Managua

The rest of the Central American tour had been fun, almost festive. Considering the time of the year, that made sense. Christmas was approaching. People had been loud, cheerful, and open to start a conversation or spontaneous lunch with the visitor from North America. So much fun that it didn’t seem like work.

In stark contrast, the airport in Nicaragua was austere and sullen. Customs were mechanical. People talked in low voices. The driver waiting for me could not be drawn into a conversation. He kept looking in his rear-view mirror. He carefully minded the speed limit. I had not observed that in the other countries.

A horn blared behind us. My driver jumped, and inched toward the side of the road.The military Jeep came up close behind us. I thought they would to stop us. Instead, the jeep roared past us. It was overloaded with uniformed men. They bounced on with Kalishnikov’s slung over their shoulders, quickly out of sight.

Next morning, I arrived at the severe government office where I was to make my presentation. I introduced myself to the translator. We worked out the standard mechanics of translating – the pace and size of the sound bites. It was getting to be time.

Leaders of business and the military were seated in the room in front of me. My first slide was up. I looked over my audience. To a man I could see they were expecting the worst news from me. I took a deep breath, and gave my usual start to the presentation:
“Thank you for taking time from your very busy schedules to listen to me. We all know that the results of this problem can have severe effects on your business and security. My team has reviewed the efforts to analyze and correct the defects. Thousands of man-hours and millions of dollars have been spent.
“As a result, I can safely assure you that the problem called the ‘Y2K Bug’ will not have an adverse impact on you. This is the first time in history that we had the time and knowledge to successfully avoid an international catastrophe.”

The room relaxed. So did I.

Whole Foods Evacuation

Just as I was entering the Whole Foods store, I encountered a wave of people exiting all at once. A fire alarm had gone off. The customers were calmly leaving under the directions of the staff.

I figured that we would be waiting for a while, so I decided to see what I could observe.

The customers who decided to wait it out in the cold clustered under the entrance. The entrance has a large portico with heaters in the center of the ceiling. We gathered into this relatively warm spot.

I looked around to see what the staff was doing. A person, whom I guessed to be the manager, was at the doors, making sure that no-one entered. He was also making sure that the entrance would be available to the firemen upon their entry.

Another person was directing traffic away from pulling into the parking lot. Those who wanted to leave were not interfered with. However, new parking was prohibited. The person was very polite, but firm. No-one gave him any trouble.

A policeman and a fire crew arrived. The policeman parked to block entry into the lot. The firemen parked their rig on the street where it would be quickly available if necessary. In the meantime, their parking did not add to the congestion in the parking lot.

The manager guided the fire crew into the store. The policeman monitored the front entrance.

I did not notice many of the stockers and clerks in the crowd. I looked around, and heard a group shout over in one corner of the lot. That was where the crew were collected. I inferred that this was their safe spot for everyone to gather and be accounted.

When the fire crew and the manager appeared to give the all clear, there was a rush of the customers to get in. As I normally do, I held back to observe. The customers clotted the doorway to the store floor. I noticed that the staff used the store’s exit to slip back onto the floors and to their stations. It gave them a few seconds to be ready when the customers started requesting service.

From a process perspective, I was impressed. It is evident that there has been a lot of safety training and practice. Everyone knew their expected roles, and enacted them correctly. It explains to me how they get a lot of other things right. Good work!

Broken Collection Process

Just before New Year’s I got a dunning letter from a Florida collection agency for hospital services dated 10/29/2013. There were three things odd about the letter. (1) We had received no services on that date. (2) We had received no bills from the hospital. (3) The letter was missing our apartment number on the address.

I did not panic. Business Process Analysis has allowed me to solve much more complex problems than this. I would just follow the process flow, instead of raging at the people. I called the hospital billing for an explanation.

The customer service at the hospital could not help me. Once the bill is sent to collections, it is out of their hands (not very friendly policy, I might add). I did discover that they had sent out a bill to the insurance company, but had received no reply. They also sent out five notices, which never arrived in our mailbox. I asked if there were an administrator that could address this issue at the root. No, it has to be handled in Florida.

I called the collection agency. It is really a part of the hospital, but presents itself as a separate company. The agent who worked with me was very helpful. We walked through the workflow together, step-by-step. First, why was a bill created on 10/29? I offered that we had a surgery scheduled for that date. However, the surgeon had rescheduled it for later in 2014. The agent researched the original code, and found that it was for lab work done on that day. No such lab work was performed, as we were not even in town on that day. The agent guessed that the person who initiated this probably was not aware of the changed schedule, and created lab bills in batch to match with her schedule of surgeries.

This is plainly a broken process. Someone has created a short-cut to save time, but invited an error to enter the process. We’ll get back to that.

Next mystery. Why did the insurance not respond. Pam went online, and checked the insurance history. There is nothing for that date of service, nor anything about the amount of the bill. I suspect that they saw a bill for a service that could not be matched up, and dropped the matter at that point.

A second break in the process. The insurance company did not have a procedure to handle rouge claims? Or, they did respond, and the hospital had no process to track such responses? Again, we’ll get back to that.

Next step. Why did I not receive any bills from the hospital? This, I could guess. We just recently moved into this apartment. The mailman was not familiar with us, yet. So, the poorly addressed bills were discarded.

You see where this is going? Each step of this flow has someone doing something that is convenient to them, but breaking the process.

Finally, the hospital pushed the bill to collections. Collections sent me the letter. The letter still had the bad address. However, the postman now knows who we are, so the dunning letter arrived.

Resolution of my problem: we are to send a letter documenting all of the goof-ups, and ask that the bill be corrected. Done and done.

However, this does nothing to solve the process problem. I need to ask the hospital to change their handling of lab bills for surgery to focus on accuracy, rather than bulk convenience. I need to ask the insurance company to explain and possibly modify their handling of unmatched claims. I need to ask the postman to organize orphaned letters instead of piling them on top of the mailbox area.

This is a multiple agency process – probably one of the most common business process problems, and one of the most difficult to fix. But, it should be fun trying.