Our Quality Journey Using Lean Six Sigma

Our Quality Journey
using Lean Six Sigma and other
Quality Improvement tools
First used Six Sigma to organize and prepare for our initial
Council on Accreditation (COA) accreditation. Through the use
of Charter and DMAIC tools we passed with flying colors in
Yellow Belt training projects (United Way):
– Improve utilization of Title XX funding in Aging
– Improve 1st visit attendance in Marriage Counseling
– Agency - wide Dashboard for Stakeholders
– Improve Appeal Deposit Process
– Improve HR Hiring Process
Green Belt training projects (UB - Center for Industrial
Effectiveness) :
– Insurance utilization project
– Better balancing of payer mix within Aging Services
– Improving computer support to the 50+ offices
– Streamline the referral of traumatized youth placed out of
home to Child Mental Health.
Other trainings and Projects
Green & Yellow Belt training projects (Canisus Center for
Professional Development):
– Closing the Gap – Increase percent of Core Functions
– Immigration & Resettlement – Decrease non-direct service
– Monsignor Carr Institute – Reduce No Shows
– Metro-District – Reduce Billing discrepancies
– Older Adults – Increase percent admissions
– Purchasing – Reduce cycle time & errors
Other Projects:
Substance Abuse Services; a Federal NIATx Project
Appeal Cash Room Six Sigma Project
Sample of Project Tools/ Products
Improved utilization of Federal
funding in Aging programs – One of
our first Yellow Belt training projects
through the United Way trainers;
William Hill PhD & Joe Rocasano
Title XX Project Team Members: James Nowak, Bill
Larsen, Adrian Slocum, Maryann Deitzer & Mike
Client Engagement Project
- Yellow Belt
Marriage Counseling
Team Members: Arlene Kaukas, Jennifer
Przynosch & David Catalano
Goals and impact:
Focus on improving 1st appointment rate.
Streamlined intake method,
6% increase in ‘show rate’.
Develop Agency-wide Dashboard
- Yellow Belt
Team Members: Andy Aprile, Jane Minichelli,
Bill Sukaly, Erin Postulka, Barb Griesmann
Went from a low level of performance
reporting compliance to nearly all.
Quality of outcome measures improved
Stronger commitment to use Dashboard/
Scoreboard tied to Strategic Plan
Appeal Deposit Process
Team Members:Therese D. Bianchi,T.J.
Jakubowicz,Janet Kraus, Paul Seitz, Sr.
Mary McCarrick OSF
Goal: Speed up reconciliation of deposits
Results in days instead of months
Run Chart of Appeal Data
Green Belt Projects via a Community Health
Foundation Grant (UB – Center for Industrial
Impact of counselor assignment re: revenue
Better balancing of payer mix within Aging
Improving computer support to the 50+ offices
Streamline the referral of traumatized youth
placed out of home to Child Mental Health.
Insurance Utilization Project
Team Members: Tracey Miers, Lorraine Rinus, Meichle Latham,
June Pamrow, Barb Griesmann, Beth Bishop, Dave Catalano
Impact on lost revenue and improve the process-reduction in
error rate from 25% to 17%.
This project prompted the agency to seek changes in the third
party payer agreements as well as a rethinking about
compensation of credentialed staff.
Credentialing of all eligible staff for insurance reimbursement
Significantly increased revenue (estimated over $31,000 in just
one department)
These actions will have a direct impact on the sustainability of
the system changes and ability to provide client care to a larger
number of people.
Insurance Utilization Project
Measure Phase - Pareto Chart
Better balancing of payer mix within
Aging Services
Team Members: Jim Nowak, Bill Larsen, Tony
Szakacs, Susan Wollenberg, Mike Smith & Erin
Balancing payer mix with in that Aging Services to
be less dependent on declining Appeal funds.
The project did provide the data to negotiate a much
higher reimbursement rate with hospital providers.
Improving computer support to the 50+
Team Members: Andrew Aprile, Dave Wirtner, Mike
Sobczak, Angel Feness, Kate Hacker & Jesse
This project did identify new ways to monitor and
improve internal IT services
The findings and operational recommendations
were presented to leadership as improved
procedures and methods to monitor IT and other
internal support services.
Bar Chart - Methods of
Improve Mental Health services for
traumatized youth placed out of home
Streamlining the referral of Foster Care and
Adoption children to Monsignor Carr Institute which
resulted in:
A dramatic reduction in wait time for children 33 to
11 days.
A greater satisfaction level of internal referral
sources from 33% to 100% satisfaction.
This project was expanded to other populations
within Catholic Charities
Team Members: Mike Venezia, Marie Andersen-Strait, Destiny Booker,
Kristin Brandel, Jose Correa, Arry Green, Kelly Grimaldi, Caterina
Plotnicki & Jan Schneider
Pre & Post Histograms
Closing the Gap – Increase Percent
Core Functions from 57% to 70%
Team Members: Andrea Meyers, Cheri
Alvarez, Alisha Baggiano, Jillian Miller,
Susan Seawood
The result of this intervention is astounding!
Site Facilitators increased the amount of time
they spend on 5 Key Functions to 88%!
Closing the Gap Process Map
Immigration & Resettlement
Team Members: William Sukaly, Dennis
Walczyk, Diana Nowak, Pat Zimmer, &
Carolyn Kwiatkowski
Decrease non-direct service time
Immigration & Resettlement
Cause & Effect Diagram
Monsignor Carr Institute
Team Members: Janice Schneider, Kristin
Brandel, Bernie Arnesen & David Wirtner
Reduce No-Shows
The number of No-Shows decreased by
2,077 visits which represents an increase in
income of approximately $186,930 and
resulted in an increase of 47% in
Monsignor Carr Institute
Run & Control Chart
Family & Community Services
Billing Process
Team Members: Marie Andersen-Strait,
Jessica Schroff & Sandy Smith
$19,440 represents the potential of reduction
in loss/ increased revenue by completing this
improvement process
Family & Community Services
Decision Matrix Example
Impact-Effort Matrix
CM to
w/ MM
Training for
staff on
method X
Sups to run
queries in
Creating a
manual for
each office X
Older Adults
Standardizing the Intake Process
Team Members: Jim Nowak, Tara Pace, Erin
Pustulka, Tony Szakacs & Beverly Eagan
Standardizing the Intake Process shifted
overall conversion rate for Older Adult
Services from 30% to 47%
Older Adults
Frequency Chart
Team Members: Terry Bianchi, Elly
Fialkowski, Angel Feness, Karen Metz &
Pam Rich
Goal: reduce cycle time from 43 to 36 days
Realized 20.9 days, a 50% reduction!
Process Map
Substance Abuse Services; a Federal
NIATx Project
Team Leader: Bernie Arnesen
Used a rapid cycle PDSA improvement method
Increased the average show rate for the second
clinical appointment from 33.3% to 77.7%.
Using a welcome packet, we had a net increase of
112% in income for the second clinical visit.
These percentages remained true six months after
adopting the new procedure
PDSA Change Model used
Six Sigma Cash Room Project
Team Members: Chuck Marra, Terry Bianchi, Cindy
Scibetta & Jim McNamara
Through cash room re-design and scale improved
work times and significantly reduced idle times
Improved the average number of days and outliers
from envelope receipt to deposit by 50%
– Average total work days – from 9 to 4.5
– % of outliers (>20 days) from 6% to 3%
Six Sigma Cash Room Project
Room & Process Redesign
Total Headcount = 21
(4) Teller
(5) Teller 1’s with Calculators.
(Total = 9 Teller 1’s) (Cash Pro V)
(Cash Pro V)
(4) Teller 2’s with
Calculators (Cash Pro VI)
(2) Teller C’s
with equipment
(Cash Pro IV)
(3) Teller 3’s with computers
and calculators (Cash Pro VII)
Envelopes from Teller B
If Manual
Appeal Supervisors (2)
with computers (Cash Pro
2nd Floor Manual
If Complete
If Exception
Deposit to Bank
With computer
and calculator
Food Table
Lessons Learned
Like learning to drive a stick
shift – Challenge to learn
Need for Charter and well
scoped out charge
Real problem may not be
‘the problem’
Data changes the
Need Leadership support
It works better than ‘see
what you can do’ or ‘try
Don’t need to shoot a fly
with elephant gun
Great return on investment
Shared vision & knowledge
– Take a learning stance
Trust the process –
It works!
For more information, contact
Michael Venezia, LCSWR, ASQ-CQM, CLSSGB
Director of Quality Improvement
(716) 218-1450 ext 2098
[email protected]