hannah beckett

Surveying the Scene

The nature of workers comp means operating in the American medical space, working with both medical and ancillary providers to address client needs. I worked with the Provider Relations department as a part of a four-month co-operative education term (internship). 

Process

Coming from Canada, critical thinking and quick learning came into play in getting up to speed on how the American medical system operates and the innate differences from the Canadian model. This allowed me to identify the unique needs of this user group. 
 

Molding the "Experience" 

The Provider Relations team tasked me with the project of "improving experience". This applied to the relationships between both internal and external customers, including the Claims and Nursing departments, as well as injured workers and providers. I was given full creative license to interpret this concept in a way I thought most effective. 

Who are the users?
The main user group I became an advocate for was the Provider Group team within the Provider Relations department. The Provider Group exists to manage all issues, concerns and complaints regarding both ancillary and medical providers. They are professional trouble-shooters and are forced to manage mass amounts of data. The problem with this system was that data and communications were tracked across several Excel spreadsheets, a shared Outlook inbox and folders on a shared drive. This opened too many opportunities for human error through a manual, time intensive process. 

Process

User profiles were created so that I could identify pain points in the experience of each group and prioritize what could be addressed in the scope of four months. My focus became process streamlining, user education, the implementation of communication strategies and a new centralized management tool. 

Process
I took the time to shadow members of the Provider Group team during their day-to-day tasks to get a better idea of what they were managing. While I was genuinely impressed with how efficient they could manage to be despite having limited resources, it became evident that this was the most vital pain point under the umbrella of "improving experience". By improving their experience, it would lead to a subsequent positive impact upon secondary user groups, namely Claims, Nursing and external customers.

 

Assessing Resources
The limitations on resources became abundantly clear early in the project. With much of the IT department preoccupied with the roll-out of a platform 18 months in development, additional assistance to bring concepts to fruition was not available. There were also budget constraints placed on the project, with no financial backing to invest in software infrastructure. This dramatically shaped the scope of the project and how it would carry forward from this point. 

Selecting JIRA
JIRA is an issue management software created by Atlassian and offered an ideal framework upon which to build a system for the Provider Group. A supported software in the Zenith system and used by Help Desk, it became an excellent fit for our purposes. With the Help Desk receiving a high-volume of issues with the necessity of logging them and reaching resolution quickly, their needs were mimicked in the Provider Group requirements.

Presenting the Pilot
The pilot was presented to the Vice President of Provider Relations and the Manager of Healthcare Vendor Management. With their feedback and support, I was directed to expand the pilot to additional processes as I saw fit. With the robust capabilities of JIRA as a backbone, the potential for expansion was extensive.

Dashboard Growth
Management expressed concerns regarding reporting capabilities within JIRA. In addition to the manual logging of issues and requests, reporting posed a serious challenge on a regular basis, particularly due to the lack of standardization and centralization of information. By expanding the customization of system dashboards, all reporting data could be available on a constant basis without the need for additional searching. This would lead to efficiency beyond the Provider Group team and assist management in completing required tasks more quickly. leading to an improved experience. 
 

Process
Additional research was conducted at this point to assess how other departments in the company managed data. My goal at this time was to find resources within the company that could be molded for our purposes without the need for additional purchases or intensive back-end restructuring. This process spanned approximately three weeks as I worked with departmental leadership to complete a full assessment. 

Process
Working with the JIRA product owner at Zenith, we developed a pilot in JIRA focused on the process utilized by the Provider Group relating to ancillary vendor issue management only. The goal of this pilot was to allow for direct input of issues through a customer-facing ticket, centralized data storage of all information relating to the ticket in customized, internal dashboards and system-generated acknowledgment and resolution emails. 

Process
Returning to my user research, I looked to integrate five more processes into JIRA, which included medical issue management, medical provider nominations to networks, provider verification requests (to determine if a provider is in the network), provider listings (multiple providers local to the claimant) and all general inquiries. 

Process
The needs of my main user group was broken up across three dashboards. The first would act as the primary dashboard for day-to-day operations, inclusive of all incoming issues as well as metrics to help identify potential problems proactively, whether the team is receiving multiple issues from the same customers or regarding the same vendor or location. The second would focus on user statistics for management to assess the workload on each team member and their productivity. The third would break down all system data on a micro level focusing on individual vendors, locations, types of requests and more. 

Secondary Presentation
A secondary presentation was conducted for both management and the Provider Group team. This presentation led to a week-long feedback session conducted with the main user group to identify areas needing to be addressed, added or removed. This was vital to the success of the project as the user has the best understanding of their needs. 

Process
With the additional user feedback, we were able to implement all necessary changes. Though we were practical in our expectation that additional concerns would be raised after product launch and it was used more extensively, we aimed to iron out as many concerns in one go as possible. 
 

Training
Ahead of product launch, training was conducted for both the Provider Group team and all internal customers. The Provider Group received 3 one-hour training sessions over the span of two weeks, with the first an initial introduction and the follow-up sessions to go over any challenges and ensure department mandated processes were being followed. I conducted branch dedicated training sessions via WebEx for all claims and nursing staff across the country. 

Process
Organizing multiple training sessions for various teams led to expected challenges in accommodating the schedules of so many individuals. An extensive training guide listing all JIRA capabilities was created as a resource document for the Provider Group team to use for reference if any challenges were to arise with the platform or the processes put in place. Instructional emails complete with screenshots were also sent out company-wide to assist with the transition.