David Turetsky and Dwight Brown – ADP Pro Series 2022: Lessons for HR from Medical Quality Analytics

Connect with Dwight:

• 
• dwight.brown@salary.com

Connect with David:

• 
• 
• david.turetsky@salary.com

 

Podcast Manager, Karissa Harris:

• HRDataLabs@salary.com

 

Production by Affogato Media

Resources:

• Compensation Consulting Services
• Compensation Data
• HR Data Labs Season 4 Episode 10
• HR Data Labs Season 4 Episode 8

• “One of the big barriers that we had to get past was people letting go of their processes.”
• “I think if organizations could move [toward automating their performance management processes], their ability to do performance management, both proactive and reactive performance management, is enhanced.”

Announcer: 0:02

Here's an experiment for you. Take passionate experts in human resource technology. Invite cross industry experts from inside and outside HR. Mix in what's happening in people analytics today. Give them the technology to connect, hit record for their discussions into a beaker. Mix thoroughly. And voila, you get the HR Data Labs podcast, where we explore the impact of data and analytics to your business. We may get passionate and even irreverent, that count on each episode challenging and enhancing your understanding of the way people data can be used to solve real world problems. Now, here's your host, David Turetsky.

 

David Turetsky: 0:46

Hello, and welcome to the HR Data Labs podcast. I'm your host, David Turetsky with me as always my friend and co host, Dwight Brown from Salary.com. Hey, Dwight, how are you?

 

Dwight Brown: 0:55

Good morning, David. I'm well. How you doing?

 

David Turetsky: 0:57

Good. We're here at the ADP Pro Summit in Dallas, Texas. And we had something in our coffee because we're both a little giddy this morning. But I uh what do they say? We have a step on our giddy up or something like that? Yeah, hitch in our giddy up?

 

Dwight Brown: 1:11

Hitch in our giddy up maybe?

 

David Turetsky: 1:12

Yeah, I don't know. I don't speak Texan.

 

Dwight Brown: 1:14

We're just so addled already this morning. We can't even think of that.

 

David Turetsky: 1:18

Yeah, yeah. Which is just strange. And so anyways, we we were talking this morning,

 

Dwight Brown: 1:21

It is. and I think we stumbled upon a very fascinating topic that we think you guys might like as well, which is Dwight's past. No, no, no... I think I think a therapist would love that topic.

 

David Turetsky: 1:37

Yeah, I was gonna say let's, let's be very clear here. We're going to focus specifically on your work at the Mayo Clinic. And some of the work you were doing, quality analytics, that focused on some very specific use cases that may provide us with good examples of how we can use automation, process automation, to not only help measure what we do, but also to in some cases, save lives. Right?

 

Dwight Brown: 1:59

Right, exactly. Through the automation, you, you're able to have cost savings, and you get some sort of benefit from it. That enables you to do more with less.

 

David Turetsky: 2:10

And in the case of nursing, and the nursing example, could potentially save lives.

 

Dwight Brown: 2:14

Yeah, exactly. Right.

 

David Turetsky: 2:24

So Dwight, talk to us about some of the history of how something like this comes up? How do we examine processes? And how do we look at what are typical things that can be automated and, and what we're going to try and do later is we're going to try and draw that back to the HR technology example. But in your past, what kind of brought up the need to do process automation, and how that intersected with your world?

 

Dwight Brown: 2:48

Yeah, so going back to this really goes back to 2007, I took over leadership of a group of 13 nurses and and four reporting staff, part of our participation in Medicare, we had to report cost and quality measures to the government. The way that the government had it set up from previous years was that we had to manually, our nurses had to manually abstract our medical records for patients. So

 

David Turetsky: 3:16

They literally had to go through patient files?

 

Dwight Brown: 3:18

Yeah, manually manually sit in front of a sit in front of a monitor, pull up a patient's medical record, read through the notes in that patient's medical record, just to figure out was the patient given a particular medication, for example, in order to get vancomycin at 1pm that afternoon? And was that within the time window that fit the quality standards? And it was laborious, it was slow.

 

David Turetsky: 3:48

Did they have to like, then transpose that into some other form, like either on paper or in another spreadsheet or something? So that you could like codify it?

 

Dwight Brown: 3:55

Yep. That's exactly what they did. They pulled it out, put it into a spreadsheet. And then the government had a, they had developed a software program. And we would then have to take the data from the spreadsheet, and once again, transcribe it into their software program.

 

David Turetsky: 4:10

And you are having nurses do that?

 

Dwight Brown: 4:11

Yeah, yeah. These are nurses that we took off the floor. I had 13 of them that were working on this when I started in 2007. And the big problem was that not only was it time consuming and laborious, the government kept adding additional measures every year that we had to do this for, and I calculated it out just from a strict data element perspective. And we were seeing a 25% year over year growth steadily from the government on this and I, you know, the automation piece

 

really was born from number one: 4:44

I have always believed heavily in automation and leaning on the technology, but number two, when it came time to, to look at budgets for the following year, and I was having to ask for more FTE and was constantly being turned down for it. I was like, we've we got to do this different, we've got to look at this differently.

 

David Turetsky: 5:09

And let's set some context here. I don't know if anybody remembers 2007. It was the year the iPhone first came out. Right. And it was not where we are today, in terms of the world of Process Automation. It was, it was much earlier on. And so tools were much more rudimentary, right?

 

Dwight Brown: 5:26

Right. Exactly.

 

David Turetsky: 5:27

It wasn't like you could screen scrape the or, or have something, transfer those files out of that proprietary system that you probably had. And do some, you know, NLP, Natural Language Processing, to be able to turn that into something different and do and do the codification. That kind of automation, right?

 

Dwight Brown: 5:46

Yeah, exactly. Exactly. In fact, at that point, NLP was was in existence, but it was in its infancy at that point. And the so you're exactly right. From a technology standpoint, the technology just wasn't there that we that we currently have this year, like you said, the screen, the scraping and a lot of the more complicated NLP algorithms and those kinds of things. And so it really, it did require intensive human intervention. But but at the same time, when you looked at it, you realize that there, there was a lot there that didn't require the human judgment. And, you know, going back to my example of was a patient given a specific medication at a specific time, and so, so that really drove a lot of it. And there was, we were in our infancy, technologically, but at the same time, there was enough on the horizon that we were able to, we were able to kind of envision, where, where to go from there. And I could, I took a look at it and said, I know that this stuff is developing is going to develop at a rapid pace, and let's utilize it as best possible.

 

David Turetsky: 7:04

So let's kind of transition that to, then what happens next, like you're envisioning what the solution is, and it should include some kind of automation. What what I mean, we're talking still 2007. What did you do to solve the problem? You don't need to be specific, if you don't want to.

 

Dwight Brown: 7:22

Right. No, it was really, it ended up being a two prong approach. We started down one road, and then another road opened up. So the the road that we started down, was working with our IT folks, first of all, saying, Is it possible to pull these these elements out of the medical record? And at that point, we had a homegrown electronic medical record. And so and there were several pieces that were put together. And so it was, you know, it took some looking on the part of IT, but they said, ultimately, we should be able to do that. Then, as we, as we started down, that we also had to get the physicians on board or the providers on board, not just the physicians, anybody who documented and put put in place some other processes to create more discrete data elements. And so we went through the ones that we typically manually abstracted and literally made a list of these things and said, Okay, what, what do you see the most frequently? What can we bite off? And kind of taking it from that process perspective. Partway into this, the government, this is when ACA came out, the Affordable Care Act. And under ACA, there was a provision called Meaningful Use, which the government incented organizations to develop electronic develop and use electronic medical records. At that point, you know, a lot of organizations

 

David Turetsky: 8:47

Outstanding. were still working off a paper for a lot of their process, their documentation process. And so, the upside to that was that it really pushed for more standardization of data. And we went from our homegrown system, we made a decision to move to a vended solution called Epic at that point, I think there were

 

three major providers: 9:13

Epic, Cerner, and I always forget the third one. But what that ended up creating was this, this junction between moving toward a standardized medical record from which we would be able to standardize the data elements, automate the poles of of those, those data points, and at the same time really getting the providers on board with the fact that they were going to have to document differently. And in some cases, that would be fewer clicks. In some cases, it would be more clicks.

 

David Turetsky: 9:42

Right. But But ultimately, at the end, what they're getting out a result, that is more reportable. It's more analytical, that can be a better analyzed right, and it serves a lot of purposes from the entire stack from providers all the way through to the insurance companies and government reporting. So lots of wins. It wasn't just win win, it was all wins all the way around.

 

Dwight Brown: 10:04

Yeah. And one of the big one of the big issues that that are one of the big barriers that we had to get past was people letting go of their processes, the...

 

David Turetsky: 10:15

Dwight, no one, no one wants to hold on to process do they?

 

Dwight Brown: 10:19

It never happens, never happens. This was the exception, not the rule. But you know, ultimately people saying, well, if a human's not doing it, it can't possibly be as good. And there's, you know, it's like any automation process. There's truth to that. But there's, there's also a lot of falsehood to that,

 

David Turetsky: 10:37

There's a lot of Who Moved My Cheese.

 

Dwight Brown: 10:38

Right, exactly. And so the biggest barrier is we talk about automation, whether it's an HR processes or otherwise, one of the biggest barriers that you reach is, is that letting go and that trusting of the data. And that's a process that doesn't just happen overnight.

 

David Turetsky: 10:57

Well, I mean, talk about the process, that's change management, right.

 

Dwight Brown: 11:00

Totally.

 

David Turetsky: 11:01

You have to invest in being able to document and educate those stakeholders, high and low, all the way through the stack all the way through the chain, as to not just the benefits, but also how to do what you used to do. How to feel comfortable with this thing, and how to live with it, because frankly, we're not going back.

 

Dwight Brown: 11:18

Right, right, exactly.

 

Announcer: 11:20

Like what you hear so far. Make sure you never miss a show by clicking subscribe. This podcast is made possible by Salary.com. Now back to the show.

 

David Turetsky: 11:29

So why don't we take that as an opportunity to now shift our focus? Because great example, right? Phenomenal example of how you had a business problem, you needed to use some kind of automation? And then you tried, yeah, did you put your foot out there. So let's talk about HR and HR is reliance on my favorite, this is my favorite example, the personnel action form, or the path as we call it. Now, we've changed the word from personnel to HR decades ago, but we're still calling the Personnel Action Forum. It's not the personal Action Forum. The personnel

 

Dwight Brown: 12:11

It can feel personal!

 

David Turetsky: 12:12

It can feel very personal at times. In fact, the stuff that we the stuff that we put in it is very personal.

 

Dwight Brown: 12:18

Right! Exactly.

 

David Turetsky: 12:19

And we put it in that extremely secure manila envelope when it gets transferred through the organization with that ultra secure red string that goes on top of it. But but we laugh, but there are still companies that are sending through the mail and through interoffice mail, personal, sorry, personnel action forms. Exactly, sorry. Okay, not enough coffee yet. But But But that brings up that they are, I don't want to say stuck. We are as in HR, we're stuck with a process that works. Maybe in our plants, maybe it works at our remote offices. And while there are lots of employee self-service, it's hard to move on this form. Right?

 

Dwight Brown: 13:03

Yeah.

 

David Turetsky: 13:04

And we have lots of checks and balances built into a personnel action form when it becomes part of Employee Self Service and HR technology. But when you actually use a form, you don't have it. And humans become those checks and balances, they look at tables and make sure that the table entry values or the table values are all entered correctly, they have to do the cross comparisons between the current records and the records on this paper form. They have to make sure there's consistency on the form itself, and that nothing looks like it's in contrast. So the form itself is not only manual, but it creates a lot of headache for the person who is not only using it on the front end, because they don't know the rules by which they're entering the data on the on the form, but also the person who's entering it into the technology. You know, it's just the start of well, the QA process of that transaction.

 

Dwight Brown: 14:02

I was going to say humans are inherently error prone. And it's from a, from a data quality perspective, it's, you know, there are all kinds of issues that, that go with it. And, you know, being able to automate some of those quality checks, like you were talking about some of those, some of those lookup tables and pieces like that really does help on the human labor side, but it also helps with the integrity of

 

David Turetsky: 14:33

Oh, absolutely. And the expedience for which the data. that thing gets processed. Because, frankly, that process probably happened already. You have communication, even though it hadn't been approved yet. But communication probably happened already. The manager already gave the increase. So the manager already communicate with the employee that you're going to get promoted, even though the promotion hasn't been finalized, signed off on nor is it actually in the system. It's not a record yet. So what we face all the time where, you know that personal action form, sorry, personnel action form gets created, maybe a day, a week, a month after the actual transaction took place, and that we're doing retro transactions. And that affects things like payroll, it affects things like, you know, if it's promotion eligibility to certain things. And when a manager goes and looks at their headcount, and they go, Wait a minute, I promoted Dwight, why is his level wrong? Why is his title wrong? This happened a month ago! Well, that's because of that personnel action form. And it hasn't been fully created, fully vetted, and fully signed off on.

 

Dwight Brown: 15:40

Exactly. I mean, you think of the DMV, that it's the stereotypical DMV!

 

David Turetsky: 15:44

Do I have to talk about the DMV, really? I was having such a good morning.

 

Dwight Brown: 15:48

But that's what processes are like, you know, you stand in line, somebody stamps your form, and then they pass you to the next person...

 

David Turetsky: 15:56

Yeah, but even in the DMV, and let's give all credit to the states. They've made those processes easier.

 

Dwight Brown: 16:01

Yes! They've automated so much of that.

 

David Turetsky: 16:04

Yeah. And you can sometimes you can walk out of the DMV with a license, mostly not, but certainly walk out with license plates. Unless they're custom license plates, you can walk out with a registration, typically. Whereas in the past, I remember when we bought a car, and you know, you go to pay the tax on the car, and you know, complete all the registration forms. You had to wait, you have to wait for the mail to come with the sticker and this and that. And the other thing and the plates, and you know, they've done a good job. Yeah, making that easier.

 

Dwight Brown: 16:33

Exactly. And I figure if the DMV can do it, anyone can do it.

 

David Turetsky: 16:37

That's right. I mean, again all credit to the automation and the Department of Motor Vehicles, especially in the great Commonwealth of Massachusetts, thank you very much for making sure that my plates come on time and everything. Everything's good. But no, seriously, it that's a really good example of where you take a very complex process with millions of transactions every day, probably, and they're simplified to the extent where all the checks and balances are built into the process, so that the end result becomes easier. QA becomes, instead of a step, it becomes part of the form becomes part of the process.

 

Dwight Brown: 17:15

Yes, exactly.

 

David Turetsky: 17:17

And for HR, you know, think about the modern HR systems, which help you along the way whether it's employee or manager self service, there are there's workflow built in. Is it optimized? Probably not. It's probably following the same personnel action form process that happened years ago, right. But but it's better, right?

 

Dwight Brown: 17:38

Yeah, exactly. And that's what it is. It's incremental improvement, you these, these small tests of change, and you kind of figure out how you're able to do things, how you're not able to do things. And so when you're, when you're talking automation, it really is a journey. It's not a it's not a full destination, it takes a while for you to get there. And that's, that's what we that's what we ran into in the example that I gave earlier, where we were making small incremental changes. And we'd pick one disease set, for example, and one data element out of that disease set and tackle that together with the providers and with the IT folks, and then continue to move on.

 

David Turetsky: 18:30

So let's take that, because that's a perfect transition to the next segment, which is, what are good examples on the HR side, being able to tackle those incremental improvements that companies can make that our audience could make that would make their lives easier? My favorite, if you don't mind me starting, the job table where we see it become, I don't want to go all the way to a cesspool. I could. But it becomes it becomes a trough though, a holding trough for literally all the jobs that have ever been processed through the HR IT. And clients don't have the time, nor the energy nor the personal touch. They don't have the people to be able to go in and actually fix it. So when someone's making that next promotion, and they go to the job table, and they're doing a search and they go, ooh, this sounds good. This one looks good. But it's one that you should have been activated. It's kind of a dead job title. And it doesn't really fit into any structures that you currently have. It's still there. Because it's not inactive. They have access to it, and they're going to do it. Yeah. So what are other examples from your perspective of good tables to kind of clean up to make sure those automations are those processes happen?

 

Dwight Brown: 19:50

I think of things like performance management, for example, performance management has been an inherently paper based in organizations and generally the data that gets input from an HR perspective was, did a performance appraisal get done or not. And that's it. Where if you start to automate some of the process, not only the process flow to say to the manager, okay, this, this employee is up for their performance appraisal, but also the actual rating of the employee, and then being able to have that data input in there. So that then you can start to cross match that with other elements of HR data. I think if organizations could move more in that direction, with the automation perspective, their ability to do performance management, both proactive and reactive, performance management is enhanced. And by having that automation in place, it's not laborious to do. It administers itself eventually, as you kind of iron out the wrinkles with it.

 

David Turetsky: 20:53

One of my favorite things about performance management systems, when especially when they're in Word, is I get to be very verbose and provide feedback, especially a lot of feedback. Sometimes it's feedback that isn't necessarily well thought through. What happens with automation is they have filters built into the technology. And actually, they have keywords, and they have suggested phrases, so that it makes the process not just easier for the for the administrators, but it makes the participants better because it prevents them from doing or from making the mistakes that we had typically seen made in the past. Yeah, of saying either very negative things, or not providing constructive criticism. Yeah. And it even has word filters that filter out curse words, for example. So that if an employee gets really angry, as they're completing their self evaluation, or the response to their evaluation, it flags them it could be flagging for follow up from HR, which we've seen happen, not not you Dwight, I'm not talking about our performance process. I'm saying that in the past, when I manage these processes, as a manager, as well, as an administrator, I've seen that happen, right? And so enhances the process and makes the process better, not just making it automated for the sake of just automation.

 

Dwight Brown: 22:17

Right. Exactly.

 

David Turetsky: 22:18

And by the way, performance management is not going to save lives. What it might do is it might help us understand who needs more training, and who needs improvement, you know, those opportunities for improvement, so that they can get the training, they need to save lives, right? Or to be to be let go, and therefore not cause problems that could lead to potential patient outcomes that are not optimal.

 

Dwight Brown: 22:43

Yes, exactly.

 

David Turetsky: 22:45

Are there any other examples you want to highlight? I think I had one other but if you have another one?

 

Dwight Brown: 22:51

No, I think we've, we've hit a good number. Okay, a little bit there. So, okay, what's your what's your other one?

 

David Turetsky: 22:58

You want to hear it?

 

Dwight Brown: 22:59

Yeah.

 

David Turetsky: 23:00

Okay.

 

Dwight Brown: 23:00

Let's hear it!

 

David Turetsky: 23:01

It's my favorite table that is used to set up the HR processes, HR transactions, it's the action reason code table. And it's one of those things that you look at when you're doing analytics to see how am I codifying things like a termination. And for those of you who have heard me say this before, I'm sorry, but I love repeating the obvious. There should never be an action reason that says termination: Resignation. Never. There should never be why they're all resignations. They're all leaving. They're all resigning, you need to go deeper, you need to go levels deeper. Why are they leaving? Are they leaving because they got a better opportunity? Are they leaving because their spouse and them are moving? Are they leaving to change careers? Are they leaving because they hate their manager? It happens. And so we need to actually look at that action reason Code table and make sure that it is within the realm of reality. Now a lot of them are standardized, like it's action may be promotion, and it might be job change. There's some that they're just standard, right? But look through them and modernize them and make sure that your processes are collecting the appropriate information necessary to make sure that those changes and those forms that are still forms, but they're now automated. They're giving you the right data you need to be able to analyze them appropriately. As well as know what the heck's going on in your organization.

 

Dwight Brown: 24:29

Yeah, well put. Very well put.

 

David Turetsky: 24:32

Thank you. I'm gonna drop the mic now and walk away. So Dwight, we talked about a lot of fun things about your experiences, and how they could lead to examples of how to make changes to process to make them better and potentially save lives. Thank you very much.

 

Dwight Brown: 24:59

Thanks for having me. Thanks for talking with me about this.

 

David Turetsky: 25:02

You're the co host. It's not me having you. Now it's us having you.

 

Dwight Brown: 25:04

You should have seen the look that I got from David when I said that. It's kind of like the dog cocks its head look.

 

David Turetsky: 25:15

That is a look that my dog sees all the time and goes, you must be my brother, or my dad. All right. Well, thank you very much, Dwight. Hopefully we will talk again soon.

 

Dwight Brown: 25:25

Thank you!

 

David Turetsky: 25:26

Take care and stay safe.

 

Announcer: 25:28

That was the HR Data Labs podcast. If you liked the episode, please subscribe. And if you know anyone that might like to hear it, please send it their way. Thank you for joining us this week, and stay tuned for our next episode. Stay safe