Return to the BDMI dashboard.

You know that processing time has decreased. Reported pending claims have decreased. Administrative cost per claim has decreased. Contractor service levels are high. Most prior corrective actions are reported closed.

You also know that beneficiary complaints have increased by 14 percent.

At this point, what can you responsibly conclude?

Not much about cause.

The complaint increase is a signal worthy of attention, not proof that BDMI is failing.

The appropriate next move is inquiry.

Consider the progression:

EVENT
A beneficiary reports a problem.

PATTERN
Complaints are increasing.

STRUCTURE
What workflows, measures, technologies, incentives, information pathways, or operating conditions should oversight examine?

SYSTEM BEHAVIOR
What might the organization be repeatedly producing that is not fully visible in its headline performance measures?

Notice what has happened.

We have not made a finding.

We have improved the question.

Begin Lesson 1

Lesson Purpose