Leveling up your RCM via gamification

What if the work of managing your revenue cycle was more like a video game — a fun, competitive and high-energy environment?

That’s exactly what Carol Wanke, vice president, post-acute revenue cycle, Sharp HealthCare, set out to do for Sharp, the largest health system in San Diego, Calif., with more than 2,900 affiliated physicians and 18,000 employees.

As more of our daily lives are reshaped by technology, it also means behaviors are driven by real-time data. Adding those elements to the workflow of her revenue cycle team was a step toward building a culture of transparency and trust, while also increasing motivation and the quality and accuracy of employee performance.

Not only that, but Wanke said that real-time information helps build manager capabilities: There are accurate insights into employees’ work, and faster interventions for peer coaching when someone falls behind. Altogether, it also reduces the amount of time required to prepare formal performance reviews while also satisfying younger employees’ desire for feedback and recognition.

When it started

In September and October 2017, Wanke’s team initiated a project to add gamification — elements of game design (e.g., point scoring, competition) for non-gaming purposes — to the revenue cycle workflow at Sharp. This process encompassed dashboard planning, on-site work sessions and weekly development calls the following year to determine three pilot teams for a gamified workflow within the practice’s athenahealth platform for:

• Hold bills
• Customer service and self-pay
• A/R credits.

“It’s to foster motivation and improve performance,” Wanke said. “The central idea is to take the building blocks of games and implement those in real-world situations, often with the goal of motivating specific behaviors.”

What it looks like

Working with gamers, the Sharp gamification project team ended up with four main game features as part of the new revenue cycle workflow:

1. Gameplay/challenges: These elements of competition and engagement lead to better employee performance.
2. Leaderboards: In addition to driving competition, these provide actionable, real-time information and recognition.
3. Performance monitoring: This helps reinforce best practices and helps influence future outcomes.
4. Manager dashboards: These help the team leaders ensure alignment of the game and outcomes to organizational goals.

As Wanke explained, each user has his or her game board when they log into the system. “They can see how many points they received, they can see who’s ahead of them, who’s behind them. … They can try to catch one another,” Wanke said. “It really is a great way to motivate folks.”

Steps to solutions

The first order of business to build out this type of program is to “understand your workflows that you’d like to be able to gamify,” Wanke said. “The key is understanding your work: What’s gold standard work?”

Wanke’s team already had what she described as a “pretty slick revenue cycle tool” for exception-based processing, so the process became focused on making sure that the best practices of that workflow were built into the game elements and the eventual analytics platforms — leaderboards, managers dashboards — would show data that reflects the organization’s aims.

The project also needed to recognize that some employees did not like the game approach. “You can choose to be in the game or not,” Wanke said. “You don’t have to, [but] we’re still going to assign those points; we’re still looking at your productivity.”

Virtual points produce real results

After implementation of gamified workflow, Sharp saw an 11% increase in overall productivity with the same level of quality. For the employees who are invested in the gamified elements of their work, there’s motivation in knowing your best daily performance and working to beat it, or seeing on a leaderboard that someone else has supplanted you in the top spot. Underneath all of it is the ability to know their work matters.

“The staff really want to have feedback on how they’re doing and how they’re performing,” Wanke said.

A teamwork element also developed. After one team member left the company, the team realized that they could replace that employee’s productivity without rehiring the position. Instead of hiring a new full-time employee, the team was able to add 125 additional tasks per person, per month. That motivation and awareness also helped turn around the performance of some of the lower-performing members of the team, Wanke said.

Similarly, the gamification had benefits for recruiting and onboarding new hires, as the Sharp team can show that there is a fun and innovative way for people to work. There also were benefits in employee retention, as staff turnover fell from 6% before the gamification to 1.8% after implementation.

The gamified approach to the revenue cycle work also was beneficial for leadership beyond the advantage of having a real-time look into staff productivity and finding problem areas faster. “It’s a lot easier to have a conversation with a staff member, when you’re looking at their performance, to say, ‘Let me show you how you can get more points; let me show you how you can be more productive,” Wanke said. “The conversation changes.”