Improving the Availability of Revenue Information in Challenging Budgetary Times

Summary

Impact Statement:

Tazewell County Health Department (TCHD) followed a Kaizen QI process to decrease the time for completing the deposit and receipt process for fee revenue. The number of days from receipt to post decreased from 30 to 5, an 83% reduction. Additional improved outcomes resulted from the Kaizen process.

Summary:

TCHD's revenue consists of checks that come in the mail and fees collected on site. It took an average of 30 days for the checks and fees to be posted on the accounting system after they were receipted. Staff thought this time frame was too long. It affected the ability to get timely revenue information and to budget, project, and close out grants. Staff also felt that the entire deposit process could be improved to reduce duplicated efforts, errors, and wait time. TCHD's QI plan allows staff to submit ideas for improvement. A request form was submitted in late 2015 and was accepted for a mini-Kaizen. The team consisted of four front-line staff members: the business operations supervisor, the business operations director, the administrator, and the assistant administrator. A mini-Kaizen was held in January 2016.

Organization that conducted the QI initiative:

TCHD

Citation:

Kato, Y. Public Health Quality Improvement Exchange. Improving the Availability of Revenue Information in Challenging Budgetary Times. Tue, 08/07/2018 - 15:59. Available at http://www.phqix.org/content/improving-availability-revenue-information-challenging-budgetary-times. Accessed April 24, 2024.

Background and Aim

Aim statement:

The goal was to reduce the mean number of days it took to post income to the accounting system by 20%.

Need For The QI Initiative:

For more than 2 years starting on July 1, 2015, Illinois was without a complete state budget. The Illinois budget impasse required frequent monitoring of cash flow and fund availability. Lack of timely revenue information affected the ability to budget and project.

Area for Improvement:

From the date on deposit sheets, receipt date on check stubs, and post date in the accounting system, staff determined how many days it took for a check to be posted to the accounting system from the time it was received. Data collected from March 2015 to September 2015 revealed that it took an average of 30 days, and the longest was 57 days. Staff felt it was too long and that they had to do something about it.

Root Cause:

The root causes were as follows: • Grant checks do not go straight to the person involved. • Two people verify the final MIP (accounting system) report. • Forms were copied several times. • Receipts were not issued the day a check came in. • Money was sitting in a drawer. • Communication with the treasurer's office was not effective. • Money was receipted twice. • There were long wait times for receipts from the treasurer's office. • It took a long time to write receipts. • The way checks are receipted was not effective. • Does MIP have to wait for deposit verification? • Some items are not in MIP from the start. • Why are Excel and MIP used? • It took a long time to break down deposit detail. • There was a long wait time for electronic detail. • Multiple processes were used depending on the division. • Do staff need to verify as many times? • Work seems to wait if a person is unavailable. • NueMD (clinical billing software) was not fully used (creates potentially duplicate work). • Clinical breakdowns are available through NueMD, so they are not needed on the accounting system. • Wrong codes were used.

Planning and Execution Details

QI Implementation:

A mini-Kaizen was conducted in January 2016. The team started with process mapping of the current process. Gaps and redundancies were identified with a time frame, so the team could measure how long each process took. The team discovered long wait times, redundancies, and manual processes: waiting for someone to enter revenue on the accounting system, waiting for the treasurer’s office to send a receipt, double entries, and use of a receipt book. Next, a cause-and-effect analysis was conducted to identify possible causes of the problem. The team used a priority matrix to determine which root causes to focus on. From there, they discussed potential improvements to address the root causes. The theory was that reducing wait time and using an electronic system would speed up the process. The team decided to enter revenue information in the accounting system before monies were deposited at the treasurer’s office. They also discovered that they were entering the same information twice: once on an Excel deposit sheet, then in the accounting system. Therefore, the team decided to eliminate the deposit sheet and enter revenue information straight from the check stub to the accounting system. The team also stopped using a receipt book and created a log on Microsoft Access on the shared server, so revenue information is tracked and available for anyone. The log allows management to view checks on the day they came in. The new process went into effect on May 1, 2016. After implementing the new process, the mean number of days decreased from 30 to 5, a total reduction of 83%. The team continues to meet at least quarterly. Data are collected and analyzed quarterly to ensure sustainability.

Focus activities

Administration:

Financial management

QI Methods:

Kaizen

QI Tools:

Brainstorming

Prioritization Matrix

Process maps

Root cause analysis

Other QI tools:

Swim lane diagram

Action steps chart

Initiative Dates:

5/1/16

Initiative Duration:

Between 18-24 months

Methods of evaluation:

To evaluate the effectiveness of the process’s change, the team used a control chart and specified an upper control limit (UCL) measure. The measure was used to identify common cause variations, which represent predictable variations in the process, and to avoid special cause variations that indicate that the process is not consistent and a corrective action might be needed. The UCL measure was set at two standard deviations above the mean number of days, which corresponds to 8 days. The UCL represents the highest level of variation acceptable for the new process. The QI team will investigate special cause variations using QI tools such as a cause-and-effect diagram.

Other Information:

Issues that were raised during the QI initiative that were not directly related to the project were put in a “parking lot” and discussed later. This helped the team to stay focused on achieving the aim.

Supplemental Materials:

Storyboard

Supplemental Files:

Attachment	Size
NNPHI 2017 Poster Presentation.pdf	528.76 KB
Deposit QI Fishbone.pptx	51.46 KB
Deposit QI pic Action Plan.jpeg	335.57 KB
Deposit QI pic Swimlane Diagram.jpeg	269.27 KB
Deposit QI pic Prioritize Matrix Issues.jpeg	324.5 KB
Deposit QI pic Prioritize Matrix Solutions.jpeg	291.9 KB
Deposit QI pic Process Map.png	2.53 MB

Improving the Availability of Revenue Information in Challenging Budgetary Times

Summary

Background and Aim

Planning and Execution Details

Results

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

QI Spotlight

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Improving the Availability of Revenue Information in Challenging Budgetary Times

Summary

Background and Aim

Planning and Execution Details

Results

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

QI Spotlight