HLTH 6882 Week 9 Change Resistance Peer Reply Example

Week 9 Discussion: Reply and Follow-Up

Reply to Jordan: Who Will Resist Tablet Check-In, and What Their Objections Reveal

Reply to Jordan

Jordan, as I read it, your proposal replaces the paper intake form at the composite rural health clinic with a tablet check-in that patients complete in the waiting room, with answers flowing straight into the record so front desk staff no longer re-key them. That should save time and reduce transcription errors, and I think it is worth doing.

I expect two groups inside the clinic to object, and I think both objections point to work your proposal has not counted. The first is the front desk staff. Paper intake is not only data entry; it is a conversation, and that conversation is where staff hear that a patient has changed jobs, lost Medicaid or added a spouse's plan. A tablet form will ask whether insurance has changed, but patients often do not know that it has, and the form will not catch what a person at the desk catches by asking a follow-up question. The second is the billing clerk, because missed coverage changes become denied claims, and denied claims land on that desk. Denials are not a small matter: when economists studied insurers' remittance records nationwide, they saw denial rates differ sharply from one payer type to another, with fee-for-service Medicaid denials running 17.8 percentage points above fee-for-service Medicare (Gottlieb et al., 2018). In a clinic with many Medicaid patients, a quiet loss of coverage checks could raise the clerk's workload more than tablets save at the desk.

I would treat both groups' resistance as information rather than obstruction. Ford and colleagues argued that resistance often carries useful knowledge about how work is really done, and that managers who treat it only as a barrier lose that knowledge (Ford et al., 2008). Lewin's idea of a force field is useful here in a practical way: easing a restraining force often moves a change further than pushing harder on the driving side (Lewin, 1947). The restraining force in this case is a real risk, missed coverage changes, and you could ease it by keeping one short coverage question at the desk for every patient, even after tablets go live.

My question: in your redesigned process, which step catches a coverage change that the patient does not know about?

Follow-Up

Jordan, thanks for the answer. Running a real-time eligibility check against the payer when the tablet form is submitted would catch many changes the patient does not know about, and it is better than relying on the form alone. I would still keep the desk question for a few months and compare: count how many coverage changes the eligibility check catches and how many the desk question catches that the check missed. If the desk question finds almost nothing extra, you can drop it with evidence, and the front desk staff will have seen that their concern was tested rather than dismissed. The billing clerk could track denials for coverage reasons before and after the change, which gives both groups a stake in the result. Gottlieb and colleagues' estimate that billing disputes tie up billions of dollars of revenue each year nationally (Gottlieb et al., 2018) is a reminder that even a small rise in denials can cost a clinic more than the time a tablet saves.

References

Ford, J. D., Ford, L. W., & D'Amelio, A. (2008). Resistance to change: The rest of the story. Academy of Management Review, 33(2), 362-377. https://doi.org/10.5465/amr.2008.31193235

Gottlieb, J. D., Shapiro, A. H., & Dunn, A. (2018). The complexity of billing and paying for physician care. Health Affairs, 37(4), 619-626. https://doi.org/10.1377/hlthaff.2017.1325

Lewin, K. (1947). Frontiers in group dynamics: Concept, method and reality in social science; social equilibria and social change. Human Relations, 1(1), 5-41. https://doi.org/10.1177/001872674700100103