Upload
dothuan
View
220
Download
0
Embed Size (px)
Citation preview
8-1
Continuous Performance Improvement Through Lean Six Sigma in the Military Health System
Gaston M. Randolph, Jr.Director, Strategy ManagementUS Army Medical Command/Office of The Surgeon [email protected]: 703.681.3015
8-2
Disclosures
Presenter has no financial interest to disclose.
This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with the MedXellence Program. PESG, MedXellence Staff, and accrediting organization do not support or endorse any product or service mentioned in this activity.
PESG and MedXellence Program Staff have no financial interest to disclose.
8-3
Learning Objectives
At the conclusion of this activity, the participant will be able to:• Introduce Lean Six Sigma as a management system for
achieving measurable results• Understand the required infrastructure for Lean Six Sigma• Understand the general structure of the DMAIC methodology
8-4
• QDR Mandate
Agenda
8-5
• QDR Mandate• Lean Six Sigma (LSS) Basics
Agenda
8-6
• QDR Mandate• Lean Six Sigma (LSS) Basics• LSS “Fit” in Strategic Performance Execution
Agenda
8-7
• QDR Mandate• Lean Six Sigma (LSS) Basics• LSS “Fit” in Strategic Performance Execution• Linking Strategy to Performance Improvement
Agenda
8-8
• QDR Mandate• Lean Six Sigma (LSS) Basics• LSS “Fit” in Strategic Performance Execution• Linking Strategy to Performance Improvement • Lessons Learned
Agenda
8-9
MHS QDR Mandate
Everyone in DoD must adopt some form of
Continuous Process Improvement
8-10
• Select the CPI method most appropriate for the MHS
MHS QDR Mandate
8-11
• Select the CPI method most appropriate for the MHS— common vocabulary, toolsets
MHS QDR Mandate
8-12
• Select the CPI method most appropriate for the MHS— common vocabulary, toolsets
• Implement across all MHS components in a consistent fashion
MHS QDR Mandate
8-13
• Select the CPI method most appropriate for the MHS— common vocabulary, toolsets
• Implement across all MHS components in a consistent fashion— learn, grow together
MHS QDR Mandate
8-14
• Select the CPI method most appropriate for the MHS— common vocabulary, toolsets
• Implement across all MHS components in a consistent fashion— learn, grow together
• Accelerate MHS’ CPI “journey” from current stage
MHS QDR Mandate
8-15
• Select the CPI method most appropriate for the MHS— common vocabulary, toolsets
• Implement across all MHS components in a consistent fashion— learn, grow together
• Accelerate MHS’ CPI “journey” from current stage— improve sooner rather than later
MHS QDR Mandate
8-16
MHS Review
High-Reliability Health Care: Getting There from Here. Mark R. Chassin and Jerod M. Loeb, The Milbank Quarterly, Vol. 91, No 3, 2013 (pp 459-490)
8-17
Three Changes for HRO
• Leadership commitment to zero patient harm• Incorporation of all principles and practices of
a Safety Culture throughout the organization• Widespread adoption and deployment of the
most effective of Process Improvement tools and methods (Lean, Six Sigma, Change Management)
8-18
Appropriate to roleRequired for all
staffOnboardingCEMin
Requirements for GB/BB
Standardized toolkitStandard process
for documentation: PowerSteering
Routine performance monitoring Gap Identified
Event ManagementSafetyErrorAdverse
OutcomeNear MissComplaint
Work section or Unit-wideProject TypeChange EventStandard WorkA3/RIEDMAIC
Draft Project Charter
Work section: Change event or Lean Project Unit-Wide:Assign Project
Sponsor/BeltComplete Draft
Project ChartersResourceExecute project
Capture results in PowerSteeringCommunicate Monitor metricsCelebrate
successes and replicate
Train Organization
1 PI Need Identified
2 Document Event / Select
Approach
3 Prioritize, Resource,
and Execute
4 Capture, Share and
Monitor
5
Project Dashboard
Robust Process ImprovementEnabling a HRO
8-19
Lean Six Sigma Basics
8-20
…LSS Builds Upon aFoundationof Continuous Performance
Improvement!
CraftProductionEli Whitney -
ProductStandards
Shewhart –StatisticalMethods
Juran –ProcessAnalysis
IndustrialProduction
StatisticalProcess Control
QualityControl
Taguchi –Customer
Focus
QualityEngineering
Deming –SystemsThinking
TQM -Total QualityManagementSmith
(Motorola) –Statistical
Rigor SixSigma v1
Welch/Bossidy –
OrganizationalInfrastructure Six
Sigma v2
Taylor –Time/Motion
Studies
ScientificManagement
Ford –Work
Analysis
AssemblyLine Manufacturing
Sloan –Modern
Management
OrganizedLabor –Worker’s
RightsMass
Production
Toyoda,Ohno,Shingo
ToyotaProduction
System
Womack& Jones
LeanEnterprise
George, ITT Industries,
CAT, Xerox
Lean SixSigma v1
Harry –DMAIC
SimplifiedManufacturing
SimplifiedService/Process
George & Wilson –OptimizedComplexity
Lean SixSigma v2
Tunner –Berlin Airlift
SimplifiedProduct Line
Zero Defects
Gilbreth
8-21
LSS Basics• Industry best practice management framework
combines “Lean” and “Six Sigma” strategies
8-22
• Industry best practice management framework combines “Lean” and “Six Sigma” strategies
• “Lean” methods…
LSS Basics
8-23
• Industry best practice management framework combines “Lean” and “Six Sigma” strategies
• “Lean” methods…• Remove non-value added waste from processes• Thus, reduce process lead time• Happy customers—reduced cost!
LSS Basics
8-24
• Industry best practice management framework combines “Lean” and “Six Sigma” strategies
• “Lean” methods…• Remove non-value added waste from processes• Thus, reduce process lead time• Happy customers—reduced cost!
• “Six Sigma” methods…
LSS Basics
8-25
• Industry best practice management framework combines “Lean” and “Six Sigma” strategies
• “Lean” methods…• Remove non-value added waste from processes• Thus, reduce process lead time• Happy customers—reduced cost!
• “Six Sigma” methods…• Analyze and reduce variability in processes• Thus, improve quality• More happy customers—more reduced cost!
LSS Basics
8-26
What’s Different About LSS?
8-27
• Prescriptive framework…vs descriptive framework
What’s Different About LSS?This is…
8-28
• Prescriptive framework…vs descriptive framework
• Trained experts leading trained project teams…vs reading a book and trying it on the fly
What’s Different About LSS?This is…
8-29
• Prescriptive framework…vs descriptive framework
• Trained experts leading trained project teams…vs reading a book and trying it on the fly
• Execution pervades the organization…vs “that’s the QA Department’s job”
What’s Different About LSS?This is…
8-30
• Prescriptive framework…vs descriptive framework
• Trained experts leading trained project teams…vs reading a book and trying it on the fly
• Execution pervades the organization…vs “that’s the QA Department’s job”
• Data-driven project selection and improvements…vs guessing, windage, shooting from the hip
What’s Different About LSS?This is…
8-31
LSS Basics: InfrastructureNeeded to Succeed!
At each level of organizations:
Green Belt(s)
Black Belt Black Belt Green Belt Green Belt
Organization’sSenior Leader
Process OwnerProcess Owner
Project Team Member(s)
Project Team Member(s)
…
MasterBlack Belt
Deployment Director
…
Full-time Positions
Process Owner
Project SupportMentor
Financial Analyst
Financial Analyst
• Senior Leader• Deployment Director• Senior Financial Mgr• Critical Process Owners• Master Black Belt (Advisor)
Executive Steering Committee
Recommended LSS Infrastructure Based on Industry Best Practice
8-32
Multi-level/multi-phased training:Training: Training & Certification
Executive Leader Green BeltProject Sponsor Black BeltProject ID/Selection Master Black BeltProject Team/Yellow BeltOrganizational Awareness
LSS Basics: Training/Certification
8-33
LSS Basics: Training/Certification
Project Sponsor Trng
Assessment
MBB Trng
BB/GB Trng
Project ID & Selection Wksp
Harvest Results and Share Know
ledge
Contractor Mentoring & Consulting
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 12 Month 18 Month 24+
Stand-up Program Perform Projects
Organizational Awareness Trng
Multi-level/multi-phased training:Training: Training & Certification
Executive Leader Green BeltProject Sponsor Black BeltProject ID/Selection Master Black BeltProject Team/Yellow BeltOrganizational Awareness
Executive Leader Trng
Project Team Trng
8-34
Structured Project Selection
ProjectCandidates
• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities
LSS Basics: Project Execution
8-35
Prioritized by Leader/Mgmt
TeamProject
Candidates
• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities
BEN
EFIT
Low
Med
Hig
h
EFFORTLow Med High
Structured Project Selection
LSS Basics: Project Execution
8-36
Prioritized by Leader/Mgmt
TeamProject
Candidates
• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities
BEN
EFIT
Low
Med
Hig
h
EFFORTLow Med High
Structured Project Selection
Assign Projectto Sponsor and Select
Belt
LSS Basics: Project Execution
8-37
Prioritized by Leader/Mgmt
TeamProject
Candidates
• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities
BEN
EFIT
Low
Med
Hig
h
EFFORTLow Med High
Structured Project Selection
Define Measure Analyze Improve Control
Define project purpose and scopeMeasure current performanceAnalyze causes & confirm with dataImprove by removing variation and
non-value added activitiesControl gains by standardizing
DMAIC Project Management Framework
Sponsor inspects deliverables & checkpoints for each phase
Assign Projectto Sponsor and Select
Belt
LSS Basics: Project Execution
8-38
Prioritized by Leader/Mgmt
TeamProject
Candidates
• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities
BEN
EFIT
Low
Med
Hig
h
EFFORTLow Med High
Structured Project Selection
Define Measure Analyze Improve Control
Define project purpose and scopeMeasure current performanceAnalyze causes & confirm with dataImprove by removing variation and
non-value added activitiesControl gains by standardizing
DMAIC Project Management Framework
Sponsor inspects deliverables & checkpoints for each phase
Assign Projectto Sponsor and Select
Belt
LSS Basics: Project Execution
8-39
Prioritized by Leader/Mgmt
TeamProject
Candidates
• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities
BEN
EFIT
Low
Med
Hig
h
EFFORTLow Med High
Structured Project Selection
Define Measure Analyze Improve Control
Define project purpose and scopeMeasure current performanceAnalyze causes & confirm with dataImprove by removing variation and
non-value added activitiesControl gains by standardizing
DMAIC Project Management Framework
Sponsor inspects deliverables & checkpoints for each phase
Assign Projectto Sponsor and Select
Belt
LSS Basics: Project Execution
8-40
Prioritized by Leader/Mgmt
TeamProject
Candidates
• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities
BEN
EFIT
Low
Med
Hig
h
EFFORTLow Med High
Structured Project Selection
Define Measure Analyze Improve Control
Define project purpose and scopeMeasure current performanceAnalyze causes & confirm with dataImprove by removing variation and
non-value added activitiesControl gains by standardizing
DMAIC Project Management Framework
Sponsor inspects deliverables & checkpoints for each phase
Assign Projectto Sponsor and Select
Belt
LSS Basics: Project Execution
8-41
Prioritized by Leader/Mgmt
TeamProject
Candidates
• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities
BEN
EFIT
Low
Med
Hig
h
EFFORTLow Med High
Structured Project Selection
Define Measure Analyze Improve Control
Define project purpose and scopeMeasure current performanceAnalyze causes & confirm with dataImprove by removing variation and
non-value added activitiesControl gains by standardizing
DMAIC Project Management Framework
Sponsor inspects deliverables & checkpoints for each phase
Assign Projectto Sponsor and Select
Belt
LSS Basics: Project Execution
8-42
Prioritized by Leader/Mgmt
TeamProject
Candidates
• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities
BEN
EFIT
Low
Med
Hig
h
EFFORTLow Med High
Structured Project Selection
Sponsor InspectsProgress
Define Measure Analyze Improve Control
Define project purpose and scopeMeasure current performanceAnalyze causes & confirm with dataImprove by removing variation and
non-value added activitiesControl gains by standardizing
DMAIC Project Management Framework
Sponsor inspects deliverables & checkpoints for each phase
Assign Projectto Sponsor and Select
Belt
LSS Basics: Project Execution
8-43
Prioritized by Leader/Mgmt
TeamProject
Candidates
• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities
BEN
EFIT
Low
Med
Hig
h
EFFORTLow Med High
Structured Project Selection
Sponsor InspectsProgress
Define Measure Analyze Improve Control
Define project purpose and scopeMeasure current performanceAnalyze causes & confirm with dataImprove by removing variation and
non-value added activitiesControl gains by standardizing
Results are Captured and
Sustained
DMAIC Project Management Framework
Sponsor inspects deliverables & checkpoints for each phase
Assign Projectto Sponsor and Select
Belt
LSS Basics: Project Execution
8-44
Prioritized by Leader/Mgmt
TeamProject
Candidates
• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities
BEN
EFIT
Low
Med
Hig
h
EFFORTLow Med High
Structured Project Selection
Sponsor InspectsProgress
Define Measure Analyze Improve Control
Define project purpose and scopeMeasure current performanceAnalyze causes & confirm with dataImprove by removing variation and
non-value added activitiesControl gains by standardizing
Results are Captured and
Sustained
DMAIC Project Management Framework
Sponsor inspects deliverables & checkpoints for each phase
Assign Projectto Sponsor and Select
Belt
LSS Basics: Project Execution
8-45
LSS “Fits” in Your Toolkit!
• Must have aligned organizational strategy
8-46
• Must start with aligned organizational strategy• LSS fits as a Strategy Improvement Engine
LSS “Fits” in Your Toolkit!
8-47
• Must start with aligned organizational strategy• LSS fits as a Strategy Improvement Engine
• Evaluate objective targets, gaps to reach them
LSS “Fits” in Your Toolkit!
8-48
• Must start with aligned organizational strategy• LSS fits as a Strategy Improvement Engine
• Evaluate objective targets, gaps to reach them• ID initiatives to close gaps
LSS “Fits” in Your Toolkit!
8-49
• Must start with aligned organizational strategy• LSS fits as a Strategy Improvement Engine
• Evaluate objective targets, gaps to reach them• ID initiatives to close gaps• Those initiatives become LSS projects!
LSS “Fits” in Your Toolkit!
8-50
• Must start with aligned organizational strategy• LSS fits as a Strategy Improvement Engine
• Evaluate objective targets, gaps to reach them• ID initiatives to close gaps• Those initiatives become LSS projects
• Aligns commitment, resources, and effort against strategically-focused projects!
LSS “Fits” in Your Toolkit!
8-51
• The MHS is ahead of the rest of the DoD!
LSS “Fits” in Your Toolkit!
8-52
• The MHS is ahead of the rest of the DoD!• Strategy and objectives defined
LSS “Fits” in Your Toolkit!
8-53
• The MHS is ahead of the rest of the DoD!• Strategy and objectives defined • Data-driven decision-making is routine
LSS “Fits” in Your Toolkit!
8-54
• The MHS is ahead of the rest of the DoD!• Strategy and objectives defined • Data-driven decision-making is routine• Data-mining already part of our infrastructure
LSS “Fits” in Your Toolkit!
8-55
An Army Medicine example:at a high level…
linking Organizational Strategyto Performance Improvement
usingLean Six Sigma
and
Best Practice Transfer!
8-56
For more information go to: https://ke2.army.mil/bsc
- Promote, Sustain and Enhance Soldier Health- Train, Develop and Equip a Medical Force that Supports Full Spectrum Operations - Deliver Leading Edge Health Services to Our Warriors and Military Family to Optimize Outcomes
This has been a dynamic, living document since 2001
America’s Premier Medical Team Saving Lives, Fostering Healthy and Resilient PeopleARMY MEDICINE
Bringing Value…Inspiring TrustMaximize Value in Health Services
Effectively and efficiently provide the right care at the right time to
promote a healthy population and ready force.
Provide Global Operational Forces
Agile and adaptive medical teams ready to execute relevant,
responsive Health Services in any operational environment and in combination with any partnered
team.
Build the Team
A compelling place to serve and a preferred partner in leading joint interagency
health services.
Balance Innovation with Standardization
A culture of innovation which provides standardized solutions to support best
practices and optimal outcomes.
Optimize Communication and Knowledge
ManagementLeverage Communication to impart
knowledge and build meaningful, positive relationships.
Pat
ient
/Cus
tom
er/
Sta
keho
lder CS 5.0
Inspire Trust in Army
Medicine
CS 3.0 Responsive Battlefield
Medical Force
CS 2.0 Improved Healthy and
Protected Families, Beneficiaries and
Army Civilians
CS 1.0 Improved
Healthy and Protected Warriors
CS 6.0 Improved
Patient and Customer
Satisfaction
IP 1.0 Optimize Medical
Readiness
IP 8.0 Build Relationships and Enhance Partnerships
LG 2.0 Improve
Training and Development
IP 2.0 Improve
Information Systems
CS 4.0 Optimized Care and
Transition of Wounded, Ill, and Injured Warriors
IP 3.0 Implement
Best Practices
IP 9.0 Tell the Army Medicine
Story
LG 4.0 Improve
Knowledge Management
LG 1.0 Improve Recruiting and Retention of
AMEDD Personnel
Inte
rnal
Pro
cess
Lear
ning
and
G
row
th LG 3.0 Promote and Foster a
Culture of Innovation
IP 6.0 Improve Quality,
Outcome-Focused Care and Services
IP 5.0 Maximize Physical and Psychological
Health Promotion and Prevention
IP 7.0 Improve Access and Continuity of
Care
R 1.0 Optimize
Resources and Value
R 2.0 Optimize Lifecycle Management
of Facilities and IT Infrastructure
R 3.0 Maximize Human Capital
EN
DS
ME
AN
SW
AYS
Res
ourc
e
IP 10.0 Leverage Research,
Development and Acquisition
Feedback Adjusts
Resourcing D
ecisions
To deliver the Strategic
Processes...
That achieve
our Strategic
Ends
We marshal our
Resources…
And enable our
People…
IP 4.0Provide
Safe Patient Care
We align MEDCOM LSS projects to our
Organization’s Strategy
8-57
For more information go to: https://ke2.army.mil/bsc
- Promote, Sustain and Enhance Soldier Health- Train, Develop and Equip a Medical Force that Supports Full Spectrum Operations - Deliver Leading Edge Health Services to Our Warriors and Military Family to Optimize Outcomes
This has been a dynamic, living document since 2001
America’s Premier Medical Team Saving Lives, Fostering Healthy and Resilient PeopleARMY MEDICINE
Bringing Value…Inspiring TrustMaximize Value in Health Services
Effectively and efficiently provide the right care at the right time to
promote a healthy population and ready force.
Provide Global Operational Forces
Agile and adaptive medical teams ready to execute relevant,
responsive Health Services in any operational environment and in combination with any partnered
team.
Build the Team
A compelling place to serve and a preferred partner in leading joint interagency
health services.
Balance Innovation with Standardization
A culture of innovation which provides standardized solutions to support best
practices and optimal outcomes.
Optimize Communication and Knowledge
ManagementLeverage Communication to impart
knowledge and build meaningful, positive relationships.
Pat
ient
/Cus
tom
er/
Sta
keho
lder CS 5.0
Inspire Trust in Army
Medicine
CS 3.0 Responsive Battlefield
Medical Force
CS 2.0 Improved Healthy and
Protected Families, Beneficiaries and
Army Civilians
CS 1.0 Improved
Healthy and Protected Warriors
CS 6.0 Improved
Patient and Customer
Satisfaction
IP 1.0 Optimize Medical
Readiness
IP 8.0 Build Relationships and Enhance Partnerships
LG 2.0 Improve
Training and Development
IP 2.0 Improve
Information Systems
CS 4.0 Optimized Care and
Transition of Wounded, Ill, and Injured Warriors
IP 3.0 Implement
Best Practices
IP 9.0 Tell the Army Medicine
Story
LG 4.0 Improve
Knowledge Management
LG 1.0 Improve Recruiting and Retention of
AMEDD Personnel
Inte
rnal
Pro
cess
Lear
ning
and
G
row
th LG 3.0 Promote and Foster a
Culture of Innovation
IP 6.0 Improve Quality,
Outcome-Focused Care and Services
IP 5.0 Maximize Physical and Psychological
Health Promotion and Prevention
IP 7.0 Improve Access and Continuity of
Care
R 1.0 Optimize
Resources and Value
R 2.0 Optimize Lifecycle Management
of Facilities and IT Infrastructure
R 3.0 Maximize Human Capital
EN
DS
ME
AN
SW
AYS
Res
ourc
e
IP 10.0 Leverage Research,
Development and Acquisition
Feedback Adjusts
Resourcing D
ecisions
To deliver the Strategic
Processes...
That achieve
our Strategic
Ends
We marshal our
Resources…
And enable our
People…
IP 4.0Provide
Safe Patient Care
We recognize we have a performance gap in
Access to Care…
8-58
Value Stream #9: Improve Access & Continuity of CarePVC #1: Maximize Value in Health Services
• Patient Satisfaction
• Access to Care Standards (e.g., achieve acute care appt. within 24 hours)
• Support Staff to Primary Care Provider Utilization ratio
• Call Hold and Handle Times, Call Abandon Rate
• Care Appointment Availability
• Schedule Availability
• Facility Availability
• Call Volume
• # of Appts. Requested
• Type of Care Requested
• Staff Availability
• Facility Scheduling
• DOD Title 10 patients
• Non-Title 10 patients
Suppliers Inputs Process Outputs Customer
Customer Input Metrics Process Metrics Output Metrics
• Satisfied beneficiary• Accessible
appointments• Standardized, utilized
support staff• Optimized provider
productivity• Optimized referral
execution, delivery• Increased utilization of
on-line appointment system
• DOD Title 10 patients (e.g., Soldiers, retirees, families)
• Non-Title 10 patients (e.g., civilian emergencies, contractors, foreign officers and families, etc.)
• Customer Service
• Telephone Services
• Provider Support Staff Utilization
• Primary Care Exam Room Utilization
• Patient Appointing, Referral Mgt.
• TRICARE Online Appointment
• Patients
• DOD Healthcare Professionals
• IMCOM
• Need for Care (preventive, acute)
• Healthcare staff
• Facilities and infrastructure
High level process maps (SIPOCs) help us better focus
on the problem/s in our work…
8-59
• Patient Satisfaction
• Access to Care Standards (e.g., achieve acute care appt. within 24 hours)
• Support Staff to Primary Care Provider Utilization ratio
• Call Hold and Handle Times, Call Abandon Rate
• Care Appointment Availability
• Schedule Availability
• Facility Availability
• Call Volume
• # of Appts. Requested
• Type of Care Requested
• Staff Availability
• Facility Scheduling
• DOD Title 10 patients
• Non-Title 10 patients
Suppliers Inputs Process Outputs Customer
Customer Input Metrics Process Metrics Output Metrics
• Satisfied beneficiary• Accessible
appointments• Standardized, utilized
support staff• Optimized provider
productivity• Optimized referral
execution, delivery• Increased utilization of
on-line appointment system
• DOD Title 10 patients (e.g., Soldiers, retirees, families)
• Non-Title 10 patients (e.g., civilian emergencies, contractors, foreign officers and families, etc.)
• Customer Service
• Telephone Services
• Provider Support Staff Utilization
• Primary Care Exam Room Utilization
• Patient Appointing, Referral Mgt.
• TRICARE Online Appointment
• Patients
• DOD Healthcare Professionals
• IMCOM
• Need for Care (preventive, acute)
• Healthcare staff
• Facilities and infrastructure
…and we decided to start by improving the Telephone
Appointing Process
Value Stream #9: Improve Access & Continuity of CarePVC #1: Maximize Value in Health Services
8-60
LSS Project LD00373: Access to Care— Improve TelephoneAppointing Process at Carl R. Darnall Army Medical Center
Documented in PowerSteering!
8-61
Overall average hold time reduced to 33 seconds Overall call abandon rate reduced: 3% Peak time call abandon rate reduced: 22% Call volume reduced 20% due to less call backs Calls handled increased from 4700 to 7300 / week Agent training time reduced from 6 weeks to 4 weeks Agent turnover reduced
• REPLICATION / WAY-AHEAD• RESULTS / BENEFITS
Agent scheduling changes to handle peak times Agent training, area setup, shift change by SOP Phone menu tree and call handling improved Future ACD design requirements specified
• IMPROVEMENTS• PROBLEM / BASELINE / GOAL
BEFORE AFTER
Hol
d Ti
me
PROBLEM STATEMENTThe telephone appointing process at CRDAMC has observed low patient satisfaction scores and long process hold times. Over the last six months, it takes an average of 3:14 minutes to answer customer calls to make an appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services.
BASELINE
Decrease process hold time to less than 90 seconds per call Decrease overall abandoned call rate to less than 10% Decrease peak time call abandon rate to less than 25%
Army’s largest call center: 10,000+ calls a week Low customer satisfaction: 68% Average wait time: 3:14 minutes Calls answered under 90 seconds: 65% Overall call abandon rate: 26%; Peak time: 49%
GOAL
Performance Action Plan Completed; Access to Care Initiative 17.2
Adjust MEDCOM BSC telephone appting standards NLT 20 Apr 07
Establish CMS metric for telephone appting NLT 1 May 07 Publish MEDCOM Telephone Appting Policy NLT 1 May 07 Replicate LSS projects across MEDCOM MTFs NLT Dec 08
the initial project was conducted at Fort Hood’s
Carl R. Darnall Army Medical Center (CRDAMC)…
Project Summary: Carl R. Darnall AMC Telephone Appointing Mark Hernandez – Black Belt Candidate
8-62
Overall average hold time reduced to 33 seconds Overall call abandon rate reduced: 3% Peak time call abandon rate reduced: 22% Call volume reduced 20% due to less call backs Calls handled increased from 4700 to 7300 / week Agent training time reduced from 6 weeks to 4 weeks Agent turnover reduced
• REPLICATION / WAY-AHEAD• RESULTS / BENEFITS
Agent scheduling changes to handle peak times Agent training, area setup, shift change by SOP Phone menu tree and call handling improved Future ACD design requirements specified
• IMPROVEMENTS• PROBLEM / BASELINE / GOAL
BEFORE AFTER
Hol
d Ti
me
PROBLEM STATEMENTThe telephone appointing process at CRDAMC has observed low patient satisfaction scores and long process hold times. Over the last six months, it takes an average of 3:14 minutes to answer customer calls to make an appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services.
BASELINE
Decrease process hold time to less than 90 seconds per call Decrease overall abandoned call rate to less than 10% Decrease peak time call abandon rate to less than 25%
Army’s largest call center: 10,000+ calls a week Low customer satisfaction: 68% Average wait time: 3:14 minutes Calls answered under 90 seconds: 65% Overall call abandon rate: 26%; Peak time: 49%
GOAL
Performance Action Plan Completed; Access to Care Initiative 17.2
Adjust MEDCOM BSC telephone appting standards NLT 20 Apr 07
Establish CMS metric for telephone appting NLT 1 May 07 Publish MEDCOM Telephone Appting Policy NLT 1 May 07 Replicate LSS projects across MEDCOM MTFs NLT Dec 08
…high call volume, low patient satisfaction, long process cycle
time, high variation…
Project Summary: Carl R. Darnall AMC Telephone Appointing Mark Hernandez – Black Belt Candidate
8-63
Overall average hold time reduced to 33 seconds Overall call abandon rate reduced: 3% Peak time call abandon rate reduced: 22% Call volume reduced 20% due to less call backs Calls handled increased from 4700 to 7300 / week Agent training time reduced from 6 weeks to 4 weeks Agent turnover reduced
• REPLICATION / WAY-AHEAD• RESULTS / BENEFITS
Agent scheduling changes to handle peak times Agent training, area setup, shift change by SOP Phone menu tree and call handling improved Future ACD design requirements specified
• IMPROVEMENTS• PROBLEM / BASELINE / GOAL
BEFORE AFTER
Hol
d Ti
me
PROBLEM STATEMENTThe telephone appointing process at CRDAMC has observed low patient satisfaction scores and long process hold times. Over the last six months, it takes an average of 3:14 minutes to answer customer calls to make an appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services.
BASELINE
Decrease process hold time to less than 90 seconds per call Decrease overall abandoned call rate to less than 10% Decrease peak time call abandon rate to less than 25%
Army’s largest call center: 10,000+ calls a week Low customer satisfaction: 68% Average wait time: 3:14 minutes Calls answered under 90 seconds: 65% Overall call abandon rate: 26%; Peak time: 49%
GOAL
Performance Action Plan Completed; Access to Care Initiative 17.2
Adjust MEDCOM BSC telephone appting standards NLT 20 Apr 07
Establish CMS metric for telephone appting NLT 1 May 07 Publish MEDCOM Telephone Appting Policy NLT 1 May 07 Replicate LSS projects across MEDCOM MTFs NLT Dec 08
…the project sought to decrease process cycle time
and call abandon rate to improve patient satisfaction…
Project Summary: Carl R. Darnall AMC Telephone Appointing Mark Hernandez – Black Belt Candidate
8-64
Overall average hold time reduced to 33 seconds Overall call abandon rate reduced: 3% Peak time call abandon rate reduced: 22% Call volume reduced 20% due to less call backs Calls handled increased from 4700 to 7300 / week Agent training time reduced from 6 weeks to 4 weeks Agent turnover reduced
• REPLICATION / WAY-AHEAD• RESULTS / BENEFITS
Agent scheduling changes to handle peak times Agent training, area setup, shift change by SOP Phone menu tree and call handling improved Future ACD design requirements specified
• IMPROVEMENTS• PROBLEM / BASELINE / GOAL
BEFORE AFTER
Hol
d Ti
me
PROBLEM STATEMENTThe telephone appointing process at CRDAMC has observed low patient satisfaction scores and long process hold times. Over the last six months, it takes an average of 3:14 minutes to answer customer calls to make an appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services.
BASELINE
Decrease process hold time to less than 90 seconds per call Decrease overall abandoned call rate to less than 10% Decrease peak time call abandon rate to less than 25%
Army’s largest call center: 10,000+ calls a week Low customer satisfaction: 68% Average wait time: 3:14 minutes Calls answered under 90 seconds: 65% Overall call abandon rate: 26%; Peak time: 49%
GOAL
Performance Action Plan Completed; Access to Care Initiative 17.2
Adjust MEDCOM BSC telephone appting standards NLT 20 Apr 07
Establish CMS metric for telephone appting NLT 1 May 07 Publish MEDCOM Telephone Appting Policy NLT 1 May 07 Replicate LSS projects across MEDCOM MTFs NLT Dec 08
WOW!
Project Summary: Carl R. Darnall AMC Telephone Appointing Mark Hernandez – Black Belt Candidate
8-65
Overall average hold time reduced to 33 seconds Overall call abandon rate reduced: 3% Peak time call abandon rate reduced: 22% Call volume reduced 20% due to less call backs Calls handled increased from 4700 to 7300 / week Agent training time reduced from 6 weeks to 4 weeks Agent turnover reduced
• REPLICATION / WAY-AHEAD• RESULTS / BENEFITS
Agent scheduling changes to handle peak times Agent training, area setup, shift change by SOP Phone menu tree and call handling improved Future ACD design requirements specified
• IMPROVEMENTS• PROBLEM / BASELINE / GOAL
BEFORE AFTER
Hol
d Ti
me
PROBLEM STATEMENTThe telephone appointing process at CRDAMC has observed low patient satisfaction scores and long process hold times. Over the last six months, it takes an average of 3:14 minutes to answer customer calls to make an appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services.
BASELINE
Decrease process hold time to less than 90 seconds per call Decrease overall abandoned call rate to less than 10% Decrease peak time call abandon rate to less than 25%
Army’s largest call center: 10,000+ calls a week Low customer satisfaction: 68% Average wait time: 3:14 minutes Calls answered under 90 seconds: 65% Overall call abandon rate: 26%; Peak time: 49%
GOAL
Performance Action Plan Completed; Access to Care Initiative 17.2
Adjust MEDCOM BSC telephone appting standards NLT 20 Apr 07
Establish CMS metric for telephone appting NLT 1 May 07 Publish MEDCOM Telephone Appting Policy NLT 1 May 07 Replicate LSS projects across MEDCOM MTFs NLT Dec 08
6-Fold Improvement
Project Summary: Carl R. Darnall AMC Telephone Appointing Mark Hernandez – Black Belt Candidate
8-66
Overall average hold time reduced to 33 seconds Overall call abandon rate reduced: 3% Peak time call abandon rate reduced: 22% Call volume reduced 20% due to less call backs Calls handled increased from 4700 to 7300 / week Agent training time reduced from 6 weeks to 4 weeks Agent turnover reduced
• REPLICATION / WAY-AHEAD• RESULTS / BENEFITS
Agent scheduling changes to handle peak times Agent training, area setup, shift change by SOP Phone menu tree and call handling improved Future ACD design requirements specified
• IMPROVEMENTS• PROBLEM / BASELINE / GOAL
BEFORE AFTER
Hol
d Ti
me
PROBLEM STATEMENTThe telephone appointing process at CRDAMC has observed low patient satisfaction scores and long process hold times. Over the last six months, it takes an average of 3:14 minutes to answer customer calls to make an appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services.
BASELINE
Decrease process hold time to less than 90 seconds per call Decrease overall abandoned call rate to less than 10% Decrease peak time call abandon rate to less than 25%
Army’s largest call center: 10,000+ calls a week Low customer satisfaction: 68% Average wait time: 3:14 minutes Calls answered under 90 seconds: 65% Overall call abandon rate: 26%; Peak time: 49%
GOAL
Performance Action Plan Completed; Access to Care Initiative 17.2
Adjust MEDCOM BSC telephone appting standards NLT 20 Apr 07
Establish CMS metric for telephone appting NLT 1 May 07 Publish MEDCOM Telephone Appting Policy NLT 1 May 07 Replicate LSS projects across MEDCOM MTFs NLT Dec 08
10-Fold Improvement
Project Summary: Carl R. Darnall AMC Telephone Appointing Mark Hernandez – Black Belt Candidate
8-67
Overall average hold time reduced to 33 seconds Overall call abandon rate reduced: 3% Peak time call abandon rate reduced: 22% Call volume reduced 20% due to less call backs Calls handled increased from 4700 to 7300 / week Agent training time reduced from 6 weeks to 4 weeks Agent turnover reduced
• REPLICATION / WAY-AHEAD• RESULTS / BENEFITS
Agent scheduling changes to handle peak times Agent training, area setup, shift change by SOP Phone menu tree and call handling improved Future ACD design requirements specified
• IMPROVEMENTS• PROBLEM / BASELINE / GOAL
BEFORE AFTER
Hol
d Ti
me
PROBLEM STATEMENTThe telephone appointing process at CRDAMC has observed low patient satisfaction scores and long process hold times. Over the last six months, it takes an average of 3:14 minutes to answer customer calls to make an appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services.
BASELINE
Decrease process hold time to less than 90 seconds per call Decrease overall abandoned call rate to less than 10% Decrease peak time call abandon rate to less than 25%
Army’s largest call center: 10,000+ calls a week Low customer satisfaction: 68% Average wait time: 3:14 minutes Calls answered under 90 seconds: 65% Overall call abandon rate: 26%; Peak time: 49%
GOAL
Performance Action Plan Completed; Access to Care Initiative 17.2
Adjust MEDCOM BSC telephone appting standards NLT 20 Apr 07
Establish CMS metric for telephone appting NLT 1 May 07 Publish MEDCOM Telephone Appting Policy NLT 1 May 07 Replicate LSS projects across MEDCOM MTFs NLT Dec 08
>2-Fold Improvement
Project Summary: Carl R. Darnall AMC Telephone Appointing Mark Hernandez – Black Belt Candidate
8-68
Overall average hold time reduced to 33 seconds Overall call abandon rate reduced: 3% Peak time call abandon rate reduced: 22% Call volume reduced 20% due to less call backs Calls handled increased from 4700 to 7300 / week Agent training time reduced from 6 weeks to 4 weeks Agent turnover reduced
• REPLICATION / WAY-AHEAD• RESULTS / BENEFITS
Agent scheduling changes to handle peak times Agent training, area setup, shift change by SOP Phone menu tree and call handling improved Future ACD design requirements specified
• IMPROVEMENTS• PROBLEM / BASELINE / GOAL
BEFORE AFTER
Hol
d Ti
me
PROBLEM STATEMENTThe telephone appointing process at CRDAMC has observed low patient satisfaction scores and long process hold times. Over the last six months, it takes an average of 3:14 minutes to answer customer calls to make an appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services.
BASELINE
Decrease process hold time to less than 90 seconds per call Decrease overall abandoned call rate to less than 10% Decrease peak time call abandon rate to less than 25%
Army’s largest call center: 10,000+ calls a week Low customer satisfaction: 68% Average wait time: 3:14 minutes Calls answered under 90 seconds: 65% Overall call abandon rate: 26%; Peak time: 49%
GOAL
Performance Action Plan Completed; Access to Care Initiative 17.2
Adjust MEDCOM BSC telephone appting standards Establish CMS metric for telephone Publish MEDCOM Telephone Appting Policy NLT 1 May 08 Replicate LSS projects across MEDCOM MTFs NLT Jun 09
Disciplined, Corporate Action to Harvest and
Replicate Across MEDCOM
Project Summary: Carl R. Darnall AMC Telephone Appointing Mark Hernandez – Black Belt Candidate
8-69
Not Only Administrative ProcessesERMC/LRMC: Streamlining the Landstuhl Regional Medical Center (LRMC) Crash Cart System (LD24008), Master Black Belt Richard Rhodes / Black Belt Candidate MAJ Daniel Coulter• Increase the Crash Cart defect-free rate from 65% to 100% • Reduced 13 Crash Carts from facility
SRMC/BAMC: Group of nine independent projects focused on OR optimization• Reduced the housekeeping turn-over time from 50.48 to 16.62 minutes• Reduced the Sterile Products Process from 56 hours to 16 hours• Improved the Preadmission process from 93 min to 63 min• Reduced Total Logistics Response Time-Maintenance (TLRT-M) from 32 to 8 days• Reduced the Cholecystectomy procedures averaged 132 min with a standard
deviation (SD) of 44.62 min to 87 min with a SD of 16.49 min with 100% of procedures within the 119 min standard.
• Improved the documentation of anesthesia blocks in S3 from 23% to 89%• Reduced complexity and errors in patient information from 100% to 6.32%
8-70
• Project Sponsors/Leadership play critical roles…their training is imperative
Lessons Learned
8-71
• Project Sponsors play critical roles…their training is imperative
• Project ID, Selection, and Chartering upfront…then worry about belt selection/training
Lessons Learned
8-72
• Project Sponsors play critical roles…their training is imperative
• Project ID, Selection, and Chartering upfront…then worry about belt selection/training
• Best and brightest leaders selected for belts…if it doesn’t hurt, you’ve probably selected poorly
Lessons Learned
8-73
• Project Sponsors play critical roles…their training is imperative
• Project ID, Selection, and Chartering upfront…then worry about belt selection/training
• Best and brightest leaders selected for belts…if it doesn’t hurt, you’ve probably selected poorly
• Belt candidates’ time dedicated 100% to LSS…during didactics & project execution part of trng
Lessons Learned
8-74
• Project Sponsors play critical roles…their training is imperative
• Project ID, Selection, and Chartering upfront…then worry about belt selection/training
• Best and brightest leaders selected for belts…if it doesn’t hurt, you’ve probably selected poorly
• Belt candidates’ time dedicated 100% to LSS…during didactics & project execution part of trng
• Coaching critical to project execution…must have MBB/BB mentors engaged
Lessons Learned
8-75
Points of Contact• LCDR John Gardner, USN, BUMED, M5 Office of Strategy Management
703.681.3906 [email protected]• Donna Whittaker/Angela Koelsch, Strategy Mgmt, G8/9, USAMEDCOM/OTSG
703.681.4754 [email protected]• Beth Kohsin, USAF, Director of Transformation, AFMOA/CCO
210.395.9010 [email protected]
8-76
Session 16: Continuous Performance Improvement Through Lean Six Sigma in the Military Health System
Gaston M. Randolph, Jr.Director, Strategy ManagementUS Army Medical Command/Office of The Surgeon [email protected]: 703.681.3015
8-77
Obtaining CME/CE credit
• If you would like to receive continuing education credit for this activity, please visit:
http://medxellence.cds.pesgce.com