What we found in New Mexico was that process management allowed us to serve increased numbers of clients without increased stress for our staff.
—KATIE FALLS, ACTING SECRETARY, NEW MEXICO HUMAN SERVICES DEPARTMENT
These last two years have tested the capacity of our SNAP offices nationwide. Systems across the country are facing crushing increases in caseloads, diminishing timeliness, operational inconsistencies, poor quality, revolving doors for staff, unhappy customers and costly errors.
We used to be able to meet increased demands by leaning heavier on the staff, pushing their caseloads and their stress levels beyond capacity. We have filled their glasses full. And now? We are trying to pour 40 percent more water into already full glasses. The results? Employees are leaving, customers are falling through the cracks, and time to get benefits and error rates is increasing. The obvious option is to add more staff; but in this budget climate, it isn’t feasible. The only two options are to reduce the amount of water coming in or to increase the capacity of the glass. This article will show you how to do both by moving from a case management model to process management.
Standing in the lobby of most SNAP offices is like standing in flood waters.
From opening to closing time, it’s a constant stream of people needing help. How can we possibly serve all these people? We can’t, and the good news is we don’t have to.
Our research consistently shows that 70–80 percent of the people in line sim- ply shouldn’t be there at all. Fewer than 3 out of 10 visitors are there to apply for benefits, yet all 10 are being poured into the already overflowing case manager glasses. Why is everyone else there?
1. Because we take too long. More than 40 percent of the visitors to the office are there to ask “where’s my stuff?” I dropped it off, did you get it? I can’t get my caseworker to answer my calls, so can I speak with him/her? Why did I lose service? What does this letter mean?” And I’m here because I don’t trust that you will receive it through the drop box or through the mail.
2. Because we couldn’t get it done on the first try. Seven out of 10 customers typically can’t complete the application on the first try and have to interact with us again — clogging the lobby, the phone lines and the mailboxes.
3. Because we were late renewing customers. Renewing a customer for the SNAP program is much easier than an initial application process.
However, miss the renewal and applicants have to go through the arduous process all over again, or take critical staff time to reinstate them out side of the normal process. In many of the offices we have worked with, more than half of the customers are not renewed on time. A majority of those (70–80 percent) will be back in the office in less than three months to start a new application. The extra work caused by missed renewals accounted for 56 full-time-staff equivalents in one state alone. What do these numbers tell us? Our pain is self-inflicted. Most of the work flooding our offices is because of our own processes, policies and constraints. And the biggest constraint we face is our business model—case management.
Increasing Our Capacity
So how did it get this way? Many try to blame the customers. “If they would only keep their appointments, or remember to bring in their documents.” Many try to lay the blame on the staff. “They need to work harder or smarter and stay on top of their cases.” The reality is, it’s not the fault of the customers or the staff. They are both victims of the business system — one that has served us so well for so long but can no longer meet the demand — case management.
Most human service delivery models are based on case management wherein a caseworker shepherds customers through all the steps necessary to receive their benefits. There is almost a romantic notion that the personal touch involved with case management comforts our customers and that staff ownership of cases breeds accountability.
The truth is that case management has some wonderful qualities that have served our industry well, so long as we have manageable caseloads, experienced staff and reliable technology. But do your public assistance offices have all three? More likely you have a backlog of cases, high turnover and legacy systems. The desire to serve the client is there, but when just one criterion fails to measure up, we lose the foundation on which case management was built.
The results of a wobbly foundation are devastating to clients and staff. There is a limited amount of increased productivity you can squeeze out of caseworkers by trying to manage and provide incentives for them to work harder when their glasses are full. So what can we do? It’s time to shift the burden. To stop hoping for creative incentives, to stop burning out super workers and start designing, managing and supporting super systems, it’s time to move from case management to process management.
In case management, the success of the client depends heavily on the clients’ ability to meet all requirements in a timely fashion. It depends upon the size of the caseload and the competency of the caseworker, as well as the ability of other applicants to get their ducks in a row.
Clients with all their documentation and correct applications can only get their benefits quickly if their caseworker has the time. The caseworker only has
time if their calendar permits and they are running on schedule. The schedule is only on time if the last client had all the documentation and application
correct — which is rarely the case — and if their co-workers all showed up today, shielding them from having to cover extra intakes.
More realistically, the two hours it should take to do the value-added work steps to get benefits is stretched over a month as we juggle pending requirements, maxed-out caseloads and chaotic appointments.
In process management, the success of the client depends on a team of people working on key processes to move the case along as quickly as possible. A public assistance case consists of intake, verification, eligibility determination, and recertification and reporting and changes throughout.
The output of each process becomes the input of the next process, allowing a smooth flow to completion. Interviews completed at intake that need additional
verifications are immediately given to the verification process team while those ready to go to eligibility are directed there. The verification team works with clients to build a complete file so the eligibility team can immediately make a decision. It’s a fluid process that follows the natural walk of a client through our systems and allows teams to specialize their work.
Benefits of Process Management
It’s faster. By splitting the work into logical processes, New Mexico offices that have implemented process management are typically distributing benefits in fewer than seven days vs. 30 days with case management. They are not alone in seeing the more than 80 percent improvement in processing time as well as a dramatic reduction in errors and rework.
Embarking on an effort to reengineer our business practices presents an exceptional opportunity to take a comprehensive look at every aspect of our business, analyze the data and make the kinds of changes that will transform the way we have traditionally delivered services in Washington state. The anticipated return on investment for families and the agency is significant. Washington is fortunate to have the technology we do, but technology itself is
not mandatory to make drastic business changes and improvement.
—LEO RIBAS, DIRECTOR OF COMMUNITY SERVICES, WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES
It’s flexible. With case management, we often deal with peak volumes by forcing overtime. With process management, staff can be moved from process to process, depending where the peaks occur. Offices that have implemented process management are able to mix and match staff daily, even hourly to meet a fluid workload. Increased interview traffic can be dealt with by moving staff from the verification or recertification process.
It’s responsive. Case management hinges on the availability of the caseworker to answer questions and conduct interviews. With process management, interviews are conducted immediately and questions about a case can be answered by any number of people. Customers may not have the comfort of a single contact, but they can be comforted with timely answers to their issues.
It’s accurate. Case management relies on one caseworker’s accurate application of the complex rules and policies. It also allows 50 caseworkers to document
and note their cases in 50 different ways. Process management involves standardized processes. With up to four different sets of eyes involved at different times, offices that have implemented process management have seen a 50 percent reduction in error rates.
It’s accountable. Process management offices have the ability to know minute by minute how many clients are being served, their wait time, error rates, and if the customers were happy. If they don’t like the results, they have a good idea of where improvements to the process need to be made.
It’s efficient. Process management has allowed offices to absorb an average caseload increase of 30 percent with faster processing time and fewer errors without additional resources. In addition, dedicated recertification teams have virtually eliminated the 50 percent rework we noted earlier.
It’s rewarding. Case management is akin to being a teacher with a class size of 700. The management of the processes allows caseworkers to do what they do best — work with customers. Staff on the interview team get to focus on interviewing customers without worrying about whether the 100 other customers they are tracking this month got their paperwork in on time. You spend so much time managing the size of the class that you don’t get to do what you truly love — to teach. Process management allows workers to do what they do best.
It’s not technology driven. Being a huge fan of technology and innovations like document imaging, it is hard to write that technology is not the answer. It’s vastly more important that we develop good business processes than automate something that just isn’t working for today’s demands. I’ve seen faster, better performance from lo-tech agencies with sound business processes. For example, there are lo-tech offices providing benefits before hi-tech offices even set up an appointment for an online application. There are lo-tech offices working and processing verifications while verifications are still being shipped to the document imaging hub in other states. Fix the business processes first, and then enhance with technology.
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*Originally published as The Case for Process Management, (Policy & Practice, December 2009)
