Post on 29-Dec-2015
transcript
TUESDAY MORNING | KEYNOTE
Welcome from Steve Collins
Coffee/tea service sponsored by
Sherlock Center on Disability
People, Tools & ProcessesThe Secrets to Excellence in Service
Steve Dickinson
Plan(Pre- Event)
Do(Event Week)
CheckPost- Event
Act(Post- Event)
4. I dentif y and
Select Solutions
Excellence
Start
•Next Steps f rom “Act”•I dentif y Process•Develop Scope•Develop Mission•I dentif y & Secure Resources•Develop the Project Charter•Form the Team
•Develop Baseline Process Map•I dentify High Level I ssues and Barriers•I .D. Root Causes•Select Solutions•Redesign Process & Process Tools•Develop I mplementation Plan•Develop Playbook•I mplement the Plan
•I mplement the Plan •Track I mplementation •Adjust Plan•Evaluate Results
•Make Adjustments•I .D. Lessons Learned•Standardize •Replicate•Communicate Remaining I ssues•Develop Next Steps
1. Plan the Project
2. Understand Current Process
3. I dentif y& Analyze I ssues & Barriers
6. Ensure Results
7. Close the Project
5. I mplement
Facilitators lead activities
Team Leader leads team, Facilitators lead
activities
Team Leader leads team, assumes f ull
project responsibility
People, Tools & Processes
Steve Dickinson
What is Excellence in Service?
Meeting your customers’ requirements within your
mission
“To help people with disabilities find and maintain employment, and enhance their independence.”
Sample VR Mission
People, Tools & Processes
Steve Dickinson
How to Obtain ExcellenceGetting from Here to Here
People, Tools & Processes
Steve Dickinson
Improvement Processes
Tools
People
• Baldrige
• Process Management
• Benchmarking Best Practices
• Lean
• Analytical Problem Solving (DMAIC)
• Process Mapping
• Pareto Analysis
• Value Stream mapping
• Matrix Analysis
• Teams
• Individual Contributors
• Management
• Customers?
Processes, Tools and People
People, Tools & Processes
Steve Dickinson
Let’s Look at Processes
People, Tools & Processes
Steve Dickinson
Malcolm Baldrige Criteria for Organization Excellence
http://www.nist.gov/baldrige/
The Inclusive Management System
Not Prescriptive – Tells you WHAT but not HOW
People, Tools & Processes
Steve Dickinson
Process ManagementIdentify Processes
Identify Customer
s
Identify Customer
Requirements
Identify Measures
Manage by
Measures
Developing the Infrastructure
Simplified Improvement
Model
People, Tools & Processes
Steve Dickinson
Watch Measures
OK?
Make Improvement
s
Yes
No
Daily Process Management
People, Tools & Processes
Steve Dickinson
Benchmarking Best Practices
Plan
DoCheck
Act
1. Set Direction
2. UnderstandProcess
3. Study Best
Perf ormers
4. I dentif y, Test & Select
Solutions
5. I mplement
6. Ensure Results
7. Remaining I ssues andFuture Plans
DRIVE!
Start
•Study Test •I mplementation Plan•Tracking I mplementation•Evaluation of Results•Redirect Activities
•Adjustments•Lessons Learned•Standardization•Replication•Sharing with Partners•Remaining I ssues•Next Steps
•Next Steps f rom “Act”•I dentif y gap•Requirements•Costs•Resources•Charter•Timeline•Process
•Mapping•Barriers•Problem Points•Partner Selection•Site Visit•Solutions•Process Redesign•Testing
Plus +
•High Probability of Success•Easier in Public Sector
Minus –
•Travel•Not Invented Here Disease
People, Tools & Processes
Steve Dickinson
Benchmarking Best Practices in VR
Research and Technical Assistance Center (RTAC) on Vocational Rehabilitation Program Management
A “collaborative initiative to identify, test, and disseminate management practices in order to build a performance management model tailored to the Vocational Rehabilitation system.” Second cohort.
• California Department of Rehabilitation• Colorado Division of Vocational Rehabilitation• Connecticut Bureau of Rehabilitation Services & Connecticut Bureau of
Education and Services for the Blind• Delaware Division of Vocational Rehabilitation• Kentucky Office for the Blind• Kentucky Office of Vocational Rehabilitation• Missouri Division of Vocational Rehabilitation• Nebraska Vocational Rehabilitation• New Jersey Division of Vocational Rehabilitation Services• North Carolina Division of Vocational Rehabilitation Services
People, Tools & Processes
Steve Dickinson
“Lean”Plan(Pre- Event)
Do(Event Week)
CheckPost- Event
Act(Post- Event)
4. I dentif y and
Select Solutions
Excellence
Start
•Next Steps f rom “Act”•I dentif y Process•Develop Scope•Develop Mission•I dentif y & Secure Resources•Develop the Project Charter•Form the Team
•Develop Baseline Process Map•I dentify High Level I ssues and Barriers•I .D. Root Causes•Select Solutions•Redesign Process & Process Tools•Develop I mplementation Plan•Develop Playbook•I mplement the Plan
•I mplement the Plan •Track I mplementation •Adjust Plan•Evaluate Results
•Make Adjustments•I .D. Lessons Learned•Standardize •Replicate•Communicate Remaining I ssues•Develop Next Steps
1. Plan the Project
2. Understand Current Process
3. I dentif y& Analyze I ssues & Barriers
6. Ensure Results
7. Close the Project
5. I mplement
Facilitators lead activities
Team Leader leads team, Facilitators lead
activities
Team Leader leads team, assumes f ull
project responsibility
Plus +
•Great Results in Short Timeframe•Employee Engagement•Inexpensive – No Cost or Low Cost Improvements•Non-Technical
Minus –
•Requires Employee Time for Kaizen EventsPQS, Inc. Rapid Process
Improvement Methodsm Model
People, Tools & Processes
Steve Dickinson
Lean Enterprise – “lean”
Eight Sources of Waste – Focus on Flow.
Removal of waste from processes, reduced cycle time & cost reductions resulting in Excellence in Service
Waste
Transport
Over-producing
Defects
Motion
Waiting(Queue time)
Over-Processing*
Inventory
* Including Over Specialization
People, Tools & Processes
Steve Dickinson
Lean Enterprise – “Lean”
• Apply tools and concepts of Lean such as:• Batch and Queue• 5 S• Excessive Specialization
Various Methods for “Kaisen Events”
• Focus on no cost or low cost process improvements that increase flow by removing process waste
• Focus on what is best for the customer
• Most involve some kind of mapping of the process
• Standardization and stabilization of the process, not necessarily the content
• Utilizes Front Line Workers in Kaisen Events
People, Tools & Processes
Steve Dickinson
Plan(Pre- Event)
Do(Event Week)
CheckPost- Event
Act(Post- Event)
4. I dentif y and
Select Solutions
Excellence
Start
•Next Steps f rom “Act”•I dentif y Process•Develop Scope•Develop Mission•I dentif y & Secure Resources•Develop the Project Charter•Form the Team
•Develop Baseline Process Map•I dentif y High Level I ssues and Barriers•I .D. Root Causes•Select Solutions•Redesign Process & Process Tools•Develop I mplementation Plan•Develop Playbook•I mplement the Plan
•I mplement the Plan •Track I mplementation •Adjust Plan•Evaluate Results
•Make Adjustments•I .D. Lessons Learned•Standardize •Replicate•Communicate Remaining I ssues•Develop Next Steps
1. Plan the Project
2. Understand Current Process
3. I dentif y& Analyze I ssues & Barriers
6. Ensure Results
7. Close the Project
5. I mplement
Facilitators lead activities
Team Leader leads team, Facilitators lead
activities
Team Leader leads team, assumes f ull
project responsibility
PQS, Inc. Rapid Process Improvement Methodsm (RPI)
Three Phases
1.Pre-event Planning
2.Team Event
3.Post-event Implementation
People, Tools & Processes
Steve Dickinson
Florida Department of Environmental Protection
Pink = Process DelayGreen = Transport/HandoffYellow = Action Steps
People, Tools & Processes
Steve Dickinson
Results
1. Reduction in processing time by as much as 83%2. Reduction in variation just as important – more predictable
enabling planning and customer service
People, Tools & Processes
Steve Dickinson
Florida VR Project Team Example Cross-functional Team of HQ and Field
Services Mission
“To reduce the number of days from the invoice being received in HQ to the invoice being sent to DOE, while maintaining the accuracy of authorizations for payment.”
ResultsRemoved 1/3 (24) of the process steps which were duplicative
Cycle time reduction from 18 days to 5 days with increased accuracy!
People, Tools & Processes
Steve Dickinson
Six-Sigma Analytic Problem Solving (DMAIC)
• Became popular in the US in 1980’s
• Tools and process around for years
• Popular in Japan since WW II
• Focus on improving quality & reducing costs through reduction of variation & thus defects
Define Project and Boundaries
Analyze the specifi c problem
for root causes
Measure and stratif y the problem
into its specifi ccomponents
Control the work process to ensure
lasting results
I mprove theprocess with lasting solutions
• Data driven statistical analysis
• Uses basic, moderate and advanced statistical tools depending on training – Yellow, Green and Black Belt levels
People, Tools & Processes
Steve Dickinson
Define Project and Boundaries
Analyze the specific problem
for root causes
Measure and stratif y the problem
into its specificcomponents
Control the work process to ensure
lasting results
I mprove theprocess with lasting solutions
Six-Sigma – The DMAIC Process
Plus +
•Great when there are many unknowns•Can solve just about anything•Data to support conclusions•Can be done by individuals
Minus –
•Time consuming•Requires extensive training (advanced tools)
People, Tools & Processes
Steve Dickinson
ALOS KPIAverage Length of Stay
(Includes Newborns; Excludes Rehab and Hospice Cases)
3.00
3.50
4.00
4.50
5.00
5.50
6.00
AL
OS
2006 YE 5.11
2007 YTD Actual 5.14 5.44 5.31 5.52 5.32 5.02
2007 YTD Target 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
2006 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Source: Decision Support; Trendstart
Good
4.7 4.45 4.25 4.35 4.25 4.0
Results
“It has been calculated by Finance that each 0.1 day translates into $560,590 of additional cost to the hospital.” ($850,000 improvement) Patients also do not want to stay in the hospital any longer than they need to.
People, Tools & Processes
Steve Dickinson
Let’s Look at ToolsMultivariable Checksheet
Market
Austin
Corpus
Chicago
Kentucky
South Florida
Other
Arizona
North Florida
Atlanta
# Claims Rejected
Hospital/ Facility Physician Equipment Seq #
All Process Steps – Include Transport and Delay TimeChanges Product?
Req for 1st time
Change import. to
Cust?
Process Analysis Worksheet
Elimination of Referrals (I llustrative Only – Not a real case)
+ Driving Forces - Restraining Forces
Reduced cost f or processing by company and Physicians
I ncreased Member satisf action as they can go to any doctor they want
I mproved political relationships as Member choices are increased
I ncreased First Pass Rate, lower suspends, less paperwork
I ncreased costs to company, without a relative increase in service. This would have to be passed on to the Members and Groups causing us to be less cost competitive
Members making improper choices of Physician needed subjecting them to unneeded medical care and unneeded co-pays and multiple visits to multiple doctors to get the correct care. Decreased Member satisf action
Loss of medical care control By the PCP leaving no one in control of the health care plan f or the member
SIPOCMembership and Billing – Option B Invoice Reconciliation Process
Rev 11-15-1956
Key Performance Measures Customer Requirements
Key Process S
teps
Suppliers
Inputs/Enablers
• Invoice with option “B”• Documentation for termination
Customers
Outputs
• Request for additional information•Reconciliation of invoice
Support Area (Enablers)
Invoice Received by CCR
• CCR applies premium to system
• CCR sends any attached documents to M&B
Invoice documents are received
by M&B
• Admin support receives invoice document
•Invoice is looked up for PSR clerk code
• Materials are placed in bin to go to PSR
Corporate Cash Receipts (CCR) (supportive only)
Membership and Billing (M&B) Administrative Support
Legal (supportive only)
Provider Services Rep
PSR receives documents
• Invoices are sorted by date order and placed in Invoice/ Reconciliation
• Prior to processing the invoice is reviewed for additional information needed
Invoice processing
• Invoice is processed if no additional information is needed
•If group indicates reason ‘B’ on back of invoice additional information is required
• Contact is made to the group to request additional information
PSR receives document for cancellation
• Cancellation of member is processed
• Invoice is reconciled
• Benefits Administrator• Corporate Cash Receipts• Administrative Support
•Benefit Administrator•Member•Customer Service
Process all invoice reconciliations with the time frame goal with 100% accuracyCorporate cycle time is 10 days
Can put Players here for each stepThese are potential RPI “Team” members
- CCR Specialist- CCR Clerk
- Admin Suppt Clerk- CCR Clerk
- Admin Suppt Clerk- PSR- PSR Mgr.
- PSR- Lead Rep- PSR Mgr
-PSR- Lead Rep- PSR Mgr
Potential Bench StrengthPotential Bench Strength
ILLUSTRATIVE ONLY
A
Process Owner ________________________B
CD
E
F
FD
GH
1 2 3 4 5
Unclear or not followed
Procedures and Guidelines
Clearly agreed upon and followed
Individuals protect self-interest
Individuals support each other and the goals/mission
1 2 3 4 5
Commitment
None set or irrelevant
Well defined and clear goals
1 2 3 4 5
Goals/Mission/Objectives
1 2 3 4 5
Had no process or was not followed
Process
Process was clear and followed
1 2 3 4 5
Few people involved
Participation
Everyone involved and eager to participate
1 2 3 4 5
Very low trust
Trust
High level of trust
1 2 3 4 5
Little evidence of conflict
Conflict
Conflict allowed, existed and was productive
1 2 3 4 5
None, everything on the table
Hidden Agendas
Great deal hidden, unresolved conflicts
1 2 3 4 5
Much wasted time
Timing
Time well spent
1 2 3 4 5
Too much direction and control
Facilitation
Just right amount of direction and control
Comments:
________________________________
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Team Member Feedback Sheet
Rating of Importance
9 9 7 10 10 9 3 2 6
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Crtiteria
Pot. Solutions Impr
oved
P.P
.I.
Cos
t
Eas
e to
Im
plem
ent
Str
ateg
ic P
rior
ity
Ris
k
Min
imal
R
esou
rce
Impa
ct
Min
imal
IT
R
esou
rce
Impa
ct
Fin
anci
al B
enef
it
Ben
efot
to
Cus
tom
er
Sat
isfa
ctio
n
Total
1PCP picks specialist
9 8 1 5 1 4 5 1 2 285
2Always call Healthy
1 1 1 1 1 1 1 1 1 65
3Eliminate referrals
0 0 0 0 0 0 0 0 0 0
4 No changes 1 1 10 1 1 5 1 1 1 164
5Claims sent to PCP first
1 1 1 1 1 2 1 1 1 74
6Provide electronic number
9 6 5 10 10 7 4 10 10 525
7Change deny to reject for no referral
10 9 9 8 5 8 6 2 5 488
(Option not possible)
Solution SelectionMatrix
$-$150,000 $300,000 $450,000 $600,000 $750,000 $900,000
$1,050,000 $1,200,000 $1,350,000
Dol
lars
Date
TOA MTD Cummulative Gross F. Goods InvoicedJuly 2003
MTD Cummulative F. Goods Sales Invoiced - Actual MTD Cummulative F.G. Sales Invoiced - Target
771,022 763,293
594,306
368,281
809,668
1,015,352 1,088,396
902,687
-
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
Nov/02 Dec/02 Jan/03 Feb/03 Mar/03 Apr/03 May/03 Jun/03
Po
und
s
Month
TOA Monthly Finished Goods InventoryJuly 2003
Finished Goods InventoryF.G. Green Level - Ok ( One Week Sales Orders)F.G. Yellow Level - Stock build up Warning (Two Weeks Sales Orders)F.G. Red Level - Stockbuild up (Over Two Weeks Sales Orders)
Good
Speed0
200
400
600
800
1,000
487
400 398
34
655
455397
524 499456
666
765
Types of Defects Received in Warranty ClaimsMachine Stuff , I nc.
2002
StartingGeneralCracked
Case
WiringMotorsBearings Paint
SealsLines
OtherFuel
Num
ber
of
Def
ects
x 1
00
Source: MSWC Report 456
0
200
400
600
800
1,000
487
400 398
34
655
455397
524 499456
666
765
Type of Defect
Speed0
200
400
600
800
1,000
487
400 398
34
655
455397
524 499456
666
765
Types of Defects Received in Warranty ClaimsMachine Stuff , I nc.
2002
StartingGeneralCracked
Case
WiringMotorsBearings Paint
SealsLines
OtherFuel
Num
ber
of
Def
ects
x 1
00
Source: MSWC Report 456
0
200
400
600
800
1,000
487
400 398
34
655
455397
524 499456
666
765
Type of Defect
Af terBefore
Source: Service deviation warranty system
Total Problem reductionValve
Problemreduction
Valves Motors Leaks
96 52 8
Compressor Failure Types 1999 (Annualized using J an - Mar data)
Type of Failure
Source: Warranty system
N=156
Valves Motors Leaks
96 52 8
Type of Failure
Source: Warranty system
N=156
Compressor Failure Types - 1997
0
200
400
600
800
1,000
1,200
Valve Failures Motor Leaks Machining ErrorOil Problems Other
Type of Failure
Num
ber
of
Fai
lure
s
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ACCU
MU
LAT
IVE %
CO
NT
RIB
UT
ION
Source: Service deviation warranty system
N = 1236
80%
86%91%
9698%
985
80 64 52 32 23
Af terBefore
Source: Service deviation warranty systemSource: Service deviation warranty system
Total Problem reductionValve
Problemreduction
Valves Motors Leaks
96 52 8
Compressor Failure Types 1999 (Annualized using J an - Mar data)
Type of Failure
Source: Warranty system
N=156
Valves Motors Leaks
96 52 8
Type of Failure
Source: Warranty system
N=156
Compressor Failure Types - 1997
0
200
400
600
800
1,000
1,200
Valve Failures Motor Leaks Machining ErrorOil Problems Other
Type of Failure
Num
ber
of
Fai
lure
s
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ACCU
MU
LAT
IVE %
CO
NT
RIB
UT
ION
Source: Service deviation warranty system
N = 1236
80%
86%91%
9698%
985
80 64 52 32 23
7
6
5
4
3
2
1
Tone of Voice
Quick Response
Trusted AnswerThoroughness
Friendly
Overall Experience
Customer Satisf action Results (Calls)San Francisco Service Center
October 2002
I mportance
Satisf action
Amount of Wait
Claims Processing TimesSan Francisco Service Center
June 2002
0
5
10
15
20
25
30
35
40
45
50
0.5 to2.0
2.0 to3.5
3.5 to5.0
5.0 to6.5
6.5 to8.0
8.0 to9.5
9.5 to11.0
11.0 to12.5
12.5 to14.0
14.0 to15.5
15.5 to17.0
17.0 to18.5
18.5 to20.0
20.0 to21.5
# Days to Process
# C
laim
s
n=159 Lower Specification Limit=5
Mean=12.
Upper Specification Limit=18
Hypothetical Claims Processing Example – Non inclusive
External Customer Needs
RequiredOutcomes
Outcome Drivers
Drivers of the Drivers
Process Drivers
Timely payment of claims
Accurate payment of claims
Understandable explanation
Ease of submittal
Adequate Margin
Maximize cash flow benefit
Meet regulatory requirements
Business Needs
Meet Contracts
Meet Regulatory Requirements
< 30 days from submittal
No Rework
No callbacks for explanations
What we want
First pass rate
Timely reconciliation of edits
Mail time <3 days
Timely COB resolution
Timely edit resolution
Timely Special Investigation
Timely Medical Necessity
High electronic claim submittal rate
Backlog < 50 claims/investigator
Aging < 2 days
Investigation complete in <6 days
No regulatory complaints or fines
Pay < 2 days from requirement
Lowest cost per claim
What we have to control or “manage” for
timely payment of claims for
contracts
P1
P2
P3 Pn
Probability of Success = P1 *P2 * P3 * …Pn
P1
P2
P3 Pn
P1
P2
P3 Pn
P1
P2
P3 Pn
Probability of Success = P1 *P2 * P3 * …Pn
Page 16
Relationship Between Study Time and Test Scores
0
20
40
60
80
100
120
140
0 10 20 30 40 50 60 70 80 90
Test Scores
Stu
dy
Tim
e (M
inu
tes)
Feedback Mechanism Worksheet
I ndicator Data Required Location Data CollectorDisplayTool
DataRecipient
Distribution FrequencyStandards/Formulas
Color of CarsPQS, Inc. Parking Lot
September 29, 2002
Brown40%
Red19%
Blue14%
Green7%
Other20%
n=457
People, Tools & Processes
Steve Dickinson
Let’s Look at People
The People Side of Excellence
Processes and Tools People
Excellence
People, Tools & Processes
Steve Dickinson
Kotter’s Eight-Step Process for Creating Major Change (From Management
Perspective)
1. Establish a Sense of Urgency
2. Create the Guiding Coalition
3. Develop a Vision and Strategy
4. Communicate that Change Vision
5. Empower Broad-Based Action
6. Generate Short-term Wins
7. Consolidate Gains and Produce More Change
8. Anchor New Approaches in the Culture
People, Tools & Processes
Steve Dickinson
What Makes People Want to “Play?”
Management
Front Line Workers
People, Tools & Processes
Steve Dickinson
People, Tools & Process
Plan(Pre- Event)
Do(Event Week)
CheckPost- Event
Act(Post- Event)
4. I dentif y and
Select Solutions
Excellence
Start
•Next Steps f rom “Act”•I dentif y Process•Develop Scope•Develop Mission•I dentif y & Secure Resources•Develop the Project Charter•Form the Team
•Develop Baseline Process Map•I dentif y High Level I ssues and Barriers•I .D. Root Causes•Select Solut ions•Redesign Process & Process Tools•Develop I mplementation Plan•Develop Playbook•I mplement the Plan
•I mplement the Plan •Track I mplementation •Adjust Plan•Evaluate Results
•Make Adjustments•I .D. Lessons Learned•Standardize •Replicate•Communicate Remaining I ssues•Develop Next Steps
1. Plan the Project
2. Understand Current Process
3. I dentif y& Analyze I ssues & Barriers
6. Ensure Results
7. Close the Project
5. I mplement
Facilitators lead activities
Team Leader leads team, Facilitators lead
activities
Team Leader leads team, assumes f ull
project responsibility
Let’s addLeadership
Processes
Tools
People+
The Secrets to Excellence
People, Tools & Processes
Steve Dickinson
The
of H.A.T.S.(How all this syncs)
Magic
People, Tools & Processes
Steve Dickinson
Thanks!N85TT
Steve DickinsonPQS, Incpqsinc@aol.comwww.pqsinc.com850-694-4235
People, Tools & Processes
Steve Dickinson