April 27, 2015

Blood Pressure and Process Efficiency

I got to my doctor’s office 5 minutes early, so I expected to wait 5 minutes before seeing him. Time kept passing, and every 10 minutes I started asking the receptionist, “How much longer do I have to wait?” Each time her response was, “I don’t know.” With each passing minute, I felt my blood pressure rising and thought, “I should not come to the doctor to feel worse!” After 35 minutes, I was finally called out of the waiting room and into a room with the nurse. I asked her the same question, and her response was, “Well, he has one more patient before you.” By the time my doctor came to see me, he was 45 minutes late and my blood pressure was through the roof!

Since tardiness is the norm for my doctor, I would love to do a gap analysis in order to understand their current scheduling process and to define a new and improved process for his office. Cleary, there is a substantial gap between their current state (i.e. angry customers waiting close to an hour past the start time of their appointment) and their planned ideal state (i.e. on-time adherence to scheduling). In business process circles, gap analysis is just that, the exercise of comparing actual performance against potential or desired performance. Having done gap analyses for clients in the past, I knew I could use the same methodology.

A gap analysis is useful at the beginning of projects driving change, because it helps you identify the gap between your current situation and the future state that you want to reach, along with the tasks that you need to complete to bridge the gap. Below I will take you through 4 high level steps for completing a gap analysis and delivering a recommendation to address those gaps.

Step 1: Identify Future State Objectives

First, identify the objectives that you need to achieve in order for a project or program to be deemed successful. These objectives provide you with your future state, or where you want your organization to be once your project has been completed.

While you might already have a possible solution in mind, it is important to force yourself to first focus on individual objectives in order to get maximum value from a gap analysis. Much of the benefit is achieved by unearthing improvement opportunities that are missed by taking a less methodical approach. So before the final solution is chosen, you need to identify what needs to be done to meet the over-arching objectives.

Using my doctor’s office as an example, the objectives would look something like:

  • Reduce appointment delays by 10% in the first 3 months, and 40% in the first year
  • Introduce new controls in the first 4 months (e.g. Track the patients’ end-to-end time at the doctor’s office–when a patient signs in, when they are assigned to a room, when the doctor leaves the room. In addition, if the doctor is running more than 15 minutes late, call patients to let them know)
  • Increase efficiency of visits by 20% in the first 3 months, and 80% in the first year

Step 2: Current State Analysis

Every gap analysis starts with introspection. For each of your objectives, analyze your current situation. To accomplish this, consider the following questions:

  • Who has the knowledge that you need to get a good picture of your current situation?
  • With whom, specifically, will you have to speak?
  • Is the information in people’s heads, or is it documented?
  • What’s the best way to get this information? By conducting brainstorming sessions? Through one-on-one interviews? By reviewing documents? By job shadowing?

In regards to my doctor’s office, the people with the knowledge about current processes would be the doctors, the nurses, and the receptionists. Since I don’t know their standard office processes, I would interview each group and gather any documented artifacts. After the interviews, I would review my notes and the artifacts and create current state documentation and process flows. To the extent technology is used to navigate the business process(es) being evaluated, information flows are also beneficial to capture. If needed, I would conduct subsequent meetings to clarify my understanding or ask questions before the documentation is completed, at which time it is imperative to gain consensus from stakeholders that the current state documentation and opportunities for improvement towards business objectives are complete and accurate.

Step 3: Identify How You’ll Bridge the Gap between Your Current State and Your Future State

Once you have captured your current state and defined your future state, you can think about what you need to do to bridge the gap to reach your project’s objectives.

You need to compare the objectives against the current state, and document a comprehensive plan that outlines ALL possible solutions that will fill the gap between its current and future states and reach its target objectives. By defining all possible solutions inclusive of automation, process changes, adding human resources, etc., you provide stakeholders with a menu approach to meeting their business objectives that fits their unique culture and most importantly their key drivers, i.e. budget, date and quality.

Using my doctor’s office as an example, I would start by populating a gap analysis spreadsheet template that I have used at past clients. This allows me to identify gaps and possible solutions at each step in the process.

Step 4: Provide Recommendations to Stakeholders

After the gap analysis is completed, schedule a review meeting with stakeholders. Details to discuss during the stakeholders meeting are as follows:

  • Previously defined business objectives and how the objectives were prioritized based on value gained from achieving them.
  • Approach taken for formulating recommendations based on value (i.e. benefits minus cost).
  • The final assessment with recommendations to address the gaps between the current state the desired future state.

Recommending a phased approach allows for gained value ASAP. This minimizes organizational change all at once to ensure that the recommendations will be institutionalized.

In this example, the doctor is the key stakeholder. I’ll explain to him how the office business objectives were defined, and I’ll explain the approach taken to identify the office gaps that support the recommended solution for the office. Once I present him with the facts, I’ll ask for sign-off to move forward with gathering detailed business requirements to implement the recommendations. Once implemented, I hope to be able to go to my doctor’s office without suffering through elevated blood pressure!

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