Always falling behind? Do the long lines, full lobbies, and never-ending stream of new work ever stress you out? Do you feel yourself aging at the very mention of the word “backlog”? You’re not alone. The Great Recession of 2008 forced nationwide budget cuts leaving us with 30 percent less staff just before the Affordable Care Act increased our workload by 150 percent. These events created a perfect storm in our human services agencies that
we have been trying to weather ever since.
There have been many attempts to deal with the aftermath, including sophisticated IT systems, call centers, interactive voice response systems, online applications, automated work flow, and automated pending notices. While designed to help us manage the tidal wave of work and meet the needs of our customers, we ended up with systems that manage our work in the 20–45 day range instead of looking at innovative ways to do much more with less. In other words, our efforts focused on coping with the debris left by the storm, not dealing with our new reality; the storm is the new normal.
The number of customers coming in is not slowing, the complexity of the work continues to grow, and the pressure to meet our deadlines is all-
consuming. Amplifying our problem is the fact that every technology solution we put in place and every mandatory guideline change requires training that pulls staff away from customers. Our hope is that with these changes we can keep up but the truth is we are only seeing longer transaction times, rising costs, and growing backlogs.
There’s a secret to living peace- fully in the storm. Step 1 is to realize that much of what is being tried is not helping, and is most likely hurting
us. Step 2 is to change our focus from 30-day timeliness to one-day timeliness.
This may sound too simplistic but the “best practices” to weather the storm today deal with moving lines faster upfront and freeing up caseworker time behind the scenes to concentrate on doing the work. This effort to “protect” the caseworker means allotting time away from clients to work uninterrupted and free of distractions to catch up on cases. In theory this designated time to do the work should help, but while we can isolate the worker, nothing can or should stop the clients from trying to interact with us. It’s as if only one team takes a timeout to strategize but the other team keeps playing.
When a customer cannot access their caseworker, they begin working different avenues to get information. They call, or “pop in” to the office, or even resubmit a new form in an attempt to see progress. Data show that after just one week, you can expect the average client to make four to five additional interactions for a single eligibility event.
While we can empathize with the customer’s frustration, we often fail to see the self-inflicted damage done when we remove caseworkers from clients. Each additional contact requires us to complete 10 to 15 minutes of work, a “pendalty” for pending cases that adds up very quickly. We are literally adding hours of time for every client we “pend” and days and weeks to the time to reach a determination. For every 100 clients that walk in the door, an average of 60-plus will be pended in states and counties that have not shifted to first- contact resolution. Those 60 average four additional contacts of 15 minutes each for a total of 60 pendalty hours of work for every 100 clients. That’s one and a half full-time caseworkers just to keep up with the pendalty time.
1. a name for the additional work added to each determination decision that is pended
2. a punishment imposed for not finishing the work during the initial contact
3. the number one contributor to delays in getting our clients the answers they need
When these pendalty minutes catch up to us and we cannot keep up, we implement overtime for our staff. While this helps the agency maintain timely performance, the problem is that overtime> becomes the normal, not the exception. Overtime should be reserved for times when it is truly needed, such as peak enrollment times. When it is the new normal, workers are losing their work–home balance, we are spending more and more money, and spending more time managing schedules than thinking about the root causes of the problem: We can’t keep up.
In search of a more permanent solution, we turn to technology. However, many of us have spent millions of dollars on new systems that give clients access to data about their status in the hope that they would stop calling, popping in, and resubmit- ting, but that does not connect us to the client in a way that helps us make determinations or increase caseworker capacity. The truth is, unless it can speed up the time to disposition, it’s not going to calm the storm or save us from the additional contacts.
The contacts have become so pronounced that we have built phone centers dedicated to diverting calls from the caseworker but even these require an agent to create a task or message that eventually requires case- worker action. The distraction wasn’t eliminated, simply delayed.
All these strategies assure we stay in the storm by either encouraging the act of pending, or are a direct result of those pends. We are literally spending
hundreds of millions of dollars trying to manage pended work instead of focusing on the second secret, focus on day one.
By focusing on day one, the first customer interaction, we can weather the storm by doing everything within our power to complete the transaction and avoid as many pends (and pendalty minutes) as possible. We need to do this, even at the expense of getting through the line faster. By slowing down and completing the transaction (no matter from which access point), we actually speed up the entire process. By how much? Just taking an additional 15 minutes to resolve a case on day one is the equivalent to adding a full-time staff for every 100 clients you serve. Instead of spending resources on pendalty,
you are actually freeing up time and building capacity!
connect that caseworker to the customer as soon as possible, and allow them to address as much of the customer’s needs at the time of the first interaction. Even if this drives up interaction time, it is essential that we do everything we can to try to make a determination on day one. If the key to unlocking your staff capacity is to eliminate the reasons that keep bringing customers into your lobbies and phone centers, then set up your processes, your technology, and your entire work areas to focus on first contact resolution.
we need to measure real-time customer demand more clearly and then manage day one workforce availability and staff utilization to match. Lobby and nonlobby traffic ebb and flow but we rarely move staff focus to assure work keeps moving. What we end up with is high pends in certain areas where we could have adjusted staff levels on day one to increase resolution and minimize the pendalty we now have to pay. By managing our staff in real time, we are able to provide faster transaction times, reduce pends and pendalty, and keep up with the majority of the work coming in. Oh yeah, it’s also a lot cheaper.
focus on the needs of the customer. What do we need to do today in order to make this determination? Are there people we could contact now, together, who can provide us with the information we need? If we absolutely have to pend, and there are some cases where we do, then let’s use the technology to provide our customers with reliable information so they don’t feel like they have to contact us unnecessarily.
Instead of just
informational phone centers,
turn your call centers into extensions of your lobby and provide full service to those calling in. Empower them to complete transactions and work on pulling cases from the queue. If we can do a good job at day one, pendalty calls about “where’s my stuff” and status will dramatically fall within the first quarter and your call centers will have capacity to attack the backlog.
There is a secret to never getting behind again. We need to shift our focus from just keeping our heads above water, understanding that, in reality, those efforts are only tiring us out and cannot be sustained. To find blue skies, we need to focus on just one day, tomorrow, and how many clients can we serve on that day. The more we can do that, the less we’ll get behind.
Texas has implemented these strategies to become one of the most efficient business process reengineering models in the country. By concentrating every effort to focus on work as it comes in, it has been able to cope with cyclical increases in volume while eliminating the pressure of falling behind. Texas shares the burden of limited staffing resources to handle workload increases, program complexity, and implementation of substantive policy changes with a demand for services projected to continue to grow. By 2020, the state population is expected to be 23 percent higher than it is today.
Under the leadership of Wayne Salter, the Office of Access and Eligibility Services within the Health and Human Services Commission continues working toward statewide implementation of a new service delivery model that represents an opportunity to eliminate tasks that waste time and resources. The goal is the same, work as much as we can at first contact and eliminate the need to pend unnecessarily.
The end result is providing staff with the capacity needed to focus on the truly meaningful work that is so important to the agency’s mission. Today, Texas has regained the capacity to process more applications per month, relies less on overtime, has reduced customer inquiries, and has increased speed in processing time by 23 percent to 56 percent, depending on program type.
Texas now provides the full scope of services and determinations to all customers walking into any of their 300 field offices, including those calling their phone centers (all access points). They have increased focus on work received through mail and online access points to speed up determinations to within three to seven days, and eliminate unnecessary inquiries and case touches.
Like many states in the country, Texas experiences large increases in demand in late fall and winter months due to seasonal spikes and open enrollment for health care. Call volume rises by 12 percent and lobby traffic increases by another 15 percent. With its improved service delivery model in place, the state now proactively prepares for this cyclical workload by using historical demand to anticipate need and leverage statewide staff. By ensuring adherence to the principles of their first contact resolution model, they minimize the impact of increase and are able to ride out these cyclical storms.
Just this year, as the agency approached the last week in February, lead times dropped back, phone and lobby volumes dropped, and the staff is not buried in new backlog.
When we make application timeliness standards same day, we essentially make the customers’ goals our goals, eliminating unnecessary work and organizational turmoil
*Originally published as Never Get Behind Again: Old Thinking Through a New Lens, (Policy & Practice, April 2017)