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Patti Rutter, RN, COHN/CM, CHC, Vice President, JPMorgan Chase
Tony Silva, CPE, Director of Ergonomic Services, Atlas Injury Prevention Solutions
National Ergonomics Conference & ErgoExpo
Using Six Sigma Methodologies to Improve Your Office Ergonomics Process
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Agenda
• JPMorgan Chase• Atlas Injury Prevention Solutions• Case Study:
– DMAIC methodology involves these five phases:1. Define – prioritize issues on VOC and state the
improvement goal2. Measure – measure the current performance3. Analyze – identify root causes4. Improve – improve the process5. Control – verify improvement results and maintain the
gains
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JPMorganChase
• CEO Jamie Dimon’s statement for the 10th anniversary:– July 1, 2014 marked the 10-year anniversary of
JPMorganChase and Bank One coming together - a critical part of a 200-year journey to form this exceptional company of ours. The past 10 years have seen some virtually unprecedented challenges, but they did not stop us from accomplishing extraordinary things.
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Health Services Department
• Specific to our domestic Health Services Department– 28 Health and Wellness Centers within 9 states– 64 Nurses who execute the program
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Atlas provides the tools and the resources that guide an organization to reduce and avoid the spiraling costs of work related injuries.
Atlas Overview
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Early Intervention
Reactive Ergonomics
Onsite Therapy
Return to Work Evaluation
Case Management
Pre-work ScreensJob Demands Analysis
Total SystemsApproach
Recordable Event
Discomfort
Proactive Ergonomics Services/SoftwareWellness Stretching
Atlas Overview
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Early Intervention
Reactive Ergonomics
Onsite Therapy
Return to Work Evaluation
Case Management
Pre-work ScreensJob Demands Analysis
Recordable Event
Discomfort
Proactive Ergonomics Services/SoftwareWellness Stretching
Atlas Overview
Hire the right people
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Early Intervention
Reactive Ergonomics
Onsite Therapy
Return to Work Evaluation
Case Management
Pre-work ScreensJob Demands Analysis
Recordable Event
Discomfort
Proactive Ergonomics Services/SoftwareWellness Stretching
Atlas Overview
Hire the right people
Help them avoid injury
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Early Intervention
Reactive Ergonomics
Onsite Therapy
Return to Work Evaluation
Case Management
Pre-work ScreensJob Demands Analysis
Recordable Event
Discomfort
Proactive Ergonomics Services/SoftwareWellness Stretching
Atlas Overview
Hire the right people
Help them avoid injury
Get them back to work quickly
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Nationwide Network of Service Providers 10,000+ cities covered
Atlas Overview
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JPMorgan Chase Ergonomic Assessment Process
• Policy– Medical documentation is not a prerequisite to
initiating the Ergonomic Assessment Process.• Most requests come from one of three
possibilities:– Employee– Manager– HRBP
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JPMorgan Chase Ergonomic Assessment Process
• Once Health Services is notified of the need for an ergonomic assessment, the nurse will:1. Contact the employee to determine the extent of the
evaluation. 2. Ask the employee to complete the online ergonomic
survey.3. Advise the employee to notify as soon as the survey
is completed to arrange for a review telephonically.
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JPMorgan Chase Ergonomic Assessment Process
• Telephonic Process1. Make an appointment for a telephonic consultation2. Review the entire survey with the employee
concentrating on areas that need actions.3. Explain to the employee what adjustments need to
be made and why. 4. Actions suggested and completed & purchases of
equipment should be noted on the survey. 5. Inform the employee of what equipment needs to be
purchased via e-Purchase.
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JPMorgan Chase Ergonomic Assessment Process
7. Follow up the Telephonic assessment with an E-mail/memo to the employee summarizing the evaluation and the recommendations, copy the manager.
8. Advise the employee to notify you once all equipment ordered (if any) has been received and assist as needed with needed adjustments.
9. Inquire about comfort/status change.10. Document all encounters on the survey to include
status change.11. If the employee continues to have issues, schedule
an onsite workstation evaluation.
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JPMorgan Chase Ergonomic Assessment Process
• Onsite Process – Nurse or Atlas1. Make an appointment for the onsite consultation2. Once evaluation is completed and recommendations
received, the nurse reviews the evaluation & recommendations with the employee and assures implementation of recommendations documented by the ergonomist.
3. Inform the employee of what equipment needs to be purchased via e-Purchase.
4. It is the responsibility of the employee and manager to initiate any purchase(s) through e-Purchase.
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JPMorgan Chase Ergonomic Assessment Process
5. Advise the employee to notify you once all equipment ordered (if any) has been received and assist as needed with needed adjustments.
6. Inquire about comfort/status change.7. Document all encounters on the survey and Omni to
include status change.
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JPMorgan Chase Ergonomic Assessment Process
• If the employee complains of symptoms that are suggestive of a medical condition, that persists after all of the steps have been completed, (which includes an onsite evaluation) refer employee to healthcare provider for diagnosis and/or recommendation of any equipment/furniture needed for their specific condition.
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JPMC Case Study
• The Situation:– Greater than 200,000 employees deployed over
5,700 individual locations across the country– Regional nurses with limited availability and expertise
that were required to provide reactive service on demand
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Volume
• 7 yr. look back at request volumes:• Over 100% increase in ergonomics and
accommodation requests (normalized)
Type of Request ’07, # Individuals(US population
142,600)
’13, # Individuals(US population
186,950)Ergonomic 259 (3.3%) 1529 (8.2%)
Accommodation 673 (4.7%) 1911 (10.2%)
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DMAIC
1. Define – state the improvement goals2. Measure – measure the current performance3. Analyze – identify root causes4. Improve – improve the process5. Control – verify improvement results and
maintain the gains
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1. Define
• Before stating the improvement goals:– What is the problem that we are trying to solve?– What is the scope of that problem? – How will we measure success?
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Define: Performance Metrics
• In Scope:– Discomfort resolution
• 100% follow ups• Discomfort to low or no level
– Time to complete assessments• Telephonic – 2 days Onsite – 10 days
– Assessment errors• < 5% additional data collection/clarification/rework
– Track completion of recommendations• 100% of assessments
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Define: Performance Metrics
• Out of scope:– I/I rates – rates are low and not the concern– Time to implement solutions – out of this group’s
control
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The Key Metric = Discomfort
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The Key Metric
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2. Measure
• Measure the current performance1. Discomfort resolution
• % of formal follow ups completed >90%• No quantitative follow up on discomfort levels so no
verification of discomfort to low or no level
2. Time to complete assessments• Use process / value stream map to capture this
3. Assessment errors• Cause and effect matrix
4. Recommendation closure• >90% of all recommendations closed
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What is Value Stream Mapping
• A technique used to analyze the flow of materials and information required to bring a product or service to a customer.
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Value Stream Mapping
1. Draw the current state value stream map, which shows the current steps, delays, and information flows required to deliver the service.
2. Assess the current state value stream map in terms of creating flow by eliminating waste.
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Time to Customer
• 2 things to measure: Process and Lead time• Measure process time:
– The time it takes to actually perform the work– Includes all of the doing, communicating, and
analysis– Aka work time
• Measure lead time:– Time from when request is made until the service is
provided– Aka elapsed time or throughput time
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Request Received from
Employee, Manager or HRBP
Assessment Completed and Report Provided
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Current State
• From request to completion of assessment(s) and recommendations = 87 hrs (> 10 days target)
• % of time work is being done (process) vs. overall lead or throughput time– Overall time = 87 hrs.– Process time = 6 hrs.– Percent activity = 7%
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Quality metrics
• On each process step:– % complete and accurate
• The percent deemed “usable as is” without having to:– Correct information that was supplied– Add information that should have been supplied– Clarify information that could have or should have been
supplied
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Quality metrics
• High quality/rework concerns– High rate of assessments not being completely
accurate or with full content (26%)– Moderate percentage deemed “usable as is” (74%)– Above target of < 5% quality/rework concerns
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Cause and Effect Matrix
5 8 10
# KPIV Tim
ely
resp
onse
Min
imiz
e co
ntac
t tim
e
Res
olut
ion
of
issu
es
Total % Rank
1Employee survey and automated recommendations
10 7 1 11612%
2 Nurse training/experience
1 10 10 18519%
3 Ergonomist training/experience
1 5 5 9510%
4 Assesment tool data and design
3 10 10 19520%
5 Recommendation detail
7 10 10 21522%
6 Follow up call/visit 3 7 10 171 18%Total 25 49 46 0 0
Cause & Effect MatrixRating of Importance to Customer
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Analyze
Identify root causes – 5 Whys• Discomfort resolution
– No SOP requiring 100% follow up– Online survey tool did not facilitate targeting
individuals for quantitative follow up• Nurse training and experience
– Lack of training for new nurses– No defined training or schedule for existing nurses– Training was generic and out of date– No learning verification
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Analyze
Identify root causes – 5 Whys• Assessment tool data and design
– No pictures for telephonic assessments– No workstation measurements– Redundant survey boxes made it difficult to quickly
identify what needed to be implemented– Outdated – did not account for multiple monitors,
tablet use, standing workstations
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Analyze
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Analyze
Identify root causes – 5 Whys• Recommendation detail
– Ergonomists recommending items not on standard product list
– Product list did not have solutions that addressed all issues
– Non prioritized list of standard products• Recommendation closure
– No SOP detailing requirement
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Improve – Striking a Balance
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Discomfort Resolution
• Update SOP to require 100% quantitative follow up for each assessment completed
• Target discomfort to low or no level• SOP also requires 100% closure of
recommendations– Trigger OMNI follow up notices– Recommendation follow up @ 15 days– Discomfort survey follow up @ 30 days
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Full or Discomfort Follow-up Surveys
Improve
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Improve
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Improve
• Nurse training and experience– Developed an on-demand training course for new
nurses and for annual refresher training– Principle based training that applies to any type of
equipment and work environment– Re-emphasis on early intervention techniques (first
aid) to address issues• RICE• Stretching• Microbreaks
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Training
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Improve
• Developed a decision matrix for assessments requests based on ergonomic risk and discomfort in online self-survey– This will reduce the lead time because it will eliminate:
• Unnecessary assessments from being performed• Telephonic assessment for high priority cases
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Decision matrix
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Improve - Employee Media Upload
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Improve
• Prioritized, standard product list from which recommendations are selected
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Improve – Guided Solutions
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Improve – Action Plan
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Closure of Recommendations
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Status of Recommendations
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Control
• A good control plan is necessary to "maintain the gain“
• Dashboards will be used primarily to monitor program performance
• Use data to push issues upstream to facilities and designers
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Track Performance
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Questions
• Patti Rutter, RN, COHN/CM, CHC, Vice President, JPMorgan Chase
• Tony Silva, CPE, Director of Ergonomic Services, Atlas Injury Prevention Solutions