Cape Cod Child Development is a trailblazer in applying Lean Six Sigma to the nonprofit world. Watch this 30 minute project presentation webinar to learn how Linda Stiles is helping to transform restore the good name of the agency.

1. Increasing Timely Discharge
of Early Intervention Children
From 35% to 50%
Presented by Linda Stiles
Director of Early Intervention
Cape Cod Child Development

2. About Our Presenter
• Director of Early Intervention
• Cape Cod Child Development
Linda Stiles

3. Take Away: Significant improvements have been made in the timeliness of
discharge forms being completed and entered within required 14 days of last
service date.
Executive Summary
Business Case
Root Cause Analysis
What are the critical findings/root causes that were discovered?
Solutions Implemented
Discharge form will be entered into EIIS within 14 days of last service
Home visitors will photocopy BDI results to include on discharge form
Staff do not complete forms within the 14 day timeline because they do
not have regular office time with access to the files to include the required
information to complete the form.
Graphical Display of Improvement
Insert a chart, graph or visual demonstrating process improvement
Update written policy/procedure
Determine who is responsible to keep track of discharge forms submitted
on time
Executive Summary
Project Results
What is the importance of doing this project? (State in lost dollars,
productivity loss, customer dissatisfaction, cost avoidance, risk, etc.)
What are the measureable process improvements/wins?
Discharge forms being submitted and entered into EIIS have increased
substantially since process has been under review.
The Department of Health requires that the discharge form be submitted
within 14 days of the last service provided and we do not have a high
percentage of discharge forms being submitted within this required
timeline. DPH reports to our agency annually regarding how we are doing
for this indicator percentage wise. We received 35% on time discharge

4. Define Phase

5. Take Away: Excellent buy-in – project is worth doing.
Project Charter
Phase Planned Actual
Define: 21-Jul
Measure: 27-Jul
Analyze: 2-Aug
Improve: 9-Aug
Control: 14-Aug
Process Start: Position Person
Process End: Team Lead Linda Stiles
In: Sponsor Phyllis Donovan
Team Member Liz Dempsey
Out: Team Member Amy Halunen
Team Member Bambi Rosario-
Wyatt
File is closed and removed from active files
Process steps, procedure changes, forms used,
standard work, identify responsible staff, staff training
No legal issues, no IT issues
Goal Statement Timeline
Increase the percentage of Early Intervention children being discharged from
35% to 50% within the required DPH timeline.
Scope Team Members
Child identified for discharge from EI Time Commitment
Project Charter
Timely discharge of early intervention children
Problem Statement Business Case & Benefits
We are not meeting the Department of Health's requirement for timely
discharge of Early Intervention children. (Specifically, we are required to
complete a discharge form within 14 days of the last service date and enter
it into the EIIS. DPH provides our agency with annual feedback about this
in the form of percentage. Last year we acheived 35% on time discharge.)
An increase in the children in Early Intervention being discharged on time
will impact our meeting the DPH data entry timeline requirements. Improving
this will allow our EI program determined to be "Exceptional" vs "Meets
Requirement" with our overall timelines.

6. Take Away: The scope of the project is from the moment the child’s last date of
service to the discharge form information entered into the EIIS.
SIPOC
S I P O C
Suppliers Inputs Process Outputs Customers
Home Visitor
Discharge form
completed and
turned in within 14
days of last service
date
Process complete
Department of
Health (DPH)
File is closed
SIPOC:
Child identified for
discharge from EI
Discharge form
kept in providers
working file
Home Visitor
completes
discharge form
Home Visitor gives
discharge form to
office manager
Customer Requirements
DPH requires EI children discharged in the EIIS
system within 14 days of last service date.
Office manager
enters discharge
info into EIIS
File is removed
from active file

7. “As-Is” Detailed Map Segment
Take Away: The team learned about the obstacles to completing the discharge
form within the 14 day requirement.
Inconsistent timely submission of discharge form by Home Visitors
Office
Manager
Home
Visitor
Regional
Director
DPH
(EIIS)
Referral
received
Inconsistent
timely
completion of
dischargeform
Receives info
re: tracking of
timeliness of
discharge
Receives file
with
discharge
form
EIfilecreated
- discharge
form included
Provides
reminder for
staff when
needed
DPH receives
data entry
info
Tracks
discharge
timeline and
shares with
RDs and HVs
Receives
discharge
form and
enters into
EIIS
Receives
info/reminder
of need for
dischargeform

8. Measure Phase

9. Data Collection Plan
Take Away: Since the data is described in whole numbers, it is referred to as
discrete data, or Attribute Data.
Measure
Title
Data Type
(Continuous
or Discrete)
Operational Definition
Stratification
Factors
(By who/what/
where/when)
Sampling Notes
(Time Frame, etc.)
Who and How
(Person responsible and
method - Check Sheet?)
% of discharge
forms turned in
on time
Discrete
How many discharge forms were entered into EIIS
within 14 days of last service (on time)
By month and by
region (Upper, Mid,
lower Cape)
August, September,
October, November
Office manager received data
from Home Visitors and entered
on a spreadsheet
Days to
discharge
Discrete
How many days since the last date of service did it
take to enter the discharge form into EIIS?
By month and by
region (Upper, Mid,
lower Cape)
August, September,
October, November
Office manager received data
from Home Visitors and entered
on a spreadsheet
Data Collection Plan

10. Baseline – Project Y - % On Time
Take Away: Improvement in the on-time submission of discharge forms to DPH
can be made over time.

11. Baseline of Days to Discharge
Take Away: Much variation in the process in August for days to discharge with
50 days being the mean.

12. Analyze Phase

13. Fishbone Diagram
Take Away: The biggest areas to analyze further how Home Visitors can access
files or info needed to complete the discharge form.
Fishbone Diagram
Systems
Lacking clear policy
and procedure
Process
Discharge form
is submitted late
due to staff not
having frequent
access to child
record
Forms
Staff need to
record
Assessment (BDI
Scores results)
on discharge
form
Regional
Directors need to
address this in
staff meetings
Home
Visitors need
ongoing
training
Discharge policy
needs updating
Home Visitors
need to come to
office to access
file for discharge
info needed
Need to designate
a specific space to
leave discharge
formfor Office
Manager
People Policies Place
EI
discharge
form
submitted
late

14. Root Cause Hypotheses & 5 Whys
Take Away: Staff needed access to the file to complete their work and being on
the road made that difficult.
Root Cause Hypothesis
#
Possible Root Cause (x)
(1 or 2-Word Descriptor)
Root Cause Hypothesis
(Theory of how "X" is influencing the Project "Y")
Theory True
or False?
Verification
(How did you prove or
disprove this theory?)
1 Access to file File is needed to complete discharge form TRUE
Process walk with Regional Directors
and support staff
2 Time to complete Takes too much time to complete discharge form FALSE Meeting with RDs to review the form
3 Time to come to office
Limited time available to come to office to access
file
TRUE
Process walk with Regional Directors
and support staff
4 Prioritizing Staff are not prioritizing the discharge form TRUE
Meeting with RDs to discuss
paperwork requirements for Home
Visitors
5 Whys
Why 1 Why 2 Why 3 Why 4 Why 5
Why? Because Why? Because Why? Because Why? Because Why? Because
Is the
discharge
form turned
in late.
Providers do
not have
consistent
access to EI
record
Can't they
make copies
of what they
need and
keep it in a
working file?
The
information
may not be
current
enough.
Is a
discharge
form
needed?
DPH
requires it
Does it need
to be
completed in
14 days?
DPH requires
it.
has this been
an ongoing
issue?
No one has
focused on
solving it.
Providers are
not aware
they do not
need to enter
certain info,
such as
assessment
results
Closes out the
file
Not a high
priority for
staff

15. Improve Phase

16. Selected Solutions
Take Away: Home visitors need to be consistently reminded of their
responsibility in meeting this timeline.
Solution Selection Matrix
Project Goal
Please rank each solution for each criteria
by using the 1-5 Scale as indicated belowEnter Goal Statement below:
(As stated on Project Charter)
DPH requires discharge form entered into EIIS
within 14 days of last service date
Very Low
(less good)
Moderate
Very High
(best)
1 2 3 4 5
Potential Solution
(Provide Brief Description)
Potential to
Meet Goal
Positive
Customer
Impact
Cost to
Implement
(1 = $$$
& 5 = $)
Stakeholder
Buy-in
Time to
Implement
(1 = Long
5 = Quick)
Total
Score
Implement?
Yes/No
Weighted Criteria 10 9 8 7 5
Determine who is responsible to keep track of
discharge forms submitted on time
5 5 1 5 5 163 Yes
Update written policy/procedure 1 1 1 1 5 59 Yes
Discharge form will be entered into EIIS within 14
days of last service
4 5 1 3 2 124 Yes
Home visitors will photocopy BDI results to include on
discharge form 5 5 2 3 2 142 Yes

17. Take Away: The number of days to discharge decreased as the project
progressed over time.
Improved Days to Discharge
August Thru November 2017

18. Run Chart Showing Improvement
Take Away: Improvements were significantly higher than the target of 50%,
although there is some decline noted which is partly due to lower numbers.

19. Control Phase

20. Monitoring and Response Plan
Take Away: Ongoing monitoring will ensure the maintenance of improvements
made.
Name of the Measure
Input,
Process or
Output?
What is the
Target?
Method of Data
Capture
Checking
Frequency
Person
Responsible
Upper/Lower
Trigger Measure
Who Will
Respond?
Reaction Plan
% Discharge forms
entered into EIIS
I
Within 14
days of last
service
Date entered on
spreadsheet
Bi weekly
Office
Assistant
Over 14 days
Office
Manager
Inform Regional Director when over received late
(past 14 days of last service)
Discharge lead time O
Within 14
days of last
service
Date entered on
spreadsheet
Bi weekly
Office
Assistant
Over 14 days
Office
Manager
Review the process when discharge is over 14
days
Last date of service I
100%
accuracy
Date entered on
spreadsheet
Every child
being
discharged
Home
Visitor
No greater than two
days after last day
of service
Office
Manager
Remind Home Visitors to inform the Office
Assistant of last date of service for each child
discharged
% Discharge form
complete
P
100%
discharge
forms
completed
Date discharge form
received entered onto
spreadsheet
Weekly
Home
Visitor
No greater than two
days after last day
of service
Regional
Director
Check with Home Visitors weekly to be sure
discharge forms are being completed and
submitted for data entry
Monitoring Plan Response Plan

21. Lessons Learned
Take Away: Improvements can be made with the involvement of key staff.
• Identifying the key responsible staff should
be a top priority
• Bringing the Stakeholders together to
discuss the issue helps identify the current
process
• Scheduling regular meetings with staff can
be challenging
• Sustaining the improvements made
requires ongoing monitoring
• Making improvements in a process calls for
a specific plan
• In order for staff to “buy into” the “new”
process, they need to be involved

22. Benefits
Take Away: A relatively simple procedure became a low priority for staff, however, through
this process all realize the importance of timely discharge of EI children.
• Our agency improved meeting the DPH requirement for timely
discharge of Early Intervention children.
• Staff are more aware of their role in discharging EI children.
• Regional Directors are providing more consistent supervision to
ensure that timely discharge of EI children occurs.
• Office Manager is able to enter the discharge form into the EIIS on
time.

23. Questions?

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