Faster Professional Credentialing

Savings: $789,000 per-year. | Approximately 30% cost reduction
Navy Medicine provides health care services to U.S. naval personnel worldwide. In order to perform this mission, contract providers and nurses are used. The professional credentialing process for these workers was cumbersome, confusing and lengthy; with the result that staffing shortages developed. A Lean Six Sigma team was formed and tasked with improving the process. Cycle times were reduced by 32.5% on average and total cost savings of $789,000 were achieved. Key to these improvements was identification and elimination of extensive rework loops in the credentialing process. The results of this project had applicability to other problem areas within Navy Medicine and were used to improve those areas as well.

Problem
Navy Medicine provides health care support to United States Navy personnel worldwide. On an ongoing basis, the process of professional credentialing of Health Care Workers in Health Services Contracts was found to be problematic and cumbersome; resulting in increased costs and difficulty in staffing critical positions. This problem resulted in a shortage of staff, and ability to support a large customer base. It was believed that a much shorter credentialing process would increase appointment availability and lead to greater provider/patient satisfaction. A meeting to capture the process issues found that the average cycle time for credentialing was excessive and required improvement to better provide service.

Approach
Navy Medicine assembled a Lean Six Sigma (LSS) Black Belt Team from internal personnel to improve the credentialing process. The team obtained Voice of the Customer (VOC) information from both internal and external customers. The internal VOC obtained feedback from administration and medical resources to determine their support needs. The external VOC captured feedback from contractor medical support personnel that supplemented or performed medical tasks. Survey of contractors found that the process for submitting professional credentials was:

• Very complicated to follow with unclear instructions
• Not user friendly and seemed to drive complication and increase cycle time
• The documentation was not concise
• The process included duplication of correspondence to provide the same information

Surveys of internal customers found that the average cycle times were 38 days for providers and 37 days for nurses (contractors). The survey also found that a cycle time of 21 days (maximum) would meet expectations. The cycle time of 21 days became the process goal and the upper boundary for the new process.

The team captured the current process map to further measure issues. As shown in Figure 1, the process map revealed large areas of rework (shown in red) which were contributing to the long cycle times. The rework appeared to be related to unclear requirements, complicated policies, and lack of tracking and feedback mechanisms. The team found that in most cases credential documentation required additional information. The team also found that in some cases, even reworked information was "lost in the paper shuffle."

The team analyzed the process and the inputs to it in order to identify the root causes of rework that increased cycle time. The rework was found to be associated with incomplete information packets that were submitted by providers and nurses, or incorrect information in the packets. The team found the critical process inputs that required improvements were:

• No tracking mechanism to maintain first-in, first-out, and provide feedback to internal and external customers
• Instructions hard to follow for new resources and external customers submitting credentials
• Need for standardization of process methods

The team used the findings in the Analyze phase of LSS's overall Define, Measure, Analyze, Improve, Control (DMAIC) process to brainstorm solutions to improve the process. The team implemented a tracking mechanism to:

• Track each contractor or provider credential review through arrival at the contract officer's office to approval
• Provide feedback to all parties in the process regarding any issues
• Provide feedback for the improvements if required
• Capture cycle times to complete and control the process, and determine if the process cycle time exceed the 21-day upper boundary

The team updated documentation and policy to improve clarity of instructions and requirements for nurses and providers. In addition to these improvements the team created a checklist of required information and qualifications to supplement the instructions. The team piloted the improved process and found that the solutions improved the process. They required only minor adjustments prior to full implementation.

As a final addition to the new process documentation, the team drafted a Control Plan to capture process quality requirements per process step, possible process issues and put controls in place to ensure that quality was maintained.

Results
Navy medicine realized a 30% reduction in process cycle time to approve provider credentials for an annual cost savings of $477,000. They also realized a 35% reduction in process cycle time to approve nurse credentials for an annual cost savings of $312,000. This was a total cost savings of $789,000 from a single project. Navy Medicine could replicate this project in a much larger scope; thereby generating additional savings. The project solution also improved morale as positions are now filled in a timely manner and customer service is substantially better.