Families

Disability and Health Supports Unit Request Inbox KaizenDecember 12th and 13th, 2018

February 21 – CME Kaizen Conference12019-02-21 FAM DHSU - CME Kaizen Conf 2019

Families What does the DHSU do?• Department of Families: one of the

largest departments with ~2,000 employees

• The DHSU is a centralized unit of 11 employees that provide disability and health-related supports to Manitobans who qualify for assistance

• The DHSU:– Provides funds directly to individuals (eg.

for purchasing special dietary needs)– Approves the purchase and delivery of

equipment and supplies (walkers, wheelchair seating components etc.)

• The DHSU reviews about 10,000 requests/year

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Families What does the Request Sorting Process involve?• Requests

– Are received via email to a central e-mail address

– Have an initial review for eligibility and completeness of request

– Are separated into two categories: Diet/Supplies and Equipment

– Are logged in a central database– Are emailed directly to the

employee who will assess the request

• Selecting the employee to receive the request is determined by: – Type of request (diet/supplies or

equipment) – Caseload distribution for staff: by

requestor last name or home area– Which employee has engaged with

this requestor in the past

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Families What did our process performance look like before?

4

The data shows a two-peak distribution of Turn Around

Time performance!

This resulted from our separation and

prioritization of the two types of requests at intake

2019-02-21 FAM DHSU - CME Kaizen Conf 2019

Families Delays in our process mean delays in providing our clients support• Hospital discharges of clients

requiring wheelchairs, walkers, or crutches– This can delay a hospital discharge,

impacting other clients waiting for a bed!

• Individuals living at home without mobility devices or bathing equipment (grab bars, bath chair)– Safety risk– Lack of independence in self-care

• Low-income individuals with special dietary requirements prescribed by their doctor– Health risk if they can’t afford to

purchase costlier food or supplements

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Families Process Map - Current State

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• The process split into two streams along the major request groupings– These two streams had very different performances

– Batch processing on one stream had a huge negative impact on performance

2019-02-21 FAM DHSU - CME Kaizen Conf 2019

Families Problems, Issues and

Observations• Defects

– Follow up needed due to errors and incomplete forms

• Waiting– Taking too long to forward requests from inbox

• Travel– Email histories were locked to personal email

boxes and not accessible

• Inventory– Duplicating statistics

• Extra-Processing– Unnecessary information put in emails and

spreadsheet

• Overburden– Workload distribution was unbalanced between

staff receiving the requests

• Unevenness– Different processes for different staff and request

types – Batch processing– Inconsistent staffing on inbox

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Families Process Map- Improved State

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Current State

Improved State

2019-02-21 FAM DHSU - CME Kaizen Conf 2019

Families We found tons of opportunities!

• We worked to eliminate process waste and to improve consistency by adding standards where none existed

• We recognized that a dedicated resource at the front end of the process was key

• We decided to shift from our “push” system to a “pull” system and eliminated many categorization methods as a result– We had to expand our scope

beyond the request sorting process to fix the batch processing problems

– Moved to a FIFO system– Finished a request? Take the next

one!– Required cross-training of our

people

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Families

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It’s working!

10

0

50

100

150

200

250

SameDay

2 3 4 5 6 7 8 9 10 11 12 13 14 +

Number of Days to Process Request

Before Kaizen After Kaizen

Families Implementation

11

Task Due Date Done?

Quick Hits

Stop tracking individual statistics on number of requests

processed Immediately✓

Gems

Develop SOP for inbox (include distributing emails with FIFO

and scanning hard copy mail daily

Jan 4, 2019 ✓

Create new inboxes to support pull system Jan 11, 2019 ✓

Train 1st staffing group to be able to pull any type of work Feb 1, 2019 ✓

Education for stakeholders regarding this restructuring Feb 22, 2019

Strategic

Permanent fulltime position for DHSU inbox Summer 2019 ✓

FIFO rules for 2nd staffing group to move to pull system &

cross train to be able to pull any type of work

Summer 2019

Create on-line applications Jan 2020

2019-02-21 FAM DHSU - CME Kaizen Conf 2019

Families Our lessons learned

• Challenge “why” we do every step of a process if you want to improve it!

• Push systems hide in office work everywhere– Whenever you divide up work by

categories, you may have a push system

– A pull system needs trust between management and staff to work!

• Batch processing might feel more efficient to an office worker, but you make your customer wait

• Standardization of work is critical when multiple people are involved

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Families Thank you for listening!

Questions?132019-02-21 FAM DHSU - CME Kaizen Conf 2019