Check-In Kiosk Eval Class of 2014 Aslie (Ashlie) Burnett.docx

Check-In Kiosk
Eval Class of 2014
Aslie (Ashlie) Burnett-Project Facilitator
Overview
Michael E. DeBakey Veterans Affairs Hospital has been a
leader in quality care since the 1930s, by serving, honoring,
providing care to the men and women who are America’s
Veterans. We have upgraded the facility and enriched
technology to better meet the needs of our veterans- we are now
excited to introduce a first-ever check-in kiosk .
Reason for Action
Problem Statement
In 2014 MEVAMC had reduced usage of innovative technology
and complaints of long lines and long wait times lead to
external customer dissatisfaction.
Business Case
The delay affects the customer's gratification, institutional
status in the waiting area of the hospital corrective actions from
higher authorities in reply to client criticisms and puts extra
pressure on internal clients.

3
Reason for Action
Aim/Goal: Within 90 days, MEDVAMC Emerging VA Leaders
will introduce the self-check-in kiosk, increase users'
understanding of its functional purpose and benefits, improve
patient satisfaction by reducing wait time and improve the kiosk
check-in by 20%.
Scope: The check-in process for patients
Start: When the patient arrive to the clinic
Stops: When the patient is called to the back to see a provider.
Constraints: limited knowledge of kiosk
Start with areas that have high number of repeat patients
Start with check in and payments, then add functions as desired
Use a greeter during initial rollout
Place the kiosks in an obvious location
Enable as many languages as you reasonably expect to use
System selectin
Freestanding kiosk and countertop kiosk
4
6 Ambassadors
3 Actors
4 Graphic designers
3 people from volunteer services
Sponsor (Adam Walmus, MEDVAMC Director (2014)
Valerie Williams, Education/ EVAL coordinator
Joycelyn Westbrook
Larry Wilkerson

Kendra Price-Mayes
Team member/ Project Facilitator: Aslie Burnett
Natalie Delahoussaye
Merisha Freeney
Gregory Austin
Karl Murray
Shauna Babers
Grant Lenued
Chakita James
Tonya Hackney
Katress King
Sharice Easterling
Diana Pham
Shirley Collins
Rickey Reed
Members from Volunteer services
Surveys: were done with 98 patients from the 100 surveyed
cases to estimate self-check-in awareness level, check-in
experience, successful check-ins, timeliness of check in
process, and why they used the kiosk.
Kiosk Interactions Report: Displayed how many interactions vs.
transactions
A team was formed to survey customers in three piolet areas:
Dental, Dermatology, & Eye clinics.
The Current State
Based on the current state, out of 79 patient complaints the top
dental complaints were dental eligibility and patient access/
wait time.

Based on the all employee survey the top complaints were low
moral amongst dental personnel and staff shortage/ burnout
Voice of customer: SHEP survey’s, v-signal, and share your
experience
Voice of customer: All employee survey’s
Low Moral -15%
Patient Access/Wait time-46%
Dental eligibility-29%
Staff shortage/burnout- 10%
Process mapping to figure out the wastage
6
Column1
Low MoralPatient Access/Wait Time Dental ElgibilityStaff
Shortage/Burnout
Appendix 1: Focus Group Protocol
Section 1:
MEDVAMC KIOSK SURVEY
Michael E. DeBakey VAMC is working on a research project to
understand how patients experience using the new kiosk in the
waiting area. The results of this survey will help us provide
better care to patients.
Please take a moment to fill out this short questionnaire so we
can better serve you as a patient in the future. Your answers are
anonymous, which means that they cannot be traced back to you
in any way. Your doctors and nurses will not see your answers.
Taking part in this study is voluntary. This means that you can
choose whether or not to fill out the survey. When you finish
the survey, please put it in the drop box by the front desk or
hand it to a greeter.

If you have questions about the kiosk, please contact Aslie
Burnett at ext. 28576.
1. How comfortable did you feel using the kiosk? (check one)
Very comfortable
Comfortable
Somewhat comfortable
Not very comfortable
Not at all comfortable
2. Were you aware of the new self-service check in option
(check one)?
Yes or No
3. How comfortable were you with the privacy level offered by
the kiosk?
Very comfortable
Comfortable
Somewhat comfortable
Not very comfortable
Not at all comfortable
4. Why did you use the kiosk for today’s visit?
5. What did you like about using the kiosk?
6. Were you able to successfully check in to the kiosk?
Yes or No
7. Is there anything else you would like us to know about your
experience with the kiosk?
8. Did the greeter in the waiting room improve your experience
with using the kiosk?
Yes or No If YES, please explain how
When you finish the survey, please put it in the drop box by the
front desk. Thank you!
Used the kiosk interaction report

7
8 forms of waste
Defects-space constraints
Overproduction
Waiting –patients waiting (idle time)
Not utilizing human potential-staff not trained on Kiosk system
or software
Transportation
Inventory
Motion
Excessive processing
Strength
Labor reductions
Weakness
Opportunity
Kiosk already available

Threat
Increased patient complaints
Wait time reduction
Convenience
Customization
Visual impaired
Improve accuracy of demographic data
Improve customer service
Software Development
Maintenance
Space constraints
Employees not trained on Vet Link software

Employee refusal to utilize the Kiosk & Vetlink system
Incorporate surveys
Alleviate language barriers
Employee burnout
Patients opt-into civilian care
Veteran refusal to utilize kiosk system
Hire more staff
Offer copayment capabilities
Best Practices for Implementing Kiosk

System Selection
Select a kiosk with the physical location in mind.
Considering more than one kiosk per area/department.
Take advantages of branding opportunities.
Deployment
Start in areas with high numbers of frequency.
Start with check-in/ insurance verification.
Use a greeter during the initial rollout.
Choose an obvious and convenient location.
Enable as many languages as reasonable.
Policies and Procedures
Make use of the patient kiosk optional.
Assign basic oversight responsibilities.

The target state
The key target state in following this approach is to address the
time wastage.
Hence, ultimately, the patient checking in time and their leaving
time shall be accounted for upon completion of this project.
Communication with the public and patients regarding the
dental healthcare wait/access time will promote awareness on
the issues leading to delays in the healthcare system.
The offering of incentives and rewards to performing employees
will promote their attitude towards work. Hence, physicians will
offer quality service to patients leading to a satisfied customer
base.
Careful scheduling and planning in all departments is essential
e.g. good arrangement of dental equipment will lead to reduced
wait/access times.
Effective community-based dental services will offer quality
service to patients leading to lower wait times in the dental
healthcare, and efficient management of dental emergency
platforms.
11
Gap Analysis Problem Statement: Gap How to Address

The implementation step involves ensuring that all the
recommended strategies are effective in the dental care unit in
the healthcare facility involved
Holding us back-Dental Eligibility, Leadership not motivating
staff, shortage of staff
Root cause analysis – not being properly educated, leadership
implementing change without staff perspective or views , HR
delays
12
Execution Timeline
Month 1
Month 2
Increase kiosk check-in by 5-10%
Increase kiosk check- in by 15%
Month 3
Increase kiosk check-in by 20%
13
Target Audience

Older
Veterans
Younger Veterans
14
3 Ways of Marketing KIOSK
Instructional Video
Pamphlets
Signage
YouTube: Informational video record by Reginald Sasser in
medical media
15
Marketing Plan:

VA Publications
2
Pop-up sign
3
Guerilla Marketing
4
Quarter review of marketing plan
5
Educational Television
1
Sign affixed to KIOSK
16
Michael E. DeBakey VA Kiosk Pamphlet
CHECK-IN TODAYS APPT.
SCREEN 1
CHECK IN TO APPOINTMENT OR

VIEW FUTURE APPT.
SCREEN 2
I DON’T HAVE ID OR SCAN CARD OR SWIPE
SCREEN 3
PLEASE ENTER BIRTH DATE
.CONFIRM OR EDIT
SCREEN 4
IS THIS YOUR NAME
SCREEN 5
CONTACT INFORMATION
EDIT OR PROCEED
SCREEN 6- PROCEED
INSURANCE INFORMATION
SCREEN 7- PROCEED
NEXT OF KIN
SCREEN 8
TODAY’S APPT DO YOU WANT PRINT
CONFIRMATION FOR CHECK-IN APPT
SCREEN 9
DO YOU WISH TO PRINT FUTURE APPT
If you have any questions or concerns, please contact the
coordinator (Larry Wilkerson) @:
713-791-1414 ext.
!!!!! ATTENTION VETERANS !!!!!!
SELF CHECK- IN NOW AVAILABLE
FOR APPOINTMENTS
NO NEED TO WAIT IN LINE, READ THE BACK FOR STEP
BY STEP INSTRUCTIONS

EVAL 2014
“Where We Care with our Hearts First”
17
Michael E. DeBakey VA Kiosk Signage
Check- In
Here
Cont. Gap analysis
Still applying the 5 whys
Low moral-root cause analysis was lack of communication
Dental eligibility –root cause analysis is poor communication
19

Solution
s approach
Incentives offered to competent employees may include award
recognition and compensatory time.
Adopting a kiosk check in system will aid reduce wait time in
long lines
Open access clinics will help the patients acquire specialized
dental care
Patients can benefit from receiving appointment slots made on
that same day.
Extended hours to patients will help ease the work load and wait
time for the subsequent days.
20
Rapid experiment to evaluate the effectiveness of the solutions

The first essence of this experiment was to determine the
viability of the team and whether they are ready to pursue their
sub-projects. Worked with all staff from dental assistants,
clerks, leadership, providers
Secondly, I reviewed the role of the projects in dealing with
time wastage in the organization.
Thirdly, Team work is dream work- team collaboration with
eligibility- Pamphlet created for educating purposes
21
Completion Plan What WhoBy WhenStandard work
documentedKendra Price-Mayes & Larry Wilkerson
03/4/2019Communication plan ExecutedAslie
Burnett04/6/2019Education Plan ExecutedEVAL
Team05/15/2019Audit plan Executed Larry
Wilkerson06/01/2019
The completion plan was not on track.

In order to for this to executed by the stated dates to enable
sustainment with 90 days
Leading measures:
Communicate new processes
Educated or provide training of new processes
Audit: internal/external reviews
Project Plan
Define phase 5/01/2014 to 5/31/2014
Measure phase 04/01/2014 to 04/31/2014
Analyze step 03/01/2014 to 03/31/2014
Improve stage 04/01/2014 to 05/01/2014
Control phase 06/01/2014
22
Completion plan

Appropriate analysis and alignment of my project- I ensured
that my project connected with the established mission, vision,
and value
Appropriate planning for quality from the commencement of the
project- I met with the stakeholders to discuss quality issues for
every deliverable since the beginning on the project
development
Beginning with the end user in mind- for every deliverable, I
ensured that I reflected on what the clients wanted.
23
Ensuring that the project implementation is successful depends
on the steps that the project manager takes in the former stages.
Some key strategies that I used to ensure sustainability in this
case included the following:
Appropriate analysis and alignment of my project

Appropriate planning for quality from the commencement of the
project
Beginning with the end user in mind
Completion Plan
Weekly huddles: improve situational awareness
monthly meetings
In order to for this to executed by the stated dates to enable
sustainment with 90 days
24
All individuals affected by the change in procedural operations

of Kiosk check-in system making sure they are on board
Training of the personnel upon changes to procedure.
Offer sustainable employee engagement during the change.
Utilizing internal/external feedback
Kiosk Interactions vs Transactions
Kiosk Check-In's Transactions
Dental Clinic
Dermatology Clinic
Eye Clinic
Kiosk interaction by kiosk
Date Range:5/01/2014 to 5/31/2014 Kiosk

Interactions Transactions
Houston Dental 670 679
Houston Dermatology 938 965
Houston Eye 926 947
Date Range: 04/01/2014 to 04/31/2014 Kiosk
Houston Eye 675 684
Date Range: 03/01/2014 to 03/31/2014 Kiosk
Houston Eye 518 526
25
Kiosk Interaction April
Kiosk Interaction by Kiosk Date Range: 04/01/2014 to
04/31/2014Interations Houston Dental Houston
DermatologyHouston Eye 489684675Kiosk Interaction by Kiosk
Date Range: 04/01/2014 to 04/31/2014Transactions Houston
Dental Houston DermatologyHouston Eye 493693684

Kiosk Interation March
Kiosk Interaction by Kiosk Date Range: 03/01/2014 to
03/31/2014InteractionsHouston Dental Houston
DermatologyHouston Eye376525518Kiosk Interaction by Kiosk
Date Range: 03/01/2014 to 03/31/2014Transactions Houston
Dental Houston DermatologyHouston Eye388532526
Kiosk Interaction May
Kiosk Interaction by Kiosk Date Range:5/01/2014 to
5/31/2014Interations Houston DentalHouston
DermatologyHouston Eye 670938926Kiosk Interaction by Kiosk
Date Range:5/01/2014 to 5/31/2014Transactions Houston
DentalHouston DermatologyHouston Eye 679965947

Confirmed State
MetricCurrent
(February 2014)Target (May 2014)Actual
(March 2014) Actual
(April 2014)Actual
(May 2014) Kiosk Interactions vs Transactions (Houston
Dental)5%20%376/388489/493670/679Kiosk
Transactions vs Transactions
(Eye)10%20%518/526675/684926/947Kiosk Interactions Vs.
Transactions (Dermatology) 11%20%525/532684/693938/965
Despite the effectiveness in addressing time wastage in this
facility, the management should examine this proposal and
implement its recommendations as a means of improving its
dental care provision.
However, this project became effective in addressing the time
wastage and enabled the clients to have efficient and
satisfactory services.
Implementation is a learning and continuous process.
Management should have an eye out for new and better

implementation opportunities.
Be more vigilant in offering community-based services if
Veteran meets eligibility criteria
26
Confirmed State
Month 1
Month 2
Increase kiosk check- in by 37%
Month 3

27
Confirmed State
This lean management proposal was effective based on the
following reasons.
Patient who checked in with receptionist were interviewed to
learn about their awareness level of the new self-service check
in option
Patients who checked in with a kiosk were asked about their
experience using this tool.
The vast majority of member who checked in using the kiosk
has a successful experience with over 75 percent of members
feeling that checking in through kiosk is faster than check in
through a receptionist
About 60 percent of members report that the reason they used
the kiosk was because the line was shorter
More than 90 percent of members who used a kiosk to check in
are able to do so successfully without needing any assistance
and the same number also report that they felt comfortable with
level of privacy it offered by the kiosk.
Kiosk interactions report: Displayed Kiosk interactions vs

Transactions
28
Insights-box analysis
29
There are several reasons projects need to be started effectively
and the entire steps focused on to promote sustainability.
For this case, I experienced an issue with wastage and this
project endeavored to address it effectively.
I ensured that the piolet areas successfully used my project to
improve customer satisfactions, increase utilization of
innovation technology, and reduce wait time by checking into
the kiosk. In the future I love to implement wayfinding

technology on the kiosk check in system.
I noted the that the project implementation is successful
depends on the steps that the project manager takes in the
former stages and my team worked on all stages effectively.
Conclusion
The plan was to create confidence and eagerness by showcasing
our new method of checking in veterans. Through increase
visibility, education, and repetitive instruction, the KIOSK
Check-in will be the premier innovation for veterans' access.
THANK YOU FOR YOUR SERVICE
Checking in for an appointment is easier and quicker: USE
THE CHECK-IN KIOSK
**Located in all Primary and Specialty Clinics**
-IN (SCHEDULED
APPOINTMENTS)

R DEMOGRAPHICS, CONTACT AND
INSURANCE INFORMATION
A3 Problem Solving Template v1.2 (April 2015) by Henrik
Kniberg and Tom Poppendieck
License: Creative Commons Attribute 4.0 International
Original link: http://www.crisp.se/lean/a3-template
Background PLAN
Current condition PLAN
Goal / Target Condition PLAN
Root Cause Analysis PLAN
Countermeasures (experiments) DO
Confirmation (results) CHECK

Follow up (actions) ACT
Owner:
Mentor:
Date:
A3: <problem statement>
http://www.crisp.se/henrik.kniberg/
http://www.poppendieck.com/people.htm
http://creativecommons.org/licenses/by/4.0/
http://www.crisp.se/lean/a3-template
Background PLAN
● Why is this important?
● Why should the reader care about this situation and be

motivated to participate in
improving?
Assessment Questions
1. Is there a clear theme for the problem report that reflects the
contents?
2. Is the topic relevant to the organization’s objectives?
3. Is there any other reason for working on this topic (e.g.
learning purposes)?
Current condition PLAN
● How do things work today?
● What is the problem?
● Baseline Metrics?
1. Is the current condition clear and logically depicted in a
visual manner?
2. How could the current condition be made clearer for the
audience?
3. Is the current condition depiction framing a problem or a
situation to be resolved?
4. What is the actual problem in the current condition?

5. Are the facts of the situation clear, or are there just
observations and opinions?
6. Is the problem quantified in some manner or is it too
qualitative?
● What outcomes are expected for what reasons?
● What changes in metrics can be plausibly expected?
1. Is there a clear goal or target?
2. What, specifically, is to be accomplished?
3. How will this goal be measured or evaluated?
4. What will improve, by how much, and when?
Root Cause Analysis PLAN
● What is the root cause(s) of the problem?
● Use a simple problem analysis tool (e.g. 5 why’s, fishbone
diagram, cause/effect diagram) to
show cause-and-effect relationships.

1. Is the analysis comprehensive at a broad level?
2. Is the analysis detailed enough and did it probe deeply
enough on the right issues?
3. Is there evidence of proper five-whys thinking about the true
cause?
4. Has cause and effect been demonstrated or linked in some
manner?
5. Are all the relevant factors considered (human, machine,
material, method, environment,
measurement, and so on?)
6. Do all those who will need to collaborate in implementing the
countermeasures agree on the
cause/effect reasoning?
● Proposed countermeasure(s) to address each candidate root
cause (this should be a series
of quick experiment to validate causal model analysis)
● Predicted result for each countermeasure

1. Are there clear countermeasure steps identified?
2. Do the countermeasures link to the root cause of the
problem?
3. Are the countermeasures focused on the right areas?
4. Who is responsible for doing what, by when (is “5 Why - 1
How” clear?)
5. Will these action items prevent recurrence of the problem?
6. Is the implementation order clear and reasonable?
7. How will the effects of the countermeasures be verified?
● Actual result of each countermeasure (experiment)
● How does the system actually behave with the
countermeasures that are being proposed for
implementation in place?
1. How will you measure the effectiveness of the
countermeasures?
2. Does the check item align with the previous goal statement?
3. Has actual performance moved in line with the goal
statement?
4. If performance has not improved, then why? What was

missed?
● What have we learned that does or does not improve the
situation?
● In the light of the learning, what should be done?
● How should the way we work or our standards be adjusted to
reflect what we learned?
● What do we need to learn next?
1. What is necessary to prevent recurrence of the problem?
2. What remains to be accomplished?
3. What other parts of the organization need to be informed of
this result?
4. How will this be standardized and communicated?
Owner: Leads the problem solving and maintains this A3 doc
Mentor: Guides and assesses the process
Date: Current version Date
A3: <problem statement>

GUIDE
Background PLAN
Games out of date, 2 years time to market
● Missed market windows ➔ revenue declining
● Demotivated teams ➔ key developers about to quit
● Overhead costs ➔ Time to develop games steadily increasing
due to declining technical quality
● Pressure to Work FASTER!
Current condition (value stream map) PLAN
● 8x faster cycle time
● 5x fewer escaped defects
● 20% improvement in revenue

Root Cause Analysis (cause-effect diagram) PLAN
1. Cross-functional teams - Graphics design through deployment
○ Predict 2x faster delivery
=> End dependencies - now spend 75% of time
waiting/negotiating
2. Abandon all but most promising 3 games in each queue. Do
ONE game at a time per cross-
functional team.
○ 4x faster delivery from reduced task switching
○ Eliminating queues will cut 1.3 years from schedule
3. Engage developers in playing games and selecting ideas
○ 30% more profit to par with best competitor

=> improved filtering on which games to develop
=> more fun games, more popular
1. Cross-functional teams
=> Half as much time waiting
2. One game at a time
=> Queues eliminated, time to complete game is 3-4 months (6-
8x faster)
=> Technical Debt is decreasing - escaped defects down by 2x
so far.
3. Engage developers in playing games and selecting ideas
=> One team taking to to play is producing more innovative
games.
=> Impact on profit is to be determined.
1. Consider more cross training of team members to reduce
waiting for expertise.
2. Reduce difficulty of integration and deployment steps
3. Improve processes for generating and selecting game ideas

a. Recruit talent if identifiable/available
b. Improve skills/process of best people already in company
c. Broaden both participation in selection and game playing
experience of everyone in the
company
4. Continue improvement of reused game components/engines to
improve development throughput
and reduce defects.
Owner: Lisa
Mentor: Henrik
Date: 18 May, 2009
A3: Slow game development
Concept
pres.
Resource
allocation

Graphics
design
Sound
design
Dev
Integrate
& deploy
Game backlog
Design-ready
games
Production-ready
games
Waste:
Value:
1 month 6 months 1 week 6 months 2 months 6 months

4 hours 1 day 1 month 3 weeks 1 month 3 weeks
3 months value add
25 months cycle time
= 12% process cycle
efficiency
WTF!
2 years?!
8 15 12
Idea Delivery
EXAM
PLE
Engineers not
proud of their work
Game quality
declining
Endless delays

& thrashing
Features cannot be
built by single team. X-
team dependencies.
Key engineers about
to quit
Declining sales
revenue
Games stale &
out of date
Taking ever longer to
complete a game
Queues
Tech Debt
increasing
Teams focus on
their own parts

only
Teams divided by
architecture No unified view of
priorities
Work in Progress
exceeds capacity
No Time to
Refactor
Defects
tolerated
Pressure from
business to work
faster
Company has not
grown people to
vet game ideas
Founder/CEO

no longer has
time to vet new
game ideas
Weak understanding
of market needs
Engineers don’t get to
play games
No
effective
selection
filter
Copying
competitors
games
Competitive
market
Too many
new game
ideas

Problem
Problem
Root cause
Root cause
Root cause
What is this?
It’s a template for A3 problem solving. Well, the first page is.
The second page
is a check list for the types of questions you should be asking
when using it.
The third page is a real-life example from a software product
development
context. The fourth page is this here FAQ.

A3? What the heck is A3?
“A3 thinking” is a problem solving approach. It is pretty central
to Toyota and
other companies with a Lean mindset. Especially useful for
systemic problems,
the kind of nasty, thorny problems that just keep coming back
despite your best
efforts to solve them..
How does it work?
A3 problem solving is about understanding the problem first,
before
jumping to solutions. For systemic problems, the obvious
solution is often the
wrong one, because it just addresses the symptoms rather than
the underlying
problem.
Use the template to guide yourself through a series of questions
to make sure
you understand the problem properly before thinking about the
solution. The
left column is all about the problem, and how you would
recognized when you’
ve solved it. The right column is all about the solution (or more

specifically,
experiments that you think might solve the problem).
The A3 also serves as a high-level journal, or log, of your
problem solving
initiative.
But why is it called A3? isn’t that a paper size?
Yeah, it’s named after the A3 paper size (297x420mm). The
idea is that you
should constrain yourself to that space, because it forces you to
express
yourself briefly and visually. And that increases the likelihood
that people will
read and maintain the doc.
So A3 problem solving isn’t really about the paper. It’s about
the problem
solving approach. But the A3 doc is there as a guide to keep you
focused on
the right questions, and keep the content short and sweet.
Do I have to follow it strictly?
No, feel free to tweak the headings and questions as needed.
Just keep in

mind that the left half of the page should normally be devoted
to understanding
the problem, and the right side devoted to solving & following
up. That way you
get a good balance between analyzing and acting.
Should I print it or use it electronically?
Take your pick. Sometimes a physical paper is best. Sometimes
a shared
google doc is best. Sometimes it’s best to start on paper and
then transcribe to
the google doc. Sometimes it’s best to start in the google doc
and then print on
paper. Experiment and find what works best for you!
What is the “owner” and “mentor”
The owner is the person (or team) who is primarily driving the
problem-solving
effort, and making sure the ball doesn’t get dropped. The
mentor is a person
well-versed in A3 thinking, who is helping the owner learn this
technique by
guiding him/her through the process.
Is this a one-off document, or a living document?

A problem solving A3 is a living document. Go back and update
it as you gain
better understanding of the problem, and document your
experiments.
Give it a shot! These types of lightweight tools can be
surprisingly effective
when applied appropriately.
FAQ
Understanding
the problem &
desired state.
Experimenting
to solve the
problem
http://en.wikipedia.org/wiki/A3_Problem_Solving

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