Improving Home Healthcare and Hospice

The 4 Pillars of Process Improvement

Home Healthcare and Hospice organizations are facing many challenges including Government regulations, reduced Medicare and Medicaid payments, issues with insurance companies getting paid, and the ability to hire enough professional staff including nurses.

It is more critical that ever to ensure their processes, especially the information and communication flows, are at a high-level efficiency and effectiveness to maximize profits, increase capabilities and level of care to their patients.

After working with many Home Healthcare and Hospice organizations, we have uncovered the key areas/processes that should be prioritized for improvement – we call them the ‘4 Pillars’.


1st Pillar – Hand-offs/Transfer of Information

The first pillar is the handoff from a hospital or doctor to the organization for in-home patient care. This process is critical because if all the necessary information isn’t available or is inaccurate/incorrect, it can impact –

  • the nurse’s time,
  • the billing process (Administration),
  • the ability to get paid,
  • the internal costs (sometimes increasing beyond the received payment of treating the patient) and
  • can impede the speed and quality of care to the patient.

Problems within the first pillar can consume resources, cause rework, waste valuable nursing available hours, cause frustration throughout, and in some cases affect the care of the patient.

2nd Pillar – Scheduling

The second pillar is the scheduling process. In the organizations we have worked with there are many very talented and devoted people that focus on the scheduling process. What the staff must deal with is

  • missing information,
  • bad information,
  • variation in the process,
  • difficulty finding the correct process information,
  • lack of standardization in their scheduling process and
  • variation (no standardization) between different offices within the same organization.

The scheduling process requires that the information is accurate and timely to ensure the patient care needs are accurate and satisfactorily met. It also impacts the efficiency of the nursing activities.

3rd Pillar – Utilization of Professional Medical staff – Nurses

The third pillar is the nurses’ ability to focus on and care for the patient. From a Lean process improvement standpoint, every minute a nurse provides care to the patient is value added to the organization.

In many Home Healthcare and Hospice organizations as much as 60% of the available nurses’ time is wasted due to process waste. The major causes of waste include –

  • delays,
  • misinformation,
  • scheduling errors due to bad information, and
  • redundant, unnecessary documentation.

These types of waste deflect and absorb the time a nurse, or medical professional, can spend caring for and assisting the patient.

4th Pillar – Billing

The fourth pillar is the billing process. For billing, most organizations have invested a great deal of money and time to get the best advanced software programs to do the billing process automatically and smoothly. We have seen that many software programs are unable to function smoothly or at the level the company expected, and normally require much effort and intervention from staff due to flawed and broken processes.

What we have seen is in many cases, the patient information and/or Insurance information is inaccurate, not up to date, and passed through broken processes which the software programs will not be able to automatically solve. It results in internal resources spending a great deal of time sorting out where the problem is and retracing back to get it resolved.

In many cases, because of process issues, the patient services are never paid for. If this was a one-time event in organizations, they could deal with it, but it happens far too often.


When a proper Value Stream Map and analysis is completed, the entire organization “sees” the waste in their processes. From this analysis, they will be able to collectively design a quick and effective Implementation Plan to eliminate the waste and make their processes ‘flow’. The improved processes will result in maximizing profits, increasing the involvement from staff, and of course, raising the level of care for the client.

You end up doing more with your existing staff and resources, which means dramatically increasing your bottom line/profits and capacity.

Some Actual Results

  • > 75% reduction in mistakes
  • > 50% improvement in quality
  • > 40% improvement in availability of nurses’ time
  • > 80% improvement in first time payment
  • > 25% reduction in overtime
  • Standardization of processes
  • Increased communications
  • Decreased response time to first patient visit