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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