We have come to the last (but not least!) element of ACE – Efficiency! Thanks for staying with us! Let’s start where we have started before – with the dictionary. The Oxford Dictionary defines efficiency as: “the quality of doing something well with no waste of time or money.” I particularly like that there is no comma in this – it underscores that efficiency is about doing things well AND with no waste of time or money.
If we stick with the restaurant example we have been using: Accuracy is making the food or assembling the order correctly – according to the recipe and/or according to how people ordered it. Consistency means doing that for every item and for every customer. But – if you wait an hour for that order, or if it takes fifteen people to make the sandwich, or if they waste a bunch of food in order to get it right, the business is not going to remain viable for very long. Either customers will stay away in droves, or you will lose so much money that you can’t survive. You have to be efficient in how you use your resources in order to be effective.
Resources tend to be scarce in LTSS – especially Medicaid-funded LTSS. We have always operated from the philosophy that this system is built on taxpayer dollars and people who administer those dollars have a very high level of responsibility to ensure that those dollars are maximized for the public good. This means that you need to use your resources as efficiently as possible. When you are contemplating the need for additional dollars and how to request those dollars, you need to ensure that you are as lean as possible in your administrative processes.
Conducting surveys, reviewing and approving Medicaid applications, conducting assessments are examples of common LTSS-related transactions (although not inclusive!). The same principles apply – you must get it consistently right while using your resources most effectively. By resources we primarily mean time and money, but people and process are the vehicles that utilize that time and money. Your efforts at improving efficiency will center on people and process.
A first step in assessing efficiency is figuring out how you currently utilize resources. That might mean a hard look at budgets. It could mean some time studies or other productivity measures. Done well it most certainly means a thorough look at your human resources – do you have the right people, and do you have them in the right roles? Your people are critically important; a lot of efforts around efficiency are about how you manage your human resources.
As with accuracy and consistency, technology is a significant tool. Automating data collection or data entry, using electronic forms, or data feeds can save you from the need to manually enter data – and prevent some of the human errors that are inevitable when you are handling data manually. Done well, this will naturally lead to gains in efficiency.
An efficient process is one that adds value with each step. It’s important to figure out why you do each piece: Why do this in triplicate? Why do we enter this information? Why is this filed in two places, etc. Know that the first answer to “why” is often “because that’s how we have always done it”. You will need to move beyond and keep asking “why” until you get to the root reason – and then decide if it is a good reason. The other day I heard someone say we had to decide if the lemonade was worth the squeeze (I love that!) The same goes here – is what you gain from that step or process necessary enough to keep doing it or to keep doing it that way?
Increasing efficiency may mean you need to make some investments. This may be an investment of time – to analyze the problem, or to develop new tools. It may be an investment of financial resources like purchasing new technology. Training your team in new ways of doing things is an investment of both time and money. Don’t be penny-wise but pound-foolish. If you have to make a request for additional funds, you must make the business case about the long term savings as well as what those efficiency gains will enable you to do.
Accuracy is getting things right. Consistency is getting things right all the time. While accuracy and consistency are both critically important, you can’t sacrifice efficiency in order to achieve them. You need all three to in order to “ACE” your business operations and maximize your performance, your outcomes and your value.
