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 2007!

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

time– 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 Venezia

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 Effectiveness)

Impact of counselor assignment re: revenue

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.

Insurance Utilization ProjectTeam 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 Pustulka

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+ offices

Team Members: Andrew Aprile, Dave Wirtner, Mike Sobczak, Angel Feness, Kate Hacker & Jesse Zeiders

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 Communication

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 SchneiderPre & 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 productivity!

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 ServicesDecision Matrix Example

HighUpdating CM to correspond w/ MM X

Training for staff on standardized method X

Low

Require Sups to run queries in CM X

Creating a manual for each office X

Low HighEffort

Imp

act

Impact-Effort Matrix

Medium

Medium

Older AdultsStandardizing 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 AdultsFrequency Chart

Purchasing

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!

PurchasingProcess Map

Receive RequestCapture date

Do we deliverto this location?

Order fromVendor

Pull pack, labeldeliver

Order fromVendor

Review Products neededor requested

Is it a vendorspecificproduct?

VendorDetermined

Check for bestpricing (at leastthree vendors)

Minimum orderchargemet?

VendorDetermined

YES

Hold for futureneed and

inform location

Place order withvendor

Capture date

Assign PO #

Placed via web, faxverbal

Record confirmationnumber

Update vendor folderwith original request,

order placed,confirmation info.

Invoice statementsreceived from

vendor capture date

Match invoices tooriginal requested

orders

Identify indirect vsdirect costs basedon department

Supervisor reviews,corrects if necessary

Check Request sentto accountingCapture Date

YES NO

Is StockAvailable?

NO YES

NO

YES

NO

YES NO

Within $10 ofminimum?

Can we mergemultiple orders tomeet minimums?

NO

Add extra itemVendor determined

VendorDetermined

YES

Item and packing slipreceived

Capture date

Do itemsmatch original

orders?

Match packing slipwith original order

Incomplete order,contact vendor tocomplete request

NO

YES

revised8-28-2012

NO

Incorrect ItemsReceived

PURCHASING SIX SIGMA PROJECTPROCESS 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 ProjectRoom & Process Redesign

Total Headcount = 21

Envelopes from Teller B 2nd Floor Manual Deposit to Bank

(2) Teller C’s with equipment

(Cash Pro IV)

(4) Teller 1’s

and

Calculators (Cash Pro V)

(5) Teller 1’s with Calculators. (Total = 9 Teller 1’s) (Cash Pro V)

(4) Teller 2’s with Calculators (Cash Pro VI)

(3) Teller 3’s with computers and calculators (Cash Pro VII)

Appeal Supervisors (2) with computers (Cash Pro

VIII)

Senior Supervisor

With computer and calculator

Counter

If Manual

If Complete

If Exception

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 conversation

Need Leadership support

It works better than ‘see what you can do’ or ‘try harder

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, contactMichael Venezia, LCSWR, ASQ-CQM, CLSSGBDirector of Quality Improvement (716) 218-1450 ext 2098 mike.venezia@ccwny.org