Here at Health Communication Partners, one of the ways we help organizations is with bringing structure to messy situations. And everyday work is messy, as I’ve written before.
Today I’ll share a tool that you may know about, that can be handy to bring clarity to some messy situations. It has its limitations, which I’ll also mention, but overall I think it can be helpful if your team is looking to get things going.
RACI is a project management tool, also called a responsibility assignment matrix. And it is just that: a way of making sure every task has an owner, and everyone knows who’s responsible for what.
RACI stand for Responsible, Accountable, Consulted and Informed. You go through each task, assign who’s Responsible, Accountable, Consulted and Informed, and there you have it. RACI can be helpful in a variety of situations:
- Refining workflows
- Role clarity, especially at a time of growth or scaling
- Clarifying communication and documentation expectations
- Data, reporting and QI processes
- Program development and implementation
If your organization is facing any of these, and you haven’t tried a RACI (or there’s a stale one hanging around), you might give it a try. I’ll share an example and then give a few tips, including how to manage limitations of a RACI matrix.
Health Communication Partners is an approved vendor for technical assistance by the State of California for the PATH TA Marketplace. This means eligible entities partner with us on custom, hands-on projects, utilizing state funding to drive improvements in service delivery and outcomes. Enhanced Care Management (ECM) is complex, and involves a great deal of ownership, handoffs, and accountability. Enter RACI. RACI can be helpful when work crosses departments, compliance risk is high, new programs are scaling, and coordination is crucial. So I’ve mocked up a very high level RACI using Enhanced Care Management as an example.
| Task / Activity | Responsible (R) | Accountable (A) | Consulted (C) | Informed (I) |
| 1. Member Intake & Assessment | Lead Care Manager | Program Manager | Behavioral Health Specialist, CHW | Supervisors, MCP liaison |
| 2. Development of Comprehensive Care Plan | Lead Care Manager | Program Manager | PCP, Behavioral Health, Family/Caregiver | CHWs, Admin Staff |
| 3. Referrals to Community & Social Supports | CHW | Lead Care Manager | Social Services, LTSS providers | Program Manager, Family/Caregiver |
| 4. Documentation & Data Entry | Care Manager / CHW | Program Manager | IT/EMR Support | Finance, Quality Improvement Team |
| 5. Quality Metrics & Outcome Reporting | Data Analyst | Quality Manager | Care Managers, Supervisors | Program Director, MCP |
| 6. Billing & Claims Submission | Billing Specialist | Finance Manager | Care Managers (for service confirmation) | Program Manager, MCP |
| 7. Compliance & Audit Readiness | Compliance Officer | Program Director | Care Managers, Finance, Legal Counsel | Staff, MCP |
| 8. Staff Training & Workforce Development | Training Coordinator | HR Manager | Supervisors, Lead Care Managers | All ECM Staff |
| 9. Workflow Optimization & SOP Updates | Program Manager | Executive Director | Care Managers, CHWs, IT | All Staff |
| 10. Program Implementation & Sustainability Planning | Program Manager | Executive Director | MCP Liaison, Finance, Quality Improvement | Staff, Funders |
This is oversimplified, but it’s to give you an idea of what a RACI might look like in your situation. In fact, oversimplification is one of the limitations of RACI. It’s not hard to see how little chart boxes could fail to capture complexity.
Another limitation is that it can cause bottlenecks around the person Accountable. RACI’s limitations also tend to show when people try to use it for decision-making, as McKinsey explains.
I’ll offer 2 tips to help you use this tool and manage its limitations:
- Don’t do this alone. Make this a collaborative activity. Divide folks into groups and have each group complete one. Make sure you’re involving people who will fall into each of the R,A,C and I categories.
- Use this as a tool to surface obstacles, not as a static constraint. Let the collaborative act of attempting to create RACI matrices support discussion around role ambiguity, conflict, and decision-making…and how your team thinks it can go forward from there.
Used in this way, RACI isn’t so much locking you in, but opening you up. Discussion around a RACI matrix can surface hidden or unspoken obstacles and opportunities in the complex everyday work of care and coordination. Want help with this? Contact me.