the Right Thing
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Adapt to Each Person

The first thing I had to learn was to adapt to each person. I didn’t always have the tools to provide each person with their optimal learning experience, or know what that was, but there were things I could do. Most of the time, it seems to me, people try to relate what they are learning to something they already know. By listening and observing them, I could usually figure out where their model had failed and what other model would serve better. The next obstacle to overcome was their anxiety about not being able to learn what I was trying to teach. If they were too anxious, they really wouldn’t get it, because, in their anxiety, they would even forget the things they already knew!

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Stick With It

No matter what method I used to teach someone, what ultimately seemed to make the biggest difference in the success of my teaching was my confidence that I knew the topic well enough to be able to do it myself and my confidence that the person I was teaching was capable of learning it. If I believed in those two things, and if my student and I were both willing to stick with it, we succeeded.

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Combine the Great Number of Modalities

I have tried many different ways of learning, and of teaching people: telling them, showing them, letting them do it themselves with instructions, audio tapes, video tapes, manuals, and figure it out yourself. I believe that different people learn more easily with a method that matches the way they learn, although I have not usually known the person I was teaching well enough to know what that was. Because what I was teaching was usually on a computer, I have most often used a screen projected demonstration with verbal instructions while the trainee was at another computer and could duplicate what I was doing, to combine the greatest number of modalities as possible at one time.

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One Time is Not Enough

I remember one complete, embarrassing failure, when I tried to do something after having been shown how to do it one time. I was walked through the procedure for dialing into a server at the air force base and downloading some information. I watched the screen as the person instructing me did it and wrote down every single step. She checked what I was writing down and made sure I had it right. After showing me one time, she left me to do it on my own, but I wasn’t worried. I dialed in to the server and starting typing in the commands exactly as I had written them down. The thing I forgot to do was wait for the computer to respond to a command before I gave it the next one. I just kept typing one thing after another. In about five minutes, I had locked up the server. My boss had to call the base and have it shut down. It was very embarrassing, because I believed that I should have been able to do it after having been shown one time, and so did my trainer and my boss.

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Give Them 100 Tries to Get It Right

It always seemed to me that I got everything right the first time I was shown how to do it. Now that I am being more realistic about my “perfection”, I know it wasn’t true, but that was what I thought was expected of me and that was what I tried to do. I always wrote down my instructions, in detail. It was a point of pride not to ask my trainer to tell me or show me anything twice. I could usually get through the task by following my instructions. After a while, I would usually even understand what I was doing. Like most people that I have observed, though, I never looked at my instructions again after I could remember them, or thought I could remember them. So, it often happened that there was one step I missed or did incorrectly. If that one thing prevented the task from working, I would go back and find it, of course. Otherwise, it has sometimes been years before I realized I was missing something every time I did that task.

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