During this rie three new clerical associates were

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who is going to take over if staff call in sick. During this RIE, three new clerical associates were hired, so the process owner assumed responsibility for training them on how to do insurance verification and scheduling, following the processes designed by the RIE team. The new insurance verification process required staff to identify patients with expired Medicaid managed care coverage who needed to be recertified in advance of their visits. In addition, staff regularly verified that physicians were on the primary care physician list with the managed care insurer. A booking system was revised to ensure patients would see their primary care physician. The appointment center was standardized and the residents’ schedules updated so that appointments could be booked 6 to 8 months in advance. The Pediatric Department director described how the frontline manger had been working in a clerical capacity rather than as a manager. His role was revised to working alongside the residents in the processor room, a space where physicians had previously not allowed clerks to work. This change enabled the frontline manager to more fully use his skills to manage walk-in patients. I tell you, the Lean process, they gave us the tools. Great tellers, good system, that's where they get to do it. They don't force things on us. They tell us, "These are the tools that we have. You can implement these tools and go this avenue." And we use the tools that they gave us and we run with them. Department lead Exhibit 5.14. Lean Tools and Activities for Pediatric Continuity of Care Project Rationale: Identified the reason for action Problem identification: Laid out the initial state of the department for this issue by conducting a walkthrough of the unit and identifying problems Brainstormed about what the target or future state might look like, including measurements for verifying the managed care primary care physician list, cleaning the clerical area, and ensuring patients were seen by their primary care doctor Future state: Drafted a future-state map of the workflow necessary to reach the target state Gap analysis: Conducted a gap analysis to see what management and personnel, equipment and systems, and methods and flow were causing gaps or issues that prevented the team from achieving its target state Solution approach: Created a solution approach to counteract the gaps identified as part of the gap analysis Conducted rapid experiments: Reviewed the daily activity reports to see which insurance information could be corrected 72 hours in advance of appointments; made reminder calls to patients; redirected walk-ins to appropriate locations or appointments; cleaned the front desk area Completion plan: Made a completion plan and assigned activities to specific staff with deadlines over the next 90 days Standard work processes: Developed standard work processes for reminder calls, appointments, walk-in redirection, and verifying insurance
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190 The team ran into challenges and needed to make adjustments to the project plan. Initially, the
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