Case Study 7: Solving Team Challenges at DocSystems Billing,
Inc.
Read the DocSystems Billing case, including the briefing
document and four scenes, and consider the following
questions:
What problems exist in this organization? How do these
problems differ based on the employees’ roles? Why do
employees object to Jim’s proposed solution?
Make a recommendation to the client about what could be done
next based on the data included. Summarize your observations
for Jim, offer possible interpretations, and suggest an approach
for next steps.
Briefing Document: DocSystems Billing, Inc.
About the Company
DocSystems Billing, Inc., processes insurance billing paperwork
for a network of small health care clinics throughout the United
States. Privately owned physician practices, as well as
specialists such as cardiologists and physical therapists,
contract with DocSystems to process the billing paperwork
through the maze of health care insurance companies and
networks. DocSystems charges either a flat fee for each bill it
processes or a percentage of the total, depending on the contract
with the provider.
About the Call Center

Forty full-time employees work at the onsite call center: 30
Medical Insurance Specialists (who handle cases of moderate
complexity) and 10 Senior Insurance Consultants (who handle
very complex cases). The senior consultants have usually
worked up through the ranks, often first working on basic
billing, then as medical insurance specialists. Most of them
have a long tenure with DocSystems, ranging from 17 to 23
years.
An additional 100 employees (called Billing Specialists) work
at an outsourced call center. DocSystems contracts out the
initial processing of claims and basic computer input. The
contract employees used to work at DocSystems until the
outsourcing.
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The call center was outsourced a year ago to another
organization. Almost all of the former DocSystems employees
were offered jobs with the new company, but the pay and
benefits were not comparable. Word has spread to the former
colleagues who remain at DocSystems that the outsourcing
company treats its employees poorly.
Call Center Reorganization
The remaining group of 40 employees was reorganized into two
new teams about 3 months ago. Initially, there had been two
managers—Alex managed the senior insurance consultants, and
Dana managed the medical insurance specialists. Both reported
to Jim, the senior director. In the new structure, Alex and Dana
both manage 20 employees, with each managing half of the
specialists and half of the consultants.

That meant that some of each group remained with their former
manager, while some moved to a new manager. Senior
management hoped that the integrated teams would start to
share knowledge between more senior and more junior
practitioners.
Roles and Work Process
Billing Specialist
The billing specialists do the initial computer input and handle
the majority of the cases. Normally this occurs without any need
for DocSystems intervention or assistance, but occasionally
there are difficult issues that arise. For example, a cardiologist
may have conducted a certain procedure that fits more than one
category in the DocSystems database, and the billing specialist
may be unsure how to categorize it accurately. A phone tree
system has been set up between the outsourced organization and
DocSystems so that the billing specialist can call any of the
medical insurance specialists, who are required to be on call at
least 4 to 5 hours during a typical 8-hour shift. The partners can
also formally escalate cases by handing them off through the
system for a medical insurance specialist to work.
Medical Insurance Specialists (MIS)
A similar process works for the medical insurance specialists.
They are assigned insurance cases on a round-robin basis. They
typically handle two types of cases: (1) any case that has been
“kicked back” by the insurance companies for more information
and (2) any case where the patient has filed a complaint,
grievance, or appeal. Like the billing specialists, they work on
the case to get it accurately processed and filed, and if they run
into problems, they can call on their senior counterparts, the
senior insurance consultants, to ask a question. They also have
the opportunity to formally escalate cases to have one of the

senior insurance consultants handle the case if it seems too
complicated.
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Senior Insurance Consultants (SIC)
The senior insurance consultants handle anything and
everything, but they usually work on only the most complex
cases. They also answer questions from the medical insurance
specialists. They usually get their work from formally escalated
cases that the medical insurance specialists cannot handle on
their own.
The DocSystems Case in Four Scenes
Central Characters
Jim: Senior Director, Customer Service, DocSystems
Dave: Organization Development Consultant, DocSystems
Rosie Jones: Medical Insurance Specialist, DocSystems
Carlos Chavez: Senior Insurance Consultant, DocSystems
Michelle: Senior Insurance Consultant and Carlos’s colleague,
DocSystems
Scene 1: The First Client Meeting
Dave and Jim sit at a large oval table in Jim’s office, discussing
the OD engagement and plans for the upcoming team meeting.

Jim:
Thanks for meeting with me. I really need your help facilitating
this team meeting.
Dave:
No problem, I’m glad to help. Maybe you can start by telling
me what you’re trying to accomplish.
Jim:
Basically we’re trying to redesign how the call center works.
We have a few problems. The first problem relates to processing
times. Our physician clients obviously want their payments as
quickly as possible, so the billing specialists must work very
rapidly to input the payment request to the insurance company.
Also, our physicians want us to service their patient problems
and appeals very quickly. Each role in the process is critical to
getting the work done and processed as quickly as possible.
Time is our number one success metric, and it’s our number one
failure right now.
Dave:
What are the results today?
Jim:
Right now we only have about 80 percent of our customers that
say that they’re satisfied with our services. From what I’ve read
in our industry, that’s at the very bottom. We’re seriously in
danger of losing customers if we can’t speed up.
Dave:
Have you done any analysis of where the bottlenecks might be
occurring?
Jim:
Yes. First, you should realize that the workload is tremendous.
Each week, the billing specialists handle almost 2,000 claims in

total. Our medical insurance specialists handle about 50 cases
each per week, and the senior consultants about 10. It might not
seem like a lot to handle only 10 or 50 cases per week, but some
of the more complex cases can take 2 to 4 hours each to
process. If we can’t meet our time commitments, our clients and
patients get frustrated. So we have metrics in place to monitor
how well it’s going. If a case takes more than 4 hours to
process, it turns “red,” which means that in our automated
system, the case shows up on our urgent list. When a case turns
red, we know from past data that it represents a customer who is
dissatisfied, or it doesn’t meet our service levels. The more red
cases, the more likely we are to lose a customer or to lose
money because we have to reimburse our clients when we don’t
meet our agreements with them.
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Dave:
What about the outsourcing? Do you have contractual
agreements with them on their own processing timelines?
Jim:
Yes, and actually they’re doing pretty well. We don’t usually
have too many problems with them. The real problem comes
when the cases get escalated to us. We have far fewer cases to
handle, yet since they’re complex they tend to take longer.
Some of our physicians have special service contracts with us
where their requests and their patients get top priority. They pay
extra for the service, and they expect higher service from us as
a result. For our Platinum Tier physicians, we have an
agreement that we will get back to them with a resolution to
their problem within 2 to 3 hours.
Dave:
What is the cycle time today?
Jim:

It’s 15 hours at the moment. In other words, they expect a
resolution in less than half a day, and we get them an answer in
2 days.
Dave:
What do you think is causing the delay?
Jim:
First, the cases are remaining with the medical insurance
specialists for too long. Their cases turn red at a faster rate than
anyone else’s. It’s the volume that’s killing us. Each of them is
forced to juggle 10 to 20 cases at a time. It’s too much for them
to take on, in addition to the calls that keep coming to them
from the billing specialists.
Dave:
Why don’t they escalate to the senior insurance consultants?
Jim:
They do, sometimes. But once they’ve started to work it, I
guess they think they may as well finish it. We just need to hire
more people, but we can’t afford it right now.
Dave:
Do you have any ideas about what could solve this problem?
Jim:
Yes, and that’s in part the reason I called to get your help. I
want the 10 senior consultants, who are the most
knowledgeable, to help the 30 medical insurance specialists
with their caseloads. We want more collaboration on the teams.
That’s why I’ve scheduled the 2-day meeting that we talked
about, and I’d like your help facilitating the team through a
design session where we get their input and figure out how this
new collaboration process will work.

Dave:
I’m definitely willing to help facilitate the session, and I
believe it’s the right approach to involve them in the design.
First, though, I think it would help me to understand their work
better if I could see how they worked. Do you think that one of
the medical specialists and one of the senior consultants would
let me observe them for a few hours?
Jim:
I’m sure they wouldn’t mind at all. You should meet with Rosie
and Carlos, who are our top performers. I’ll send them an e-mail
and ask if it would be okay if you contacted them and set up a
time to talk. Rosie and Carlos will also be on our project design
team, so it will be good for you to get to know them now.
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Scene 2: Observation With Rosie Jones
Rosie Jones, a medical insurance specialist, looks up as Dave
approaches her desk.
Dave:
Hi, Rosie. I’m Dave.
Rosie:
Nice to meet you. Please have a seat. I hope I can help you
with your questions.
Dave: I appreciate you letting me observe. As I said when we
arranged this, I really don’t want to take up too much of your
time. I’m just interested in learning more about what you do so
we can figure out this project together. What are these monitors
for?
[Dave points to the three computer monitors all located side by

side on Rosie’s desk.]
Rosie:
This one is for my e-mail, this one is for the case database, and
this one shows the calls that are currently waiting on hold.
Dave:
And the one with the case database—what are the numbers and
colors?
[Dave notices that the screen is full of line after line of case
numbers, patient names, and insurance company names. About
half are black and about half are red. More than 30 cases are
listed on the screen.]
Rosie:
These are all of my open cases. The numbers represent the case
numbers, and the red type means that the case is behind. This
last column shows the status. So if you look, most of them
either say “Waiting Patient” or “Waiting Physician.” On those,
I’m waiting for a return call. Some I could just close out now.
So at the moment, there’s not much I can do. Well, I guess on
these last three I could get started on them. Let’s see what they
say.
[Rosie clicks on the screen and opens up one of the red cases.]
Rosie:
This one says DED-1, which means “Denied for patient status.”
I’m not sure what happened, but it looks like we may have sent
the case to the wrong insurance company, who denied the case
and sent it back to us. This patient also has two health insurance
companies to deal with. I’m going to have to call the physician.
[Dave looks at the screens, mesmerized by the amount of detail
there is to monitor. Rosie is typing and clicking so quickly,

Dave can’t follow. Rosie marks the current case “Waiting
Physician.”]
Dave:
It certainly seems that there’s a lot going on at any one time.
How often do you escalate cases?
Rosie:
[looks up quickly and stares at Dave]
I don’t really need to. I know how to do my job. These are my
cases, and I want to work them. Besides, we all know what
happened to the billing specialists when they got outsourced.
You think I want to give up my work and not be doing
anything?
Dave:
What do you think about the model that Jim is talking about,
where the senior consultants would jump in and help out with
your caseload when it’s too much?
Rosie:
[forcefully]
You mean Big Brother watching over me?
Scene 3: Observation With Carlos Chavez
Later that same day, Dave arrives at his appointment with
Carlos Chavez, a senior insurance consultant.
Dave:
Thanks for letting me sit with you for a bit. How long have you
been with DocSystems?
Carlos:

[pouring a cup of coffee]
It will be 19 years next month. I’ve done it all, from billing, to
insurance, to management. I remember when we used to have
only three insurance companies to deal with, and I knew the
physicians personally. Now there are so many clients, patients,
and insurance companies, it’s really amazing.
[Carlos adds sugar and cream to his cup and they return to his
desk, just a row of cubicles away from Rosie’s. Like Rosie,
Carlos has three monitors arranged in a semicircle on his desk,
each showing the same information that Dave saw on Rosie’s
monitors.]
Dave:
What kinds of cases do you tend to work on?
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Carlos:
Well, here’s my list right now.
[Carlos points to the case monitor. There are just three cases
showing, all listed in red.]
Carlos:
I have this one, which was escalated because the patient was so
upset. She had three different physicians she was working with,
and only two were part of our client list. The insurance
company got confused and ended up paying too much, but we
also ended up mistakenly billing the patient for the work of one
of the physicians. You can see the case notes are three screens
long.
[Carlos scrolls through the case record showing the extensive
list of comments.]

Dave:
Looks like there is indeed a lot to sort through. How many of
these do you work at a time?
Carlos:
[putting his feet up on his desk]
Ah, it’s not that bad. This is pretty typical, with about one new
case per day. It will take a few hours to sort through, but mostly
it’s manageable, isn’t it, Michelle?
[Carlos yells over his cubicle wall to a neighbor. Michelle
stands up and introduces herself to Dave as a senior insurance
consultant.]
Carlos:
Michelle and I both left Alex’s team to work for Dana. Well, I
supposed we were technically forced to work for Dana.
[They laugh.]
Michelle:
Yeah, that’s been a joy, hasn’t it? If at first you don’t succeed,
reorganize to make sure you won’t.
Carlos:
[turning to Dave, voice rising]
You know, we were put into our new team 3 months ago. Dana
just had our first staff meeting on Thursday last week. She
hadn’t even called us to welcome us to her team.
[Michelle pulls out a sheet of paper filled with tally marks. At
the top it reads, “Where’s Dana?” There is a cartoon drawing of
a person on top of a mountain with “Dana” written above it, and
15 stick figures at the bottom of the mountain with question
marks over their heads.]

Dave:
So until last week, you hadn’t even spoken to your new
manager?
Carlos:
Whatever. It was much better on Alex’s team, but hey, I figure
the pay’s the same whether I leave at 5:00 or 6:30, whether I
have 3 cases or 30. We’ve had the standard 2 percent raise for
the past 3 years, and it won’t be any different this year.
Dave:
What do you think about the model that Jim has proposed to the
design team, where the senior consultants would help out on the
medical insurance specialist caseload?
Carlos:
I guess I understand where he’s coming from. But I don’t want
to sit on the phone all day dealing with the same old patient
status issues. Been there, done that. And I’m not about to take
over the caseload for a lazy med specialist who just waits until
the case gets old enough for me to work it for them.
Scene 4: The Design Session
It’s 8:30 on Wednesday morning. Jim begins the design session
meeting with a kickoff presentation. In attendance are Dave,
Rosie, Carlos, and Alex (the manager of one of the call center
groups).
Jim:
I really appreciate everyone taking time out of their schedules
to work on this program. I’m confident that we can come up
with a good solution. You’re among our top performers in the
division, and you know best what will work and what won’t
work in our company.

Jim spends the first few hours of the meeting reviewing the
importance of the call cycle times, showing the group charts
with the data he has collected: customer satisfaction numbers
(last year, year to date, last month), call answering times (in
minutes, listed by month for the past 12 months), case volumes
(number of new cases opened, number of cases closed for the
past 12 months), and number of red cases (by month).
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Next, Dave facilitates the group through an approach that Jim
has suggested all along, where the senior insurance consultants
would collaborate on cases with medical insurance specialists.
In the new process, senior consultants would have a new job
task of monitoring the current list of red cases and pulling them
from the medical insurance specialists if they felt that they
could work the case faster based on their knowledge and
experience. The new process would require that all senior
consultants monitor the list regularly and read through any new
red cases.
Dave notes to himself that neither Rosie nor Carlos raised the
objections they had shared with him privately, but instead both
seem very energetic and willing to experiment with some
changes. With confidence high, the group takes a lunch break.
After lunch, Dave checks the agreement the team appears to
have reached.
Dave:
So, Carlos, what do you think of the solution we’re proposing?
Carlos:
It will never work.
Dave:

Why?
Carlos:
I don’t know. I can just tell you right now, this will never
work.
[The group looks silently at Dave.]
Dave:
You seemed more confident this morning. What changed your
mind?
Carlos:
I was out at lunch talking with Michelle and a couple of other
people on Dana’s team. They hate the idea and think it’s just
more work for us, and a way for the medical insurance
specialists to pawn off their tough cases. I mean, no offense to
Rosie, she handles her own cases well. But why should we jump
in? We have our own work to do. People are basically lazy, and
unless you force them to work on the new cases, they aren’t
going to volunteer.
After an hour of discussion, the group makes little progress.
The morning’s agreement has dissolved. With only a few hours
to go in the meeting, the attendees begin to abandon hope that
they could reach a solution, and Jim intervenes.
Jim:
Look, here’s what I propose. Let’s call it a day for now, and we
can reconvene next week to talk about it more. Thanks for your
input, everyone, I know that we can handle this. It’s a tough
situation but I appreciate your participation on this project.
Dave, can you hang around for a few minutes?
[The group walks out quietly as Dave begins to stack up some
of his papers.]

Jim:
[shaking his head]
I really thought we were headed toward a solution.
[raising his voice]
Why can’t people just say what they think if they have a
problem? Why did we have to go through all of this?
Dave:
I know that you’re frustrated, and I’m getting a bit frustrated
myself. Clearly the team is frustrated. But I also have to
remember that it’s better that we find out their objections now
rather than a month from now when we’re wondering why the
new model isn’t working.
Jim:
I’m at a loss. What do we do now?
Dave:
I’ve listened carefully to the team today, and I’m also thinking
about my meetings with Rosie and Carlos. I’m also thinking
about the structure of the work and of the two teams at this
point. Let’s plan to meet at 8 on Friday morning. I’ll prepare
my thoughts about what I’ve heard so far and what I think we
should do next.
Jim:
Friday at 8 works for me. I’m anxious to get your perspective.