How to outplay the  administrative variation  that plagues health systems

Any time humans are involved in a process, inconsistencies are bound to happen. And while there has been a significant focus on removing inconsistencies in clinical practice to improve outcomes and reduce costs, there has been less attention paid to reducing variation within health care administrative and operational processes. But this is a missed opportunity.

As we emerge from nearly a decade of industry consolidation, the years of mergers and acquisitions have resulted in many systems struggling with a varied patchwork of differing management styles, processes and even business cultures that persist long after the deals close. The result of these variations in process are underperforming operations that weigh down a health system, literally costing it time and money. However, addressing administrative and operational variation can truly deliver the organization-wide benefits of working as a single “system.” These benefits include compliance, revenue integrity and teams working more effectively from the same enterprise playbook.

While “systemness” can encompass many functional areas where health care organizations align their priorities, strategies and performance decisions, case management is one example where a consistent approach can drive improvement across a system. Many hospitals struggle with utilization review due to the manual nature of the process, whether carried out by case managers or UR nurses. Teams of doctors and nurses oftentimes read through patient charts to determine medical necessity, coordinate care and secure preauthorization.