Blog Post

The Goldilocks Problem: Finding “Just Enough” Variability in Standardization

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Standardization is a difficult concept to get “just right,” particularly within the areas of policy, procedure, workflow, and deployment of tools and IT capabilities. On one hand, without standardization of these components, managing operations and driving accountability can become untenable rapidly. On the other hand, most providers do not embrace being told what to do, how to practice, and how they will be evaluated without being given the opportunity to provide their input. For leaders with operational and administrative responsibilities in a complex, ever-changing healthcare environment, it can be extremely difficult to achieve the appropriate combination of operational management and adequate levels of stakeholder engagement and satisfaction. How does an organization find the right balance?

The “Too Hot” Bowl of Porridge: Full Standardization

Full standardization of processes, policy, and technology is appealing, as it offers advantages and efficiencies with respect to deployment of resources and tools and performance oversight and, more generally, streamlines management capabilities. Take charge capture for example. Conceptually, defining standards, methods, and requirements for entering charges is relatively simple, as most providers would agree that charges should be entered in a timely and compliant manner. This is especially true when you consider that predictable, opportune, and accurate charge entry is imperative to organizational economic sustainability. Given what’s at stake, it’s not an option to let each provider and staff member adopt their preferred tools, methods, and timelines for charge entry. Therefore, the solution is simple—you should select and enforce a single standard, inclusive of consistent policies, procedures, charge entry tools, and workflows, right?

The “Too Cold” Bowl of Porridge: Little or No Standardization

Let’s evaluate the alternative argument. While applying standardization across the organization is often the goal, it’s also usually unrealistic to do so in totality. For example, consider the number of care settings where services are delivered, the spectrum of provider and user preferences, and the countless other variables requiring consideration. Given these factors, how do you select a single standard that is viable? Keeping with the charge capture example, it’s unreasonable to ask a rounding physician, a pediatrician operating predominantly within the confines of an office setting, and a home health professional to all use the same charge capture parameters, tools, and guidelines. It may make sense for the pediatrician to enter charges using their desktop computer immediately following an encounter, whereas the home health professional or rounding physician may need to utilize an application on a mobile device to enter charges while providing services. Therefore, a logical case can be made that flexibility is necessary.

The “Just Right” Bowl of Porridge: Enough Standardization

Full standardization offers streamlined management, accountability, and process implementation, while flexibility helps drive adoption and engagement. How does an organization meet all these objectives, as each is critical? It’s about finding the right balance and compromise. Let’s revisit the charge capture example: The appropriate degree of standardization may include defining only the timelines and criteria for which a charge is entered and supporting the development of the tools needed to meet the stated guidelines. For instance, an organization may construct a policy that requires charges to be entered within 24 hours of the patient encounter, which provides latitude for the method of entry to account for the varied care settings and practices. This blend of standardization and flexibility allows the pediatrician in an office setting to enter charges from their office in between patients, while also allowing the rounding physician and home health professional to submit charges through an application on their mobile devices when most appropriate. Assuming methods are also deployed to ensure accountability and process transparency, the policy would meet organizational goals for timely and consistent entry but would also enable care providers to meet standards in a user-friendly and nonrestrictive manner.

Discovering the right equilibrium comes down to having an effective governance model that encourages standardization yet offers avenues for variation where appropriate. In our experience, an adequate governing body is led by respected influencers who believe in the common benefits of pursuing standardization and can effectively communicate these advantages to their peers. It also includes leadership with the authority and ability to make well-informed, thoughtful decisions. Furthermore, a successful governance capability supports the ability to evaluate the varied needs of each stakeholder group, develop well-documented guidelines and parameters, gain consensus through compromise, and ensure that the processes are consistent with the organization’s overarching goals. Said another way, the “secret ingredient” really isn’t a secret; for an organization to achieve the appropriate levels of standardization, governance must emphasize sound guiding principles, use a defined structure for making purposeful decisions based on input from appropriate stakeholders, and hold all parties accountable to the expected performance metrics. Finding the standardization equilibrium is possible, but it requires a thoughtful governance strategy and consistency with respect to execution and enforcement. It’s not easy, but it’s certainly an endeavor worth pursuing, as the alternative is a no-win proposition!

Learn more about how the standardization balance played a role in the Adventist Health System’s operational transformation.

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