When Debbie and I were in the state agency, we wanted to reduce turnaround times for some of our common transactions. We started to measure transaction processing times and put up boards to track those times and formulated plans to bring those turnaround times down. That seems like a good plan if those times are important (and they were because people’s lives or providers’ livelihoods were at stake) – but – how important was it to be fast, if we weren’t doing it accurately? If people got the wrong answer, or if a process had to be re-done, had we gained anything? We realized that it didn’t matter if it was fast if we got it wrong –we couldn’t sacrifice accuracy for speed. While all of the elements of ACE are important, the others don’t matter without accuracy. Accuracy is the first element of “ACE”.
According to the Oxford dictionary, “Accuracy” is defined as: “the quality or state of being correct or precise”. The sub-definition reads “the degree to which the result of a measurement, calculation or specification conforms to the correct value or a standard”.
If your agency or organization is performing any type of repetitive task you need to have some type of standard against which you are measuring. We have written before about our previous experience managing restaurants – accuracy means that the customer’s order is made correctly: according to the standard of how the customer ordered it and according to the proper recipe. Accuracy in Medicaid eligibility means that the determination of eligibility was made correctly according to the policy standards. If you are performing survey oversight visits, the visit documentation should clearly capture what is being observed and determinations of compliance are made against the regulatory standard.
The word “accuracy” conjures up the notion that one is either accurate or one is wrong. That accuracy is either black or it’s white. Some things are straightforward – the sandwich gets two pickles, it’s got two pickles, eligibility threshold is $X, individual has less than $X dollars, you provided 10 units of service, you submitted a claim for 10 units of service. Other things have some gray area – does the setting promote community integration, does the individual need X hours a week of personal care, does the individual meet nursing facility level of care, is the care plan increase warranted, etc. Those shades of gray may be found in how regulations are interpreted, how documentation is interpreted, how decisions are made using the information that is at hand, among other things. These are all common in the LTSS world.
What does it take to instill an accuracy mindset in your team? You and your team have to know what accurate looks like and how to achieve it. You must consider all the elements of an accurate decision or action. What rules are there; what policies or procedures must be followed; are there caps, limits, minimums, etc. that must be applied?
Creating process flows, decision trees, job aides, etc. can help to minimize the gray areas, improving accuracy. Automation in processes reliant on data entry can improve accuracy by eliminating human error, i.e. “typos”.
Technology systems that use strong business rules or even algorithms can also help improve accuracy. Things as simple as checking digits in a phone number you enter, validating zip codes, checking for blank fields that are required in certain steps of the process, even spell checking notes and other documentation, allow you to use technology in pursuit of accuracy. More sophisticated systems might flag outliers, like high cost care plans, unusual variations in recorded assets or income, extreme changes in assessment scores, etc. for additional review to catch other errors.
Achieving accuracy is critical to developing faith and confidence among your stakeholders – whether those are customers to your restaurant, people applying for Medicaid for long term care needs, or providers who rely on the survey process as a key measure of the quality of care that they provide. But being accurate once doesn’t build that confidence, it’s getting it right every time. And that is Consistency. More on that next time.