Accuracy, CONSISTENCY, Efficiency, Part 2

Accuracy is the first principle of ACE, but accuracy alone isn’t enough if it is not applied throughout your organization. Consistency is the second principle of ACE and it is just as important as accuracy is in establishing your credibility. The Oxford Dictionary defines “consistent” as:  always behaving in the same way, or having the same opinions, standards, etc.

Accuracy means you are getting it right – consistency means you are getting it right all the time. Consistency may mean that you always put two pickles on the sandwich, but it also means that different people come to the same correct decision about matters of interpretation. You may recognize the latter as “inter-rater reliability”. Inter-rater reliability is the extent to which multiple people come to similar conclusions and establishes the consistency of any given system of assessment or evaluation.

Consistency can also refer to process. Regardless of individual decision or outcome, the process involved in making that decision is consistent. That consistency of process is also part of how you reach “inter-rater reliability”. 

Achieving operational consistency takes a combination of coaching and tools, including the use of technology. As we discussed in our last post, tools and technology are good ways to facilitate accuracy by limiting the scope of human error. The use of tools and technology also helps establish consistency as long as they are used by all of those who perform a task. 

Here’s an example:  The nursing facility survey process is one that has been notorious for inconsistency and subjective assessment. Providers have complained for years about the fact that survey results can vary widely based on the surveyor. Over the course of 2018 and 2019, CMS rolled out an updated survey process. The new process included updated tools and automated certain elements in an effort to increase the overall level of consistency in the process. While it is still too early to ascertain definitively that this process is more consistent, we have heard favorable information from state survey agencies who believe that the process is leading them toward more consistent determinations. 

Another example is nursing facility level of care. Using the right tools can reduce reliance on subjective decision-making or eliminate the ability of individuals to “override” determinations by substituting their own judgment.  

Tools and technology can be of limited value where judgment calls ultimately have to be made especially where they can appear to be very subjective. Employee performance management is an area where different supervisors can see the exact same behavior or results and come to completely different conclusions. Tools like behavioral anchors can help but not eliminate this challenge.

In these situations, organizations can work to “calibrate” assessments. This can be achieved a couple of different ways. One well-trained person’s assessments can stand as the standard against which other assessments are evaluated and people are trained until their determinations are similar. Another way to do this is to hold “calibration” meetings in which assessors gather to discuss their evaluations and identify variables that need to be hashed out among the group in order to come to similar conclusions with similar inputs.  

Achieving consistency takes ongoing effort. It’s not something that you can just set and forget. Managers need to continuously monitor results by setting up reports and reviewing these regularly. Technology can assist here but this can also be done with Excel spreadsheets. 

Measure and track error rates. It’s all the better if these can be tracked at the agency, team and individual levels. It will aid you in being able to identify outliers and to troubleshoot problems. When mistakes happen, figure out why they happen at the root cause level and correct those root causes.  

When consistency and accuracy come together perfectly, you could be 100% accurate. While that may be a stretch goal, you can set incremental goals along the way to 100%. The consequences of working in human services is that errors have a direct impact on people’s lives – some profoundly so. Standards should be high.

As you set ambitious goals for your team, make sure you tie these goals to your organization’s mission and/or your strategic plan. Explain why it is important. Create a clear line of sight for each individual from their individual goals and responsibilities to those of the organization as a whole. Everyone should understand how they contribute to mission accomplishment. 

Your processes build reliability and gain in confidence with internal and external stakeholders as accuracy and consistency improve. But you are not an ACE yet. Efficiency is up next. 

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