No Late Payments: Improving Invoice Processing in Boston

A team of six staff members began a formal QI process using the 10-step Model for Improvement. Staff participated in an in-house basic QI training to map the existing invoice posting process and to identify pain points and waste. The team also analyzed the aforementioned root causes by using a fishbone diagram during the training. This team then met every 2 weeks to brainstorm, test ideas, and analyze the results using a run chart. The AP office current process trained all AP staff in all steps of the invoice processing method, including processing invoices, reviewing for errors and posting approved invoices, leading check runs to administer payment, and resolving issues with problem invoices. However, this tended to complicate the method because of lack of clarity on where individual invoices were in the process, which contributed to possible delays. To address this issue, the team first tested an idea of assigning AP staff specific roles to enhance efficiency of posting invoices, so one staff person was responsible for each of the aforementioned processing steps. After approximately 1 month of testing this change, the team decided to adapt it so that all AP staff would rotate roles once a month to avoid boredom and allow staff to continue to perform multiple steps in a way that still allowed for efficient processing. Each AP staff member would continue to perform that role until the next rotation the following month. While continuing to rotate AP staff roles, the team also tested a checklist for programs to remind them of everything they need when completing an invoice and to avoid unnecessary delays due to incomplete or incorrect information.

The team tracked two process measures: the percentage of invoices that were posted within 30 days and the average number of days to resolve and post problem invoices.