Data Usage, Lean Thinking and Process Improvement

Transcription

1 Data Usage, Lean Thinking and Process Improvement Vicki C. Grant, PhD, MSW Vice President NAPIPM August 31, 2005

2 While all changes do not lead to improvement, all improvement requires change. The Improvement Guide

3 Caseload 20,000 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05

4 Accuracy of Decisions Child or Adult Eligible Not Eligible Office Decision Determined Eligible Determined Not Eligible (1) Accurate Decision (3) Inaccurate Decision (2) Inaccurate Decision (4) Accurate Decision

5 Approved 94% 92% 90% 88% 86% 84% 82% 80% 78% 76% 74% Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05

6 Closed at Renewal 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% Continued Coverage Failed to Renew All Other Reasons 20.0% 10.0% 0.0% Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05

7 Count Percent Pareto Chart of Denial Reasons Failure to Comply Other Covera ge Premium Non-Pay ment Excess Inc ome Voluntary W ithdrawal 0 Other Count Percent Cum %

8 Pareto Chart of Closure Reasons Count Percent Failure to Comply Excess Income Categorical Reasons Age Requested Closure 60 Day Post-Partum Other 20 0 Count Percent Cum %

9 I-MR Chart of Denied UCL=124.7 Individual Value _ X=77.9 LCL= /03 2/04 4/04 6/04 8/04 10/04 Observation 12/04 2/05 4/05 6/05 60 UCL=57.61 Moving Range MR= LCL=0 12/03 2/04 4/04 6/04 8/04 10/04 Observation 12/04 2/05 4/05 6/05

10 Individual Value Plot of Two Time Periods Data /03--8/04 9/04--7/05

11 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec Days to Process by Month, 2004 Jan-04 Days

12 Why 99% Is Not Good Enough (From The George Group) The goodness level of 99% equates to: 20,000 lost articles of mail per hour Unsafe drinking water almost 15 minutes each day 5,000 incorrect surgical operations per week 2 short or long landings at most major airports each day 200,000 wrong drug prescriptions each year No electricity for almost 7 hours per month

13 Six Sigma History (From The George Group) Motorola was the first advocate in the 80 s Six Sigma Black Belt methodology began in late 80 s/early 90 s More recently, other companies have embraced Six Sigma: GE Allied Signal Bombardier Sony

14 Origins of Lean Thinking (From The George Group) Lean has been around a long time: Pioneered by Ford in the early 1900 s (33 hrs from iron ore to finished Model T, almost zero inventory but also zero flexibility!) Perfected by Toyota post WWII (multiple models/colors/options, rapid setups, Kanban, mistake-proofing, almost zero inventory with maximum flexibility!) Known by many names: Toyota Production System Just-In-Time Continuous Flow Focused on reducing/eliminating the waste and cost in all processes

15 The Seven Transactional Wastes (From the George Group) 1. Waste of Overproduction Preparing unneeded reports, reports not read or acted on, multiple copies in storage 2. Waste of Time (Idle) Batch processing, i.e., monthly closings, weekly billing, monthly collection reports 3. Waste in Transportation Unneeded steps, document/data travel distance 4. Waste of Processing (Too Fast) Excessive sign-offs 5. Waste of Stock on Hand (Inventory) Transactions waiting to be processed 6. Waste of Movement (Worker) Unneeded data entry, extra steps 7. Waste of Making Defective Products Incorrect data entry

16 The Process

17 Model for Improvement Aim What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Measurement Cycle for Learning & Improvement Act Study Plan Do The Improvement Guide

18 Determining the Scale of a Test Confidence Consequences Failed Test Would Have Minor Consequences Failed Test Would Have Major Consequences Low Degree of Belief in Success Medium scale tests Very small scale tests High Degree of Belief in Success One cycle to implement the change Small-to-medium scale tests

19 Cause and Effect Computer Verification Notice Not Read Overwhelmed Too many Auto close/deny Could not obtain Did not understand Received late Delivered late Illiterate Wrong language Failed to Comply Excess demand Data entry error Policy not clear Request unnecessary documents Worker failed to enter change Client failed to notify of change Worker Notice Not Received

20 Churning is Rework Data and Case Reviews: 30% of closures reopened within 30 days this becomes next month s work. 95% of closures reopened in a 6 month period this is rework. 45% of closures statewide re-enroll within 12 months.

21 Ineffective Communication: Notices Problem: System Generated Communication 24,000 clients received at least 1 official notice in the last 6 months Average number of notices per client was 4.1 per day Range of notices was 1 to 48 in a day Solution: Change the Computer System 172,660 fewer pieces of paper 43,165 fewer envelopes Save 2 hours/day per worker by reducing inquiries about notices Save 30 minutes/day per worker in researching notice and explaining

22 Ineffective Communication: Language Match In a large county, the Spanish caseload retention rate increased by 34% when the annual redetermination form was changed to multilingual.

23 Ineffective Communication: Incorrect Addresses Local office counted returned mail over three days: Received 473 pieces of mail 228 pieces (48%) were returned by post office

24 Streamlining Work BEFORE AFTER Processing Time 28 days 3 days Wait Time 87.5% 14% Eligibility Determination Time 40 min per app 18 min per app Touches Overtime Cost $27,000 monthly $0 monthly.

25 One Office Went From This: OHP Application / Case Set Up Process Delivered from Bar Coding OHP Application / Mail Room Process Pre-Sorted by Team/Language/Category START Sorts Team 1 Team 2 Team 3 Team 4 Team 5 Team 6 MAA/MAF/BCCP SPD Self Employment Unknown Reapplications Labled Non UCMS Transfer for P2 Cases Line thru branch #, put 5503 VP, CP, NA Cases Mark Case Status on Application New WEBM FIND for Case Information Open CM Closed CM No CM Case Case Case Case Membership List Select Persons Priority Unborn DV/GC Mother's Care 17 & Under Emergency Adult Child START CM Case Set Up Add Persons Filed by Next Day Priority Assigned to Lead Redirected Faxes Sorted to Unit Mail Boxes File Duplicate Faxed Barcode Worker Sorts Research for Duplicates db2 Worker Mail Sorted to Worker Mail Boxes Non-Duplicate File Team 1 Team 2 Team 3 Team 4 Team 5 Team 6 OHP Application / Bar Code Process Sorted Self Employment Unknown Update Descriptors Update Address & Phone Pending or Change Status Complete Case Info at Top of App Contact Client to Complete 7211 Faxed Filed in Cabinet by date and Team order Barcode Worker Assign START Non-Citizen INS Number &/ UPS HNA or INS Card Application Lead Takes to Mail Room Mail Room and Bar Code Process Lead takes to Case Set Up Call INS SAVE form Attach to application Imaged Flicked Delivered to OFDM Next Day, Pick up 1st Page of Application Filed in Buckets by Assigned date and to Lead Team order Assigned to HSS1 Team 1 Application Workflow START Lead brings from Case Set UP Assigned to HSS2 Prints Information from DB2 Given to Lead Worker to Research Team Mother's Care Enters on Log Sheet Stapled Date Stamped Emergency Color-Flagged Barcode Worker Sorts Teams 1 & 4 DV/GC English Unborn Barcode Worker Sorts Teams 2 & 6 Russian Barcode Worker Sorts Teams 3 & 5 Sorted by Language Spanish Sorted by Category Vietnamese Identifies Unknown Barcode Worker Other Self Employment Redirected Faxes Sorted to Unit Mail Boxes Duplicate Prints Information from DB2 Given to Lead Worker to Research Team Application Assignments Sorts Provided by Lead Worker Assignment by Amount Requested and order of Processing Priority Worker Mail Research for Duplicates Sorted to Worker Reapplications Mail Boxes New Non-Duplicate Dispositioned by Enters on Log Worker Sheet Delivered to Team Stapled Date Stamped Color-Flagged Priority Emergency Lead Worker Returns for Absent Workers Mother's Care News Reapps UB DV/GC May be Pended Client Notified Mother's Care Faxed Eligibility Begins Eligibility Decision TRACS Narrative Medical Trans. HIP Payment Complete AFS443 HSS4 Reviews MAA MAA Referral Put in MAA Bucket Lead takes to Case Set Up Referred to other team/program/ process SLF Referral Cover Sheet Put in SLF Bucket Lead takes to SLF team SPD End Stage BCCP Referral Renal Delivered to Point Put in SPD Bucket Scan Ready Reapplications Scan Ready New New to be Scanned Unborn Domestic Violence DV/GC Unborn Mother's Care Emergency Client Notified Coordinator Notified Copy AFS443 Bar Code Created Application Disposition Copy with Application Copy to Coordinator are Dispositioned Image Bucket Delivered to Case Set Up Lead takes to Imaging END

26 Expectation: A new flowchart Proposed OHP Application Process START Application is run through mail opener Worker opens, assembles and date stamps applications Labels Unlabeled applications will have labels made Labeled applications are scanned and sorted by language are assigned to workers END

27 However beautiful the strategy, you should occasionally look at the results. -Sir Winston Churchill