Overcoming bottlenecks

Overcoming bottlenecks in mental health practice

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For a practice to operate efficiently, managers and owners must get good at overcoming bottlenecks. These bottlenecks can come from multiple sources. Let’s look at a few and see how to overcome them.

Workload bottlenecks

First off, what is a bottleneck? The way I am using the term, a bottleneck is a constriction in the flow of work that diminishes efficiency. It both slows us down and adds frustration to our work. 

Assessing the problem

Some bottlenecks are about how each employee gets the work done. In these cases, the employee is not completing a critical function in a consistent and timely way. Moreover, both support staff and clinicians have essential tasks to accomplish for an organization to run smoothly. 

To cite one example, to accurately bill a session, both the clinician and the support person must do their respective roles correctly. The clinician must record the session with the correct CPT and DSM/ICD codes. Furthermore, the therapist must write a clinical note for each session. 

Then the support person can take the information the clinician supplies and use it to file the insurance claim correctly. 

The therapist can become the bottleneck if the therapist does not keep up with the daily flow of record-keeping that is required. The support person can become the bottleneck if the flow of information is beyond the capacity to enter data and file claims. 

Solutions to workload issues

In this billing example, the answers can be quite obvious. The manager can work with the therapist on how to keep up with the critical records efficiently. This training might involve taking a few minutes between every session or to stay at the end or beginning of every day to finish up records. And, of course, if there is resistance or non-compliance, then the managers can examine why and seek solutions that work.

With support staff, because of the broad range of activities that might compete with data entry and filing claims, the answer can take a little more digging. Typically the solution requires some redistribution of tasks, say, moving the data entry person off of the phones.

When the issue is a clinician

Of course, the clinician or support person may not be good at the critical tasks. In that case, then, overcoming bottlenecks means facing a management challenge.

As you doubtless know, manage care insurance policies typically require additional paperwork every five or eight sessions as a condition of authorizing continued treatment. We had a clinician who would not take the time to complete the paperwork. We tried everything.

One of our support staff found the solution. She would block out one of the clinician’s hours and let him know. During that hour, she would come into his office and sit with the clinician as he completed the paperwork. It worked. She did this about every month and kept all the authorizations current. 

This example may seem extreme. It is. To this day, I do not understand the inability to keep the paperwork up. But the clinician was a great therapist. This system was the way to get what the organization needed without too much strain. And bottom line, it worked.

When the issue is support staff

We had times when a support person was not able to do specific tasks accurately or quickly enough. Sometimes we were able to reassign that person to vital functions that fit. We had several times when we found a better fit for the support person’s skills. Everyone was the winner.

When we could not find a way to reassign duties, and yet, our concern about performance continued, we had candid and direct conversations about the issues. Sometimes, that was enough. Performance improved, at least temporarily. But if not, we wrote out a Corrective Action Plan with some deadlines. Unfortunately, sometimes we could not find a way to keep the person. 

Read more about Corrective Action Plans and the termination of employment here: When we need to fire an employee.

Overcoming workflow bottlenecks

Sometimes the issue is not with the employees but was in the workflow itself. And sometimes, overcoming bottlenecks means facing the truth that I was the most significant bottleneck. Every decision that had to wait for me slowed the team. 

The solution? The more I could train and authorize others to do it the way I wanted it done, the better for them and the organization. 

Read more on delegating here: The dilemma of success: Do it myself or delegate

Additionally, there were times when a person other than the owner was the bottleneck. This person holds onto decision-making authority in a way that enhances their power but does not create an efficient workflow.

This problem is not an easy one to confront. Why? Because typically, the person taking this approach is in a prominent position. Any perception that the owner is reducing their power risks a resignation. 

In my view, an owner should only bend the system so far around a particular person. Some adjustments may be appropriate. And yet, managers should be guided by the most efficient method for getting the work done. We should not be bending the work around the personalities doing the work. I have talked about this issue here: The training we never had–Managing staff

How technology can create or solve bottlenecks

Sometimes we found bottlenecks that related to the demands that software imposed for accomplishing some tasks. We had a time when we realized that our current software was cumbersome in how it handled critical duties. 

More specifically, in our state, Blue Cross/Blue Shield sends one check per week to the company checking account. It comes very early Friday morning. Additionally, it comes with a 25-30 page list of the claims processed in that check. With our old software system, a support person would spend eight to ten hours per week processing that claim information. When we switched software vendors, the same process took only two hours per week. 

In my experience with software, the data entry and the claim verification process can vary greatly. When evaluating software, think about what it takes to get the right info into and out of the software. The right choices can save you many “workarounds” and bottlenecks. 

Read more about evaluating software here: Selecting a practice management system.

Overcoming bottlenecks

So, in the end, overcoming bottlenecks is a process of evaluating the steps in every critical activity. We are looking for ways to do everything more efficiently and accurately. The problems might be in how employees are doing things. If so, then revise the tasks and processes. Or it could be in the tools that staff are using. If so, then we want to explore more efficient applications. 

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