tuesday morning | keynote

TUESDAY MORNING | KEYNOTE

Welcome from Steve Collins

Coffee/tea service sponsored by

Sherlock Center on Disability

People, Tools & ProcessesThe Secrets to Excellence in Service

Steve Dickinson

Plan(Pre- Event)

Do(Event Week)

CheckPost- Event

Act(Post- Event)

4. I dentif y and

Select Solutions

Excellence

Start

•Next Steps f rom “Act”•I dentif y Process•Develop Scope•Develop Mission•I dentif y & Secure Resources•Develop the Project Charter•Form the Team

•Develop Baseline Process Map•I dentify High Level I ssues and Barriers•I .D. Root Causes•Select Solutions•Redesign Process & Process Tools•Develop I mplementation Plan•Develop Playbook•I mplement the Plan

•I mplement the Plan •Track I mplementation •Adjust Plan•Evaluate Results

•Make Adjustments•I .D. Lessons Learned•Standardize •Replicate•Communicate Remaining I ssues•Develop Next Steps

1. Plan the Project

2. Understand Current Process

3. I dentif y& Analyze I ssues & Barriers

6. Ensure Results

7. Close the Project

5. I mplement

Facilitators lead activities

Team Leader leads team, Facilitators lead

activities

Team Leader leads team, assumes f ull

project responsibility

People, Tools & Processes

Steve Dickinson

What is Excellence in Service?

Meeting your customers’ requirements within your

mission

“To help people with disabilities find and maintain employment, and enhance their independence.”

Sample VR Mission


Steve Dickinson

How to Obtain ExcellenceGetting from Here to Here


Steve Dickinson

Improvement Processes

Tools

People

• Baldrige

• Process Management

• Benchmarking Best Practices

• Lean

• Analytical Problem Solving (DMAIC)

• Process Mapping

• Pareto Analysis

• Value Stream mapping

• Matrix Analysis

• Teams

• Individual Contributors

• Management

• Customers?

Processes, Tools and People


Steve Dickinson

Let’s Look at Processes


Steve Dickinson

Malcolm Baldrige Criteria for Organization Excellence

http://www.nist.gov/baldrige/

The Inclusive Management System

Not Prescriptive – Tells you WHAT but not HOW


Steve Dickinson

Process ManagementIdentify Processes

Identify Customer

s

Identify Customer

Requirements

Identify Measures

Manage by

Measures

Developing the Infrastructure

Simplified Improvement

Model


Steve Dickinson

Watch Measures

OK?

Make Improvement

s

Yes

No

Daily Process Management


Steve Dickinson

Benchmarking Best Practices

Plan

DoCheck

Act

1. Set Direction

2. UnderstandProcess

3. Study Best

Perf ormers

4. I dentif y, Test & Select

Solutions

5. I mplement

6. Ensure Results

7. Remaining I ssues andFuture Plans

DRIVE!

Start

•Study Test •I mplementation Plan•Tracking I mplementation•Evaluation of Results•Redirect Activities

•Adjustments•Lessons Learned•Standardization•Replication•Sharing with Partners•Remaining I ssues•Next Steps

•Next Steps f rom “Act”•I dentif y gap•Requirements•Costs•Resources•Charter•Timeline•Process

•Mapping•Barriers•Problem Points•Partner Selection•Site Visit•Solutions•Process Redesign•Testing

Plus +

•High Probability of Success•Easier in Public Sector

Minus –

•Travel•Not Invented Here Disease


Steve Dickinson

Benchmarking Best Practices in VR

Research and Technical Assistance Center (RTAC) on Vocational Rehabilitation Program Management

A “collaborative initiative to identify, test, and disseminate management practices in order to build a performance management model tailored to the Vocational Rehabilitation system.” Second cohort.

• California Department of Rehabilitation• Colorado Division of Vocational Rehabilitation• Connecticut Bureau of Rehabilitation Services & Connecticut Bureau of

Education and Services for the Blind• Delaware Division of Vocational Rehabilitation• Kentucky Office for the Blind• Kentucky Office of Vocational Rehabilitation• Missouri Division of Vocational Rehabilitation• Nebraska Vocational Rehabilitation• New Jersey Division of Vocational Rehabilitation Services• North Carolina Division of Vocational Rehabilitation Services


Steve Dickinson

http://www.vr-rtac.org/

“Lean”Plan(Pre- Event)

Do(Event Week)

CheckPost- Event

Act(Post- Event)

4. I dentif y and

Select Solutions

Excellence

Start


•Develop Baseline Process Map•I dentify High Level I ssues and Barriers•I .D. Root Causes•Select Solutions•Redesign Process & Process Tools•Develop I mplementation Plan•Develop Playbook•I mplement the Plan



1. Plan the Project



6. Ensure Results


5. I mplement



activities



Plus +

•Great Results in Short Timeframe•Employee Engagement•Inexpensive – No Cost or Low Cost Improvements•Non-Technical

Minus –

•Requires Employee Time for Kaizen EventsPQS, Inc. Rapid Process

Improvement Methodsm Model


Steve Dickinson

Lean Enterprise – “lean”

Eight Sources of Waste – Focus on Flow.

Removal of waste from processes, reduced cycle time & cost reductions resulting in Excellence in Service

Waste

Transport

Over-producing

Defects

Motion

Waiting(Queue time)

Over-Processing*

Inventory

* Including Over Specialization


Steve Dickinson

Lean Enterprise – “Lean”

• Apply tools and concepts of Lean such as:• Batch and Queue• 5 S• Excessive Specialization

Various Methods for “Kaisen Events”

• Focus on no cost or low cost process improvements that increase flow by removing process waste

• Focus on what is best for the customer

• Most involve some kind of mapping of the process

• Standardization and stabilization of the process, not necessarily the content

• Utilizes Front Line Workers in Kaisen Events


Steve Dickinson

Plan(Pre- Event)

Do(Event Week)

CheckPost- Event

Act(Post- Event)

4. I dentif y and

Select Solutions

Excellence

Start


•Develop Baseline Process Map•I dentif y High Level I ssues and Barriers•I .D. Root Causes•Select Solutions•Redesign Process & Process Tools•Develop I mplementation Plan•Develop Playbook•I mplement the Plan



1. Plan the Project



6. Ensure Results


5. I mplement



activities



PQS, Inc. Rapid Process Improvement Methodsm (RPI)

Three Phases

1.Pre-event Planning

2.Team Event

3.Post-event Implementation


Steve Dickinson

Florida Department of Environmental Protection

Pink = Process DelayGreen = Transport/HandoffYellow = Action Steps


Steve Dickinson

Results

1. Reduction in processing time by as much as 83%2. Reduction in variation just as important – more predictable

enabling planning and customer service


Steve Dickinson

Florida VR Project Team Example Cross-functional Team of HQ and Field

Services Mission

“To reduce the number of days from the invoice being received in HQ to the invoice being sent to DOE, while maintaining the accuracy of authorizations for payment.”

ResultsRemoved 1/3 (24) of the process steps which were duplicative

Cycle time reduction from 18 days to 5 days with increased accuracy!


Steve Dickinson

Six-Sigma Analytic Problem Solving (DMAIC)

• Became popular in the US in 1980’s

• Tools and process around for years

• Popular in Japan since WW II

• Focus on improving quality & reducing costs through reduction of variation & thus defects

Define Project and Boundaries

Analyze the specifi c problem

for root causes

Measure and stratif y the problem

into its specifi ccomponents

Control the work process to ensure

lasting results

I mprove theprocess with lasting solutions

• Data driven statistical analysis

• Uses basic, moderate and advanced statistical tools depending on training – Yellow, Green and Black Belt levels


Steve Dickinson

Define Project and Boundaries

Analyze the specific problem

for root causes

Measure and stratif y the problem

into its specificcomponents

Control the work process to ensure

lasting results

I mprove theprocess with lasting solutions

Six-Sigma – The DMAIC Process

Plus +

•Great when there are many unknowns•Can solve just about anything•Data to support conclusions•Can be done by individuals

Minus –

•Time consuming•Requires extensive training (advanced tools)


Steve Dickinson

ALOS KPIAverage Length of Stay

(Includes Newborns; Excludes Rehab and Hospice Cases)

3.00

3.50

4.00

4.50

5.00

5.50

6.00

AL

OS

2006 YE 5.11

2007 YTD Actual 5.14 5.44 5.31 5.52 5.32 5.02

2007 YTD Target 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00

2006 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Source: Decision Support; Trendstart

Good

4.7 4.45 4.25 4.35 4.25 4.0

Results

“It has been calculated by Finance that each 0.1 day translates into $560,590 of additional cost to the hospital.” ($850,000 improvement) Patients also do not want to stay in the hospital any longer than they need to.


Steve Dickinson

Let’s Look at ToolsMultivariable Checksheet

Market

Austin

Corpus

Chicago

Kentucky

South Florida

Other

Arizona

North Florida

Atlanta

# Claims Rejected

Hospital/ Facility Physician Equipment Seq #

All Process Steps – Include Transport and Delay TimeChanges Product?

Req for 1st time

Change import. to

Cust?

Process Analysis Worksheet

Elimination of Referrals (I llustrative Only – Not a real case)

+ Driving Forces - Restraining Forces

Reduced cost f or processing by company and Physicians

I ncreased Member satisf action as they can go to any doctor they want

I mproved political relationships as Member choices are increased

I ncreased First Pass Rate, lower suspends, less paperwork

I ncreased costs to company, without a relative increase in service. This would have to be passed on to the Members and Groups causing us to be less cost competitive

Members making improper choices of Physician needed subjecting them to unneeded medical care and unneeded co-pays and multiple visits to multiple doctors to get the correct care. Decreased Member satisf action

Loss of medical care control By the PCP leaving no one in control of the health care plan f or the member

SIPOCMembership and Billing – Option B Invoice Reconciliation Process

Rev 11-15-1956

Key Performance Measures Customer Requirements

Key Process S

teps

Suppliers

Inputs/Enablers

• Invoice with option “B”• Documentation for termination

Customers

Outputs

• Request for additional information•Reconciliation of invoice

Support Area (Enablers)

Invoice Received by CCR

• CCR applies premium to system

• CCR sends any attached documents to M&B

Invoice documents are received

by M&B

• Admin support receives invoice document

•Invoice is looked up for PSR clerk code

• Materials are placed in bin to go to PSR

Corporate Cash Receipts (CCR) (supportive only)

Membership and Billing (M&B) Administrative Support

Legal (supportive only)

Provider Services Rep

PSR receives documents

• Invoices are sorted by date order and placed in Invoice/ Reconciliation

• Prior to processing the invoice is reviewed for additional information needed

Invoice processing

• Invoice is processed if no additional information is needed

•If group indicates reason ‘B’ on back of invoice additional information is required

• Contact is made to the group to request additional information

PSR receives document for cancellation

• Cancellation of member is processed

• Invoice is reconciled

• Benefits Administrator• Corporate Cash Receipts• Administrative Support

•Benefit Administrator•Member•Customer Service

Process all invoice reconciliations with the time frame goal with 100% accuracyCorporate cycle time is 10 days

Can put Players here for each stepThese are potential RPI “Team” members

- CCR Specialist- CCR Clerk

- Admin Suppt Clerk- CCR Clerk

- Admin Suppt Clerk- PSR- PSR Mgr.

- PSR- Lead Rep- PSR Mgr

-PSR- Lead Rep- PSR Mgr

Potential Bench StrengthPotential Bench Strength

ILLUSTRATIVE ONLY

A

Process Owner ________________________B

CD

E

F

FD

GH

1 2 3 4 5

Unclear or not followed

Procedures and Guidelines

Clearly agreed upon and followed

Individuals protect self-interest

Individuals support each other and the goals/mission

1 2 3 4 5

Commitment

None set or irrelevant

Well defined and clear goals

1 2 3 4 5

Goals/Mission/Objectives

1 2 3 4 5

Had no process or was not followed

Process

Process was clear and followed

1 2 3 4 5

Few people involved

Participation

Everyone involved and eager to participate

1 2 3 4 5

Very low trust

Trust

High level of trust

1 2 3 4 5

Little evidence of conflict

Conflict

Conflict allowed, existed and was productive

1 2 3 4 5

None, everything on the table

Hidden Agendas

Great deal hidden, unresolved conflicts

1 2 3 4 5

Much wasted time

Timing

Time well spent

1 2 3 4 5

Too much direction and control

Facilitation

Just right amount of direction and control

Comments:

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

Team Member Feedback Sheet

Rating of Importance

9 9 7 10 10 9 3 2 6

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Crtiteria

Pot. Solutions Impr

oved

P.P

.I.

Cos

t

Eas

e to

Im

plem

ent

Str

ateg

ic P

rior

ity

Ris

k

Min

imal

R

esou

rce

Impa

ct

Min

imal

IT

R

esou

rce

Impa

ct

Fin

anci

al B

enef

it

Ben

efot

to

Cus

tom

er

Sat

isfa

ctio

n

Total

1PCP picks specialist

9 8 1 5 1 4 5 1 2 285

2Always call Healthy

1 1 1 1 1 1 1 1 1 65

3Eliminate referrals

0 0 0 0 0 0 0 0 0 0

4 No changes 1 1 10 1 1 5 1 1 1 164

5Claims sent to PCP first

1 1 1 1 1 2 1 1 1 74

6Provide electronic number

9 6 5 10 10 7 4 10 10 525

7Change deny to reject for no referral

10 9 9 8 5 8 6 2 5 488

(Option not possible)

Solution SelectionMatrix

$-$150,000 $300,000 $450,000 $600,000 $750,000 $900,000

$1,050,000 $1,200,000 $1,350,000

Dol

lars

Date

TOA MTD Cummulative Gross F. Goods InvoicedJuly 2003

MTD Cummulative F. Goods Sales Invoiced - Actual MTD Cummulative F.G. Sales Invoiced - Target

771,022 763,293

594,306

368,281

809,668

1,015,352 1,088,396

902,687

-

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

Nov/02 Dec/02 Jan/03 Feb/03 Mar/03 Apr/03 May/03 Jun/03

Po

und

s

Month

TOA Monthly Finished Goods InventoryJuly 2003

Finished Goods InventoryF.G. Green Level - Ok ( One Week Sales Orders)F.G. Yellow Level - Stock build up Warning (Two Weeks Sales Orders)F.G. Red Level - Stockbuild up (Over Two Weeks Sales Orders)

Good

Speed0

200

400

600

800

1,000

487

400 398

34

655

455397

524 499456

666

765

Types of Defects Received in Warranty ClaimsMachine Stuff , I nc.

2002

StartingGeneralCracked

Case

WiringMotorsBearings Paint

SealsLines

OtherFuel

Num

ber

of

Def

ects

x 1

00

Source: MSWC Report 456

0

200

400

600

800

1,000

487

400 398

34

655

455397

524 499456

666

765

Type of Defect

Speed0

200

400

600

800

1,000

487

400 398

34

655

455397

524 499456

666

765

Types of Defects Received in Warranty ClaimsMachine Stuff , I nc.

2002

StartingGeneralCracked

Case

WiringMotorsBearings Paint

SealsLines

OtherFuel

Num

ber

of

Def

ects

x 1

00

Source: MSWC Report 456

0

200

400

600

800

1,000

487

400 398

34

655

455397

524 499456

666

765

Type of Defect

Af terBefore

Source: Service deviation warranty system

Total Problem reductionValve

Problemreduction

Valves Motors Leaks

96 52 8

Compressor Failure Types 1999 (Annualized using J an - Mar data)

Type of Failure

Source: Warranty system

N=156

Valves Motors Leaks

96 52 8

Type of Failure


N=156

Compressor Failure Types - 1997

0

200

400

600

800

1,000

1,200

Valve Failures Motor Leaks Machining ErrorOil Problems Other

Type of Failure

Num

ber

of

Fai

lure

s

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ACCU

MU

LAT

IVE %

CO

NT

RIB

UT

ION


N = 1236

80%

86%91%

9698%

985

80 64 52 32 23

Af terBefore

Source: Service deviation warranty systemSource: Service deviation warranty system

Total Problem reductionValve

Problemreduction

Valves Motors Leaks

96 52 8

Compressor Failure Types 1999 (Annualized using J an - Mar data)

Type of Failure


N=156

Valves Motors Leaks

96 52 8

Type of Failure


N=156

Compressor Failure Types - 1997

0

200

400

600

800

1,000

1,200

Valve Failures Motor Leaks Machining ErrorOil Problems Other

Type of Failure

Num

ber

of

Fai

lure

s

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ACCU

MU

LAT

IVE %

CO

NT

RIB

UT

ION


N = 1236

80%

86%91%

9698%

985

80 64 52 32 23

7

6

5

4

3

2

1

Tone of Voice

Quick Response

Trusted AnswerThoroughness

Friendly

Overall Experience

Customer Satisf action Results (Calls)San Francisco Service Center

October 2002

I mportance

Satisf action

Amount of Wait

Claims Processing TimesSan Francisco Service Center

June 2002

0

5

10

15

20

25

30

35

40

45

50

0.5 to2.0

2.0 to3.5

3.5 to5.0

5.0 to6.5

6.5 to8.0

8.0 to9.5

9.5 to11.0

11.0 to12.5

12.5 to14.0

14.0 to15.5

15.5 to17.0

17.0 to18.5

18.5 to20.0

20.0 to21.5

# Days to Process

# C

laim

s

n=159 Lower Specification Limit=5

Mean=12.

Upper Specification Limit=18

Hypothetical Claims Processing Example – Non inclusive

External Customer Needs

RequiredOutcomes

Outcome Drivers

Drivers of the Drivers

Process Drivers

Timely payment of claims

Accurate payment of claims

Understandable explanation

Ease of submittal

Adequate Margin

Maximize cash flow benefit

Meet regulatory requirements

Business Needs

Meet Contracts

Meet Regulatory Requirements

< 30 days from submittal

No Rework

No callbacks for explanations

What we want

First pass rate

Timely reconciliation of edits

Mail time <3 days

Timely COB resolution

Timely edit resolution

Timely Special Investigation

Timely Medical Necessity

High electronic claim submittal rate

Backlog < 50 claims/investigator

Aging < 2 days

Investigation complete in <6 days

No regulatory complaints or fines

Pay < 2 days from requirement

Lowest cost per claim

What we have to control or “manage” for

timely payment of claims for

contracts

P1

P2

P3 Pn

Probability of Success = P1 *P2 * P3 * …Pn

P1

P2

P3 Pn

P1

P2

P3 Pn

P1

P2

P3 Pn

Probability of Success = P1 *P2 * P3 * …Pn

Page 16

Relationship Between Study Time and Test Scores

0

20

40

60

80

100

120

140

0 10 20 30 40 50 60 70 80 90

Test Scores

Stu

dy

Tim

e (M

inu

tes)

Feedback Mechanism Worksheet

I ndicator Data Required Location Data CollectorDisplayTool

DataRecipient

Distribution FrequencyStandards/Formulas

Color of CarsPQS, Inc. Parking Lot

September 29, 2002

Brown40%

Red19%

Blue14%

Green7%

Other20%

n=457


Steve Dickinson

Let’s Look at People

The People Side of Excellence

Processes and Tools People

Excellence


Steve Dickinson

Kotter’s Eight-Step Process for Creating Major Change (From Management

Perspective)

1. Establish a Sense of Urgency

2. Create the Guiding Coalition

3. Develop a Vision and Strategy

4. Communicate that Change Vision

5. Empower Broad-Based Action

6. Generate Short-term Wins

7. Consolidate Gains and Produce More Change

8. Anchor New Approaches in the Culture


Steve Dickinson

What Makes People Want to “Play?”

Management

Front Line Workers


Steve Dickinson

People, Tools & Process

Plan(Pre- Event)

Do(Event Week)

CheckPost- Event

Act(Post- Event)

4. I dentif y and

Select Solutions

Excellence

Start


•Develop Baseline Process Map•I dentif y High Level I ssues and Barriers•I .D. Root Causes•Select Solut ions•Redesign Process & Process Tools•Develop I mplementation Plan•Develop Playbook•I mplement the Plan



1. Plan the Project



6. Ensure Results


5. I mplement



activities



Let’s addLeadership

Processes

Tools

People+

The Secrets to Excellence


Steve Dickinson

The

of H.A.T.S.(How all this syncs)

Magic


Steve Dickinson

Thanks!N85TT

Steve DickinsonPQS, [email protected]


Steve Dickinson

tuesday morning | keynote

Documents