Session 8 - Introduction to Lean Six Sigma

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Session 8 - Introduction to Lean Six Sigma

  1. 1. Session 8: ContinuousPerformance ImprovementThrough Lean Six Sigma in theMilitary Health System COL Angela Koelsch, FACHE, MBB, Process Improvement Specialist Strategy & Innovation Knowledge Management Officer angela.koelsch@us.army.mil 1
  2. 2. Agenda• Military Health System (MHS) Decision 2
  3. 3. Agenda• Military Health System (MHS) Decision• Lean Six Sigma (LSS) Basics 3
  4. 4. Agenda• Military Health System (MHS) Decision• Lean Six Sigma (LSS) Basics• LSS “Fits” in Strategic Performance Execution 4
  5. 5. Agenda• Military Health System (MHS) Decision• Lean Six Sigma (LSS) Basics• LSS “Fits” in Strategic Performance Execution• Linking Strategy to Performance Improvement 5
  6. 6. Agenda• Military Health System (MHS) Decision• Lean Six Sigma (LSS) Basics• LSS “Fits” in Strategic Performance Execution• Linking Strategy to Performance Improvement• Leveraging Learning Across the Organization 6
  7. 7. Agenda• Military Health System (MHS) Decision• Lean Six Sigma (LSS) Basics• LSS “Fits” in Strategic Performance Execution• Linking Strategy to Performance Improvement• Leveraging Learning Across the Organization• Early Lessons Learned 7
  8. 8. MHS QDR Mandate 8
  9. 9. MHS QDR Mandate • Select the CPI method most appropriate for the MHS 9
  10. 10. MHS QDR Mandate • Select the CPI method most appropriate for the MHS— common vocabulary, toolsets 10
  11. 11. MHS QDR Mandate • Select the CPI method most appropriate for the MHS— common vocabulary, toolsets • Implement across all MHS components in a consistent fashion 11
  12. 12. MHS QDR Mandate • Select the CPI method most appropriate for the MHS— common vocabulary, toolsets • Implement across all MHS components in a consistent fashion— learn, grow together 12
  13. 13. MHS QDR Mandate • 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 13
  14. 14. MHS QDR Mandate • 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 14
  15. 15. Pathway to MHS Decision 15
  16. 16. Pathway to MHS Decision• MHS QDR-9 PI Tiger Team Coordination • Throughout Summer 06, teeing up for SMMAC decision • No implementation consensus; LSS fait-accompli by Fall 16
  17. 17. Pathway to MHS Decision• MHS QDR-9 PI Tiger Team Coordination • Throughout Summer 06, teeing up for SMMAC decision • No implementation consensus; LSS fait-accompli by Fall• Execution in the Services: • USA: Lean Six Sigma • USAF: AFSO-21 (Air Force Smart Operations-21st Century) • USN/USMC: Lean Six Sigma 17
  18. 18. Lean Six Sigma Basics 18
  19. 19. LSS Basics• Industry best practice management framework combines “Lean” and “Six Sigma” strategies 19
  20. 20. LSS Basics• Industry best practice management framework combines “Lean” and “Six Sigma” strategies• “Lean” methods… 20
  21. 21. LSS Basics• Industry best practice management framework combines “Lean” and “Six Sigma” strategies• “Lean” methods… • Remove non-value added waste from processes • Thus, reduce process cycle time • Happy customers—reduced cost! 21
  22. 22. LSS Basics• Industry best practice management framework combines “Lean” and “Six Sigma” strategies• “Lean” methods… • Remove non-value added waste from processes • Thus, reduce process cycle time • Happy customers—reduced cost!• “Six Sigma” methods… 22
  23. 23. LSS Basics• Industry best practice management framework combines “Lean” and “Six Sigma” strategies• “Lean” methods… • Remove non-value added waste from processes • Thus, reduce process cycle time • Happy customers—reduced cost!• “Six Sigma” methods… • Analyze and reduce variability in processes • Thus, improve quality • More happy customers—more reduced cost! 23
  24. 24. What’s Different About LSS? 24
  25. 25. Craft Taylor – Eli Whitney - Time/Motion Production Product Studies … LSS Builds Upon a Standards Gilbreth Industrial Scientific Shewhart – Production Management Statistical Foundation Ford – Methods Work Statistical Analysis Process Control Juran – Assembly Simplified of Continuous Process Line Manufacturing Manufacturing Analysis Quality Organized Sloan – Control Tunner – Labor – Modern Taguchi – Berlin Airlift Worker’s Management Customer Performance Rights Focus Mass Simplified Quality Production Service/Process Engineering Zero Improvement! Deming – Toyoda, Defects Systems Ohno, Thinking Shingo TQM - Toyota Simplified Total Quality Production Product Line Management Smith System Harry – (Motorola) – DMAIC Statistical Womack Rigor Six & Jones George & Wilson – Sigma v1 Optimized Welch/ Lean George, ITT Enterprise Complexity Bossidy – Industries,Organizational CAT, XeroxInfrastructure Six Sigma v2 Lean Six Sigma v1 Lean Six Sigma v2 25
  26. 26. What’s Different About LSS?This is… 26
  27. 27. What’s Different About LSS?This is…• Prescriptive framework …vs descriptive framework 27
  28. 28. What’s Different About LSS?This is…• Prescriptive framework …vs descriptive framework• Trained experts leading trained project teams …vs reading a book and trying it on the fly 28
  29. 29. What’s Different About LSS?This is…• 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” 29
  30. 30. What’s Different About LSS?This is…• 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 30
  31. 31. LSS Basics: InfrastructureNeeded to Succeed! Executive Steering Committee At each level of organizations: • Senior Leader • Deployment Director • Senior Financial Mgr • Critical Process Owners Organization’s • Master Black Belt (Advisor) Senior Leader Deployment Director Master Process Owner Process Process Owner Black Belt Owner Black Belt Green Belt Green Belt Black Belt Full-time Positions Project Team Member(s) Green Belt(s) Financial Analyst Project Team Member(s) Project Support … Financial Analyst Mentor … Recommended LSS Infrastructure Based on Industry Best Practice 31
  32. 32. LSS Basics: Training/Certification Multi-level/multi-phased training: Training: Training & Certification Executive Leader Green Belt Project Sponsor Black Belt Project ID/Selection Master Black Belt Project Team/Yellow Belt Organizational Awareness 32
  33. 33. LSS Basics: Training/Certification Multi-level/multi-phased training: Training: Training & Certification Executive Leader Green Belt Project Sponsor Black Belt Project ID/Selection Master Black Belt Project Team/Yellow Belt Organizational Awareness MBB Trng Harvest Results and Share Knowledge Contractor Mentoring & Consulting Project Team Trng BB/GB Trng Project ID & Selection Wksp Project Sponsor Trng Organizational Awareness Trng Executive Leader Trng Assessment Stand-up Program Perform Projects Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 12 Month 18 Month 24+ 33
  34. 34. LSS Basics: Project Execution 34
  35. 35. LSS Basics: Project Execution• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities Project Candidates Structured Project Selection 35
  36. 36. LSS Basics: Project Execution• Customer Issues/Opportunities• Business Strategy• Goals/Objectives• Priorities Prioritized by Project Leader/Mgmt Candidates Team Structured Project Selection HighBENEFIT Med Low EFFORT Low Med High 36
  37. 37. LSS Basics: Project Execution• Customer Issues/Opportunities• Business Strategy• Goals/Objectives Assign Project• Priorities Prioritized by to Sponsor Project Leader/Mgmt and Select Candidates Team Belt Structured Project Selection HighBENEFIT Med Low EFFORT Low Med High 37
  38. 38. LSS Basics: Project Execution• Customer Issues/Opportunities• Business Strategy• Goals/Objectives Assign Project• Priorities Prioritized by to Sponsor Project Leader/Mgmt and Select Candidates Team Belt Structured Project Selection DMAIC Project Management Framework High Define Measure Analyze Improve Control Sponsor Define project purpose and scopeBENEFIT inspects Measure current performance Med deliverables Analyze causes & confirm with data & checkpoints Improve by removing variation and for each non-value added activities Low phase EFFORT Control gains by standardizing Low Med High 38
  39. 39. LSS Basics: Project Execution• Customer Issues/Opportunities• Business Strategy• Goals/Objectives Assign Project• Priorities Prioritized by to Sponsor Project Leader/Mgmt and Select Candidates Team Belt Structured Project Selection DMAIC Project Management Framework High Define Measure Analyze Improve Control Sponsor Define project purpose and scopeBENEFIT inspects Measure current performance Med deliverables Analyze causes & confirm with data & checkpoints Improve by removing variation and for each non-value added activities Low phase EFFORT Control gains by standardizing Low Med High 39
  40. 40. LSS Basics: Project Execution• Customer Issues/Opportunities• Business Strategy• Goals/Objectives Assign Project• Priorities Prioritized by to Sponsor Project Leader/Mgmt and Select Candidates Team Belt Structured Project Selection DMAIC Project Management Framework High Define Measure Analyze Improve Control Sponsor Define project purpose and scopeBENEFIT inspects Measure current performance Med deliverables Analyze causes & confirm with data & checkpoints Improve by removing variation and for each non-value added activities Low phase EFFORT Control gains by standardizing Low Med High 40
  41. 41. LSS Basics: Project Execution• Customer Issues/Opportunities• Business Strategy• Goals/Objectives Assign Project• Priorities Prioritized by to Sponsor Project Leader/Mgmt and Select Candidates Team Belt Structured Project Selection DMAIC Project Management Framework High Define Measure Analyze Improve Control Sponsor Define project purpose and scopeBENEFIT inspects Measure current performance Med deliverables Analyze causes & confirm with data & checkpoints Improve by removing variation and for each non-value added activities Low phase EFFORT Control gains by standardizing Low Med High 41
  42. 42. LSS Basics: Project Execution• Customer Issues/Opportunities• Business Strategy• Goals/Objectives Assign Project• Priorities Prioritized by to Sponsor Project Leader/Mgmt and Select Candidates Team Belt Structured Project Selection DMAIC Project Management Framework High Define Measure Analyze Improve Control Sponsor Define project purpose and scopeBENEFIT inspects Measure current performance Med deliverables Analyze causes & confirm with data & checkpoints Improve by removing variation and for each non-value added activities Low phase EFFORT Control gains by standardizing Low Med High 42
  43. 43. LSS Basics: Project Execution• Customer Issues/Opportunities• Business Strategy• Goals/Objectives Assign Project• Priorities Prioritized by Sponsor to Sponsor Project Leader/Mgmt Inspects and Select Candidates Team Progress Belt Structured Project Selection DMAIC Project Management Framework High Define Measure Analyze Improve Control Sponsor Define project purpose and scopeBENEFIT inspects Measure current performance Med deliverables Analyze causes & confirm with data & checkpoints Improve by removing variation and for each non-value added activities Low phase EFFORT Control gains by standardizing Low Med High 43
  44. 44. LSS Basics: Project Execution• Customer Issues/Opportunities• Business Strategy• Goals/Objectives Assign Project• Priorities Prioritized by Sponsor Results are to Sponsor Project Leader/Mgmt Inspects Captured and and Select Candidates Team Progress Sustained Belt Structured Project Selection DMAIC Project Management Framework High Define Measure Analyze Improve Control Sponsor Define project purpose and scopeBENEFIT inspects Measure current performance Med deliverables Analyze causes & confirm with data & checkpoints Improve by removing variation and for each non-value added activities Low phase EFFORT Control gains by standardizing Low Med High 44
  45. 45. LSS Basics: Project Execution• Customer Issues/Opportunities• Business Strategy• Goals/Objectives Assign Project• Priorities Prioritized by Sponsor Results are to Sponsor Project Leader/Mgmt Inspects Captured and and Select Candidates Team Progress Sustained Belt Structured Project Selection DMAIC Project Management Framework High Define Measure Analyze Improve Control Sponsor Define project purpose and scopeBENEFIT inspects Measure current performance Med deliverables Analyze causes & confirm with data & checkpoints Improve by removing variation and for each non-value added activities Low phase EFFORT Control gains by standardizing Low Med High 45
  46. 46. How LSS Could “Fit” in YourBusiness Innovation Toolkit• BSC defines USAMEDCOM’s org strategy 46
  47. 47. How LSS Could “Fit” in YourBusiness Innovation Toolkit• BSC defines USAMEDCOM’s org strategy • Yours may be defined by another strategy tool 47
  48. 48. How LSS Could “Fit” in YourBusiness Innovation Toolkit• BSC defines USAMEDCOM’s org strategy • Yours may be defined by another strategy tool• LSS fits as Performance Improvement Engine… 48
  49. 49. How LSS Could “Fit” in YourBusiness Innovation Toolkit• BSC defines USAMEDCOM’s org strategy • Yours may be defined by another strategy tool• LSS fits as Performance Improvement Engine… • Evaluate objective targets, performance gaps to reach them 49
  50. 50. How LSS Could “Fit” in YourBusiness Innovation Toolkit• BSC defines USAMEDCOM’s org strategy • Yours may be defined by another strategy tool• LSS fits as Performance Improvement Engine… • Evaluate objective targets, performance gaps to reach them • ID initiatives to close performance gaps 50
  51. 51. How LSS Could “Fit” in YourBusiness Innovation Toolkit• BSC defines USAMEDCOM’s org strategy • Yours may be defined by another strategy tool• LSS fits as Performance Improvement Engine… • Evaluate objective targets, performance gaps to reach them • ID initiatives to close performance gaps • Those initiatives become LSS projects! 51
  52. 52. How LSS Could “Fit” in YourBusiness Innovation Toolkit• BSC defines USAMEDCOM’s org strategy • Yours may be defined by another strategy tool• LSS fits as Performance Improvement Engine… • Evaluate objective targets, performance gaps to reach them • ID initiatives to close performance gaps • Those initiatives become LSS projects• Aligns commitment, resources, and effort against strategically-focused projects 52
  53. 53. How LSS Could “Fit” in YourBusiness Innovation Toolkit ……• Aligns commitment, resources, and effort against strategically-focused projects• The MHS is ahead of the rest of the DoD! • Strategy and objectives defined…MHS BSC, other tools • Data-driven decision-making is routine • Data-mining already part of our infrastructure 53
  54. 54. Challenge: Leveraging Learning Across the Organization 54
  55. 55. Knowledge Management(its Best Practice Transfer component) our next big challenge… 55
  56. 56. Think about it… 56
  57. 57. “Cave dwellers froze todeath on beds of coal… - Adapted from Carla O’Dell, If Only We Knew What We Know, p. ix. 57
  58. 58. Coal was right under them!but they couldn’t see it… mine it… or use it… - Adapted from Carla O’Dell, If Only We Knew What We Know, p. ix. 58
  59. 59. What you don’t knowreally can hurt you! - Adapted from Carla O’Dell, If Only We Knew What We Know, p. ix. 59
  60. 60. But it’s happening all overagain in the 21st Century! - Adapted from Carla O’Dell, If Only We Knew What We Know, p. ix. 60
  61. 61. Now it’s not beds of coal… …it’s beds of knowledge - Adapted from Carla O’Dell, If Only We Knew What We Know, p. ix. 61
  62. 62. they exist in all organizations! relatively untapped… relatively unmined… relatively unused… - Adapted from Carla O’Dell, If Only We Knew What We Know, p. ix. 62
  63. 63. Unwarranted variation... Unpredictability for patients… Sub-optimizedtransactional outcomes…Poor Knowledge Management can hurt us…here’s how… Sub-optimized Best Practice Transfer clinical outcomes…measured in years vs months… Misdirected (wasted) resources… Incremental improvement vs enterprise-wide improvement… 63
  64. 64. Why Best Practices Don’tGet…from If Only We Knew What We Know: The Transfer of Internal Knowledge and Best Practice, Carla O’Dell, author Transferred Why Don’t Why Don’t Best Practices Best Practices Get Get Transferred? Transferred? 64
  65. 65. Why Best Practices Don’tGet…from If Only We Knew What We Know: The Transfer of Internal Knowledge and Best Practice, Carla O’Dell, author Transferred • Reason #1: Ignorance… 65
  66. 66. Why Best Practices Don’tGet…from If Only We Knew What We Know: The Transfer of Internal Knowledge and Best Practice, Carla O’Dell, author Transferred• Reason #1: Ignorance… • People with knowledge don’t realize others may find it useful • People who could benefit from knowledge don’t know others have it 66
  67. 67. Why Best Practices Don’tGet…from If Only We Knew What We Know: The Transfer of Internal Knowledge and Best Practice, Carla O’Dell, author Transferred• Reason #1: Ignorance… • People with knowledge don’t realize others may find it useful • People who could benefit from knowledge don’t know others have it• Reason #2: No absorptive capacity… 67
  68. 68. Why Best Practices Don’tGet…from If Only We Knew What We Know: The Transfer of Internal Knowledge and Best Practice, Carla O’Dell, author Transferred • Reason #1: Ignorance… – People with knowledge don’t realize others may find it useful – People who could benefit from knowledge don’t know others have it • Reason #2: No absorptive capacity… – People lack the money, time, and to make it useful to their work 68
  69. 69. Why Best Practices Don’tGet…from If Only We Knew What We Know: The Transfer of Internal Knowledge and Best Practice, Carla O’Dell, author Transferred • Reason #1: Ignorance… – People with knowledge don’t realize others may find it useful – People who could benefit from knowledge don’t know others have it • Reason #2: No absorptive capacity… – People lack the money, time, and resources to make it useful to their work • Reason #3: The lack of preexisting relationships… 69
  70. 70. Why Best Practices Don’tGet…from If Only We Knew What We Know: The Transfer of Internal Knowledge and Best Practice, Carla O’Dell, author Transferred • Reason #1: Ignorance… – People with knowledge don’t realize others may find it useful – People who could benefit from knowledge don’t know others have it • Reason #2: No absorptive capacity… – People lack the money, time, and resources to make it useful to their work • Reason #3: The lack of preexisting relationships… – People absorb knowledge & practice from people they know, respect, trust 70
  71. 71. Why Best Practices Don’tGet…from If Only We Knew What We Know: The Transfer of Internal Knowledge and Best Practice, Carla O’Dell, author Transferred• Reason #1: Ignorance… – People with knowledge don’t realize others may find it useful – People who could benefit from knowledge don’t know others have it• Reason #2: No absorptive capacity… – People lack the money, time, and resources to make it useful to their work• Reason #3: The lack of preexisting relationships… – People absorb knowledge & practice from people they know, respect, trust• Reason #4: Lack of motivation… 71
  72. 72. Why Best Practices Don’tGet…from If Only We Knew What We Know: The Transfer of Internal Knowledge and Best Practice, Carla O’Dell, author Transferred • Reason #1: Ignorance… – People with knowledge don’t realize others may find it useful – People who could benefit from knowledge don’t know others have it • Reason #2: No absorptive capacity… – People lack the money, time, and resources to make it useful to their work • Reason #3: The lack of preexisting relationships… – People absorb knowledge & practice from people they know, respect, trust • Reason #4: Lack of motivation… – People may not perceive a clear reason for pursuing the transfer 72
  73. 73. Why Best Practices Don’tGet…from If Only We Knew What We Know: The Transfer of Internal Knowledge and Best Practice, Carla O’Dell, author Transferred• Reason #1: Ignorance… – People with knowledge don’t realize others may find it useful – People who could benefit from knowledge don’t know others have it• Reason #2: No absorptive capacity… – People lack the money, time, and resources to make it useful to their work• Reason #3: The lack of preexisting relationships… – People absorb knowledge & practice from people they know, respect, trust• Reason #4: Lack of motivation… – People may not perceive a clear reason for pursuing the transfer – People must have a sense of urgency! 73
  74. 74. An Army Medicine example: at a high level…linking Organizational Strategy to Performance Improvement using Lean Six Sigma and Best Practice Transfer! 74
  75. 75. 75
  76. 76. We align all MEDCOM LSS projects to our organization’s strategy…ourBalanced Scorecard… 76
  77. 77. We recognize we havea performance gap in Access to Care… 77
  78. 78. Value Stream #9: Improve Access & Continuity of CarePVC #1: Maximize Value in Health Services Suppliers Inputs Process Outputs Customer • Patients • Need for Care • Customer Service • Satisfied beneficiary • DOD Title 10 patients (preventive, acute) • Accessible (e.g., Soldiers, • Telephone Services • DOD appointments retirees, families) • Healthcare staff Healthcare • Provider Support Staff Utilization • Standardized, utilized • Non-Title 10 patients Professionals • Facilities and support staff • Primary Care Exam Room (e.g., civilian infrastructure • Optimized provider Utilization emergencies, • IMCOM productivity contractors, foreign • Patient Appointing, Referral Mgt. • Optimized referral officers and families, execution, delivery • TRICARE Online Appointment etc.) • Increased utilization of on-line appointment system High level process maps Customer (SIPOCs) help us better focus Input Metrics Process Metrics Output Metrics • DOD Title 10 onCall Volume • the problem/s in our work… • Call Hold and Handle Times, • Patient Satisfaction patients • # of Appts. Requested Call Abandon Rate • Access to Care Standards (e.g., achieve acute care appt. within • Non-Title 10 • Type of Care Requested • Care Appointment Availability 24 hours) patients • Schedule Availability • Support Staff to Primary Care • Staff Availability Provider Utilization ratio • Facility Scheduling • Facility Availability 78
  79. 79. Value Stream #9: Improve Access & Continuity of CarePVC #1: Maximize Value in Health Services Suppliers Inputs Process Outputs Customer • Patients • Need for Care • Customer Service • Satisfied beneficiary • DOD Title 10 patients (preventive, acute) • Accessible (e.g., Soldiers, • Telephone Services • DOD appointments retirees, families) • Healthcare staff Healthcare • Provider Support Staff Utilization • Standardized, utilized • Non-Title 10 patients Professionals • Facilities and support staff • Primary Care Exam Room (e.g., civilian infrastructure • Optimized provider Utilization emergencies, • IMCOM productivity contractors, foreign • Patient Appointing, Referral Mgt. • Optimized referral …and we decided to start by • TRICARE Online Appointment execution, delivery officers and families, etc.) • Increased utilization of improving the Telephone on-line appointment system Appointing Process Customer Input Metrics Process Metrics Output Metrics • Call Volume • Patient Satisfaction • DOD Title 10 • Call Hold and Handle Times, patients • # of Appts. Requested Call Abandon Rate • Access to Care Standards (e.g., achieve acute care appt. within • Non-Title 10 • Type of Care Requested • Care Appointment Availability 24 hours) patients • Schedule Availability • Support Staff to Primary Care • Staff Availability Provider Utilization ratio • Facility Scheduling • Facility Availability 79
  80. 80. LSS Project LD00373:Access to Care— Improve TelephoneAppointing Process at Darnall Army Medical Center Documented in PowerSteering! 80
  81. 81. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP 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  Phone menu tree and call handling improved led to lower patient satisfaction scores for telephone appointing services. BASELINE  Future ACD design requirements specified  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% BEFORE AFTER Hold Time  Average wait time: 3:14 minutes  Calls answered under 90 seconds: 65% GOAL  Overall call abandon rate: 26%; Peak time: 49%  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% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 81
  82. 82. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP 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  Phone menu tree and call handling improved led to lower patient satisfaction scores for telephone appointing services. BASELINE  Future ACD design requirements specified  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% …the initialBEFORE project was AFTER Hold Time  Average wait time: 3:14 minutes  Calls answered under 90 seconds: 65% conducted at Fort Hood’s Carl GOAL  Overall call abandon rate: 26%; Peak time: 49%  Decrease process hold time to less than 90 seconds per call R. Darnall Army Medical Center  Decrease overall abandoned call rate to less than 10% (CRDAMC)…  Decrease peak time call abandon rate to less than 25% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 82
  83. 83. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP 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  Phone menu tree and call handling improved led to lower patient satisfaction scores for telephone appointing services. BASELINE  Future ACD design requirements specified  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% BEFORE AFTER Hold Time  Average wait time: 3:14 minutes …high call volume, low patient  Calls answered under 90 seconds: 65% GOAL  Overall call abandon rate: 26%; Peak time: 49% satisfaction, long process cycle  Decrease process hold time to less than 90 seconds per call time, high variation…  Decrease overall abandoned call rate to less than 10%  Decrease peak time call abandon rate to less than 25% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 83
  84. 84. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP 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  Phone menu tree and call handling improved led to lower patient satisfaction scores for telephone appointing services. BASELINE  Future ACD design requirements specified  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% BEFORE AFTER Hold Time  Average wait time: 3:14 minutes …the project sought to  Calls answered under 90 seconds: 65% GOAL  Overall call abandon rate: 26%; Peak time: 49% decrease process cycle time  Decrease process hold time to less than 90 seconds per call and call abandon rate to  Decrease overall abandoned call rate to less than 10%  Decrease peak time call abandon rate to less than 25% improve patient satisfaction… • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 84
  85. 85. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP 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  Phone menu tree and call handling improved led to lower patient satisfaction scores for telephone appointing services. BASELINE  Future ACD design requirements specified  Army’s largest call center: 10,000+ calls a week WOW  Low customer satisfaction: 68% BEFORE AFTER Hold Time  Average wait time: 3:14 minutes  Calls answered under 90 seconds: 65% GOAL  Overall call abandon rate: 26%; Peak time: 49%  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% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 85
  86. 86. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP 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  Phone menu tree and call handling improved led to lower patient satisfaction scores for telephone appointing services. BASELINE  Future ACD design requirements specified  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% BEFORE AFTER Hold Time  Average wait time: 3:14 minutes 7-Fold  Calls answered under 90 seconds: 65% GOAL Improvement  Overall call abandon rate: 26%; Peak time: 49%  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% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 86
  87. 87. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP 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  Phone menu tree and call handling improved led to lower patient satisfaction scores for telephone appointing services. BASELINE  Future ACD design requirements specified  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% BEFORE AFTER Hold Time  Average wait time: 3:14 minutes  Calls answered under 90 seconds: 65% GOAL  Overall call abandon rate: 26%; Peak time: 49% 10-Fold  Decrease process hold time to less than 90 seconds per call Improvement  Decrease overall abandoned call rate to less than 10%  Decrease peak time call abandon rate to less than 25% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 87
  88. 88. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP 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  Phone menu tree and call handling improved led to lower patient satisfaction scores for telephone appointing services. BASELINE  Future ACD design requirements specified  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% BEFORE AFTER Hold Time  Average wait time: 3:14 minutes  Calls answered under 90 seconds: 65% GOAL  Overall call abandon rate: 26%; Peak time: 49%  Decrease process hold time to less than 90 seconds per call >2-Fold  Decrease overall abandoned call rate to less than 10% Improvement  Decrease peak time call abandon rate to less than 25% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 88
  89. 89. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP 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  Phone menu tree and call handling improved led to lower patient satisfaction scores for telephone appointing services. BASELINE Disciplined, Corporate  Future ACD design requirements specified Action to Harvest and  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% BEFORE AFTER Replicate Across Hold Time  Average wait time: 3:14 minutes MEDCOM  Calls answered under 90 seconds: 65% GOAL  Overall call abandon rate: 26%; Peak time: 49%  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% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards  Peak time call abandon rate reduced: 22%  Establish CMS metric for telephone  Call volume reduced 20% due to less call backs  Publish MEDCOM Telephone Appting Policy NLT 1 May 08  Calls handled increased from 4700 to 7300 / week  Replicate LSS projects across MEDCOM MTFs NLT Jun 09  Agent training time reduced from 6 weeks to 4 weeks  Agent turnover reduced 89
  90. 90. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP it takes an average of 3:14 minutes to answer customer calls to make an A project result not anticipated… and call handling improved  Phone menu tree appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services. BASELINE  Future ACD design requirements specified  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% BEFORE AFTER Hold Time  Average wait time: 3:14 minutes  Calls answered under 90 seconds: 65% GOAL  Overall call abandon rate: 26%; Peak time: 49%  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% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 90
  91. 91. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP it takes an average of 3:14 minutes to answer customer calls to make an A project result not anticipated… and call handling improved  Phone menu tree appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services. BASELINE  Future ACD design requirements specified Although patient satisfaction with  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% telephone appointing improved, BEFORE AFTER Hold Time  Average wait time: 3:14 minutes overall patient satisfaction at  Calls answered under 90 seconds: 65% GOAL Darnall decreased!  Overall call abandon rate: 26%; Peak time: 49%  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% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 91
  92. 92. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP it takes an average of 3:14 minutes to answer customer calls to make an A project result not anticipated… and call handling improved  Phone menu tree appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services. BASELINE  Future ACD design requirements specified Although patient satisfaction with  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% telephone appointing improved, BEFORE AFTER Hold Time  Average wait time: 3:14 minutes overall patient satisfaction at  Calls answered under 90 seconds: 65% GOAL Darnall decreased!  Overall call abandon rate: 26%; Peak time: 49%  Decrease process hold time to less than 90 seconds per call Patients’ phone calls were now  Decrease overall abandoned call rate to less than 10% being answered quicker, only to be  Decrease peak time call abandon rate to less than 25% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD told Darnall had no appointment  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care available!  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 92
  93. 93. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP it takes an average of 3:14 minutes to answer customer calls to make an Teaching Point: appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services.  Phone menu tree and call handling improved BASELINE  Future ACD design requirements specified Ofttimes you must consider the  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% project dependencies along the BEFORE AFTER Hold Time  Average wait time: 3:14 minutes value stream…  Calls answered under 90 seconds: 65% GOAL  Overall call abandon rate: 26%; Peak time: solution The 49% set from Project B  Decrease process hold time to less than 90 seconds per call  Decrease overall abandoned call rate to less than 10% be realized before the may best solution set from Project A!  Decrease peak time call abandon rate to less than 25% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 93
  94. 94. Project Summary: Carl R. Darnall AMCTelephone Appointing Mark Hernandez – Black Belt Candidate • PROBLEM / BASELINE / GOAL • IMPROVEMENTS PROBLEM STATEMENT The telephone appointing process at CRDAMC has observed low patient  Agent scheduling changes to handle peak times satisfaction scores and long process hold times. Over the last six months,  Agent training, area setup, shift change by SOP 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  Phone menu tree and call handling improved led to lower patient satisfaction scores for telephone appointing services. BASELINE  Future ACD design requirements specified  Army’s largest call center: 10,000+ calls a week  Low customer satisfaction: 68% BEFORE AFTER Hold Time  Average wait time: 3:14 minutes And Today?  Calls answered under 90 seconds: 65% GOAL  Overall call abandon rate: 26%; Peak time: 49%  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% • RESULTS / BENEFITS • REPLICATION / WAY-AHEAD  Overall average hold time reduced to 33 seconds  Performance Action Plan Completed; Access to Care  Overall call abandon rate reduced: 3% Initiative 17.2  Adjust MEDCOM BSC telephone appting standards NLT 20  Peak time call abandon rate reduced: 22% Apr 07  Call volume reduced 20% due to less call backs  Establish CMS metric for telephone appting NLT 1 May 07  Calls handled increased from 4700 to 7300 / week  Publish MEDCOM Telephone Appting Policy NLT 1 May 07  Agent training time reduced from 6 weeks to 4 weeks  Replicate LSS projects across MEDCOM MTFs NLT Dec 08  Agent turnover reduced 94

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