Special Thanks…Debra Isaac, Customer Service Supervisor – Vital

StatisticsCheryl M. Williams, Deputy Registrar – Vital StatisticsSimon Trevino, Senior Computer Operator – Vital

StatisticsVital Statistics Cashiers

Luis CarrilloMary CouteeEsmeralda GonzalezCathy GrantLoretha JimmersonWillie “Tweety” McClintokJuanita VelasquezHelen Smith

Larissa EstesJulia Gee

Naomi MaciasCelina Garza Ridge

Varsha Vakil

Public Health Department Accreditation Measurement of performance against nationally

recognized, evidence-based standards

Improve and protect the health of the public by advancing the quality and performance of public health departments

Benefits Systematic approach to public health Ensures quality services are provided to residents Enhances visibility and validates commitment to residents Means to obtain additional funding Provides an opportunity to identify areas of performance

improvement

Why Quality Improvement?Foundation of public health

accreditationAccountability

Results of investment in public healthDeclining – do more with lessFuture funding requirement

Getting better all the time Improving performance Improving health outcomes Improving customer satisfaction

Definition of Quality Improvement In Public Health

“Quality improvement in public health is the use of a deliberate and defined improvement process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health. 

It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.”

Defining Quality Improvement in Public Health; Journal of Public Health Management & Practice: January/February 2010 - Volume 16 - Issue 1 - p 5–7, Riley, William J. PhD; Moran, John W. PhD, MBA, CQIA, CQM, CMC; Corso, Liza C. MPA; Beitsch, Leslie M. MD, JD; Bialek, Ronald MPP; Cofsky, Abbey -

Continuous Improvement

Act

DoCheck/Study

Plan The continuous improvement phase of a process is how youmake a change in direction.The change usually is because the process output is deterioratingor customer needs have changed

What Is Quality?Today the most progressive view of quality is

that it is defined entirely by the customer or end user and is based upon that person's evaluation of his or her entire customer experience.

The customer experience is the aggregate of all the Touch Pointsouch Points that customers have with the organization’s product and services, and is by definition a combination of these. (RFT)

“Quality is not an act. It is a habit”Aristotle 384BC-322BC, Greek philosopher and scientist, student of Plato and

teacher of Alexander the Great  

Vital Statistics Lobby

AIM StatementAn opportunity exists to improve the Vital

Statistics Customer Flow beginning with

customer receipt of ticket number from

information window and ending with being

called by a cashier to complete financial

transaction. This effort should reduce wait

time by 15 minutes for the customer.

AIM StatementThis process is important to work on now because

wait times are experienced between the info desk

and cashier and to provide good, efficient customer

service

The baseline measurement is defined as the

following metric: Average wait time per cashier

window of 28 minutes by cashier by day

MethodologyObserved the customer waiting areaMultiple one-on-one discussions with

supervisor and deputy registrar Observed cashiers during several time points

during the work weekSummary analysis of operational reports

Customer Wait TimeTransaction TimePrint Time

Cashier Survey

SIPOC+CMConstraints: •Language•Signage•Volume•Incomplete documentation•Printer •Database, Network•Problematic application searches

Begins with: Customer receiving ticket # from info desk

Ends with: Customer call to cashier window

Process/Activities: • Customer waiting for cashier call (in lobby)•Cashier call

Outputs: • Check documents• Begin database search• Send to Print•Complete transaction

Customers: •General public (Residents of Texas state)

Measures: Average Customer wait timeCashier feedbackCustomer feedback

Inputs: • # of Customers• # of Cashiers•Supervisor triggers/alerts• Previously completed application (at home, office etc)•Availability of all needed documents

Suppliers: • Texas State database• Network

Call # Assigned

NY

Cashier Call

Complete SearchFinancial Transaction

Sent to Printer

Obtain Correct Information

Customer Wait TimeAvg.: 28 min

Is application information correct?

Pick up Certificate at window #10

Print Window CallCustomer Wait Time, includes SOD certificates Avg.: 7 min

Customer enters Vital Statistics Lobby

Info Desk

NY

Complete correct section

Leave if cannot

complete form or

missing docs

Is a correct application section complete and required documentation available?

Customer Wait Time: UnknownFlow Chart

Fishbone – Cause and Effect

Wait time of 28 minutes for vital statistic customers

•Database•Equipment•Network, server•Software

•Training, skill set•Communication

•“problem” certificates•Printing process•Signage/layout

PROCESS

MechanicalWo-Man Power

•Staffing Adjustments# of windows openSupervisor moderates flow

•Distribution of tasks, responsibilities↓ customer flow – additional tasks↑customer flow - ↑# of windows open

Staffing level

Staffing adjustments

Dist of tasks, responsibilities

•Staffing levelTriggersSupervisor calling for back up

Pilot TestIdea – transfer 1 person from correspondence

to window #6; add lunch coverage 4 windows open at all times

Results – June 4th – 8th

Plan

1. Identify / Prioritize Opportunities:Customer average wait time

more than 28 minutes

2. AIM: Reduce customerwait time to 15 minutes

3. Current Process: Limited number of cashiers

to process transactions

4. Collect Data On: Number of cashiers and the wait time

per customer

5. Identify Possible Causes: No. of cashier windows open,

Printer/network issues, Incomplete documentation etc.

6. Identify Potential Improvements:Increase the number of cashier

windows open(especially at rush hour)

7. Develop Improvement Theory: Create trigger system for supervisor to

improve customer flow. Maintain wait time to 15mins.

8. Develop Action Plan: Pilot Program – One additional cashier added from

Correspondence and additional cashier/swhen wait time exceeds 15 minutes

1. Implement the Improvement:Implementation of Pilot

Program for a week

Do

2. Collect and Document the data:Wait time reduced by 50%

3. Problems, Observations, Lessons LearnedPilot Program ImplementationDay 1: Ran a snag – 4 staff out

Day 2: Successfully implemented Pilot Program (5 cashier windows open)

Day 2-5: Pilot Successfully implemented

Check/Study

1. Reflect on the Analysis:Data obtained for wait time - 1 Week

pilot program. Cashier Survey data

Act:

2. Document Problems: Unavailability of Staff and Communication issues.

Observation: Smooth running of pilotLessons learned: Customer Wait time

directly proportional to # of cashier window open

Adopt

Adapt

Abandon

Standardize

Do

Plan

Vital Statistics

Priorities: Enhance the

ability to serve customers in timely

fashion and reduce long

wait times

Develop:MOU’s, SOP’s

Execute:Project

implemented after studying the pros and cons of

and fine-tuning theprogram , maintain

any progress.

Feedback:Cashier feedback

(Pilot project)Customer Survey

Incentive:Satisfied customers

reflect job well done by HDHHSVital Statistics.

Demonstrate:Measurable

improvementin HDHHS

Vital Statisticscustomer

wait time.

Overcome:Language barriersand geographical(satellite location)

barriers.

Encourage: Staff

and partnersto maintain

usage of available resources / manpower.

Develop:Agreements

between HDHHS

Vital Statisticsfor implementation

of pilot program

Prepare: Roadmap to

implement pilot program

and overcome any foreseen

barriers

Document:Pros and Cons

of Pilot program

Develop: Avenues and

trigger modules for Vital Statistics

Supervisor/s to access other

resources/manpower

Prepare: Pilot program

Instruct:Supervisor/s,

Cashiers

Identify:Supervisor, Cashier

and staff roles / responsibilities

Implement: Pilot program for 1 week

Evaluate: Data

Participants:Supervisor/s,

Cashiers,and Staff of

HDHHS Vital Statistics

Agencies:Satellite location

partners and otherAffiliated partners

Staff: HDHHS

QI STAR Trak TeamVital Statistics

Materials: Office supplies

Cash boxes(Vital Statistics)

Equipment:Printers

Xerox machinesComputers

Inputs OutputsActivities Participation

Outcomes- ImpactShort term Medium Term Long Term

SituationHDHHS Vital Statistics currently experiencing average customer wait time of 28minutes. Among the reasons for these difficulties is few cashier windows open to serve customers.

AssumptionsVital Statistics will work collaboratively

to implement the project

External factorsStaff feels alienated, incentives not good

enough to motivate and organizational bureaucracies.

EvaluationDemonstrate measureable improvement in Vital Statistics customer wait time. Customer Feedback Survey

And Cashier Feedback. Increase in customer satisfaction to access HDHHS Vital Statistics resources.

Goal: Build avenues to instruct supervisor/s on available resources that can be implemented to reduce customer wait time and assist them to adopt multiple trigger modules to use the available resources. Avenues created are flexible to accommodate all barriers.

Houston Department of Health and Human Services (HDDHS) aims to reduce Vital Statistics customer wait time.

RESULTS

Cashier Survey

Bureau of Vital Statistics - Cashier Feedback

STAR Trak (Blue Team) Pilot program initiative

(To be completed by Cashier)

Cashier Initials (optional): _________________________________________________

Cashier Work Days and Hours: _____________________________________________

Did you like the STAR Pilot Program Initiative? Yes/No: _______________

Why? (please provide details): ___________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

Please provide any suggestion/comments to improve the program:

____________________________________________________________

____________________________________________________________

Thank you for your participation!

Customers waiting in lobby with 4 Cashier Windows Open Pilot program - Friday 06/08/12 at 2 pm

Cashier Feedback (N = 6)

Q. Did you like the Star TRaK Pilot Program? A. Yes = 5 No = 0

Cashier Comments:“Were able to assist customers faster, continue with more windows open.” “Compliments from customers really made me feel good.”“One [extra] window does make a difference.”“Need to keep more windows open.”“Enjoyed all windows being open, made everything flow smoothly and faster.”“Need more bilingual staff.”

Update on improvement effortsUpdate Cashier Standard Operating Procedures

(SOP)Brought on board temporary staff for Vital

StatisticsStreamlining tasks Workload analysis, resultsPerformance expectations – improved Bureau &

staff functionality New vacation/ sick time policyStaffing levels to improve efficiency &

effectiveness

Next Steps Employee SurveyContinue to monitor & Plan Do Check ActCustomer Survey

Lessons LearnedBlack box / Ripple effectCashiers

Great customer service skillsEfficient and FASTExcellent troubleshooting

Control what you can control… Customer Cashier

???

Lessons learned from Vital Open to change, constructive criticismGoal improved customer servicesListen to othersSuggestions are a way to improve

Improvements ≠ failure it is an opportunity to make it even better

Questions…