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Special Thanks…Debra Isaac, Customer Service Supervisor – Vital
StatisticsCheryl M. Williams, Deputy Registrar – Vital StatisticsSimon Trevino, Senior Computer Operator – Vital
StatisticsVital Statistics Cashiers
Luis CarrilloMary CouteeEsmeralda GonzalezCathy GrantLoretha JimmersonWillie “Tweety” McClintokJuanita VelasquezHelen Smith
Public Health Department Accreditation Measurement of performance against nationally
recognized, evidence-based standards
Improve and protect the health of the public by advancing the quality and performance of public health departments
Benefits Systematic approach to public health Ensures quality services are provided to residents Enhances visibility and validates commitment to residents Means to obtain additional funding Provides an opportunity to identify areas of performance
improvement
Why Quality Improvement?Foundation of public health
accreditationAccountability
Results of investment in public healthDeclining – do more with lessFuture funding requirement
Getting better all the time Improving performance Improving health outcomes Improving customer satisfaction
Definition of Quality Improvement In Public Health
“Quality improvement in public health is the use of a deliberate and defined improvement process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health.
It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.”
Defining Quality Improvement in Public Health; Journal of Public Health Management & Practice: January/February 2010 - Volume 16 - Issue 1 - p 5–7, Riley, William J. PhD; Moran, John W. PhD, MBA, CQIA, CQM, CMC; Corso, Liza C. MPA; Beitsch, Leslie M. MD, JD; Bialek, Ronald MPP; Cofsky, Abbey -
Continuous Improvement
Act
DoCheck/Study
Plan The continuous improvement phase of a process is how youmake a change in direction.The change usually is because the process output is deterioratingor customer needs have changed
What Is Quality?Today the most progressive view of quality is
that it is defined entirely by the customer or end user and is based upon that person's evaluation of his or her entire customer experience.
The customer experience is the aggregate of all the Touch Pointsouch Points that customers have with the organization’s product and services, and is by definition a combination of these. (RFT)
“Quality is not an act. It is a habit”Aristotle 384BC-322BC, Greek philosopher and scientist, student of Plato and
teacher of Alexander the Great
AIM StatementAn opportunity exists to improve the Vital
Statistics Customer Flow beginning with
customer receipt of ticket number from
information window and ending with being
called by a cashier to complete financial
transaction. This effort should reduce wait
time by 15 minutes for the customer.
AIM StatementThis process is important to work on now because
wait times are experienced between the info desk
and cashier and to provide good, efficient customer
service
The baseline measurement is defined as the
following metric: Average wait time per cashier
window of 28 minutes by cashier by day
MethodologyObserved the customer waiting areaMultiple one-on-one discussions with
supervisor and deputy registrar Observed cashiers during several time points
during the work weekSummary analysis of operational reports
Customer Wait TimeTransaction TimePrint Time
Cashier Survey
SIPOC+CMConstraints: •Language•Signage•Volume•Incomplete documentation•Printer •Database, Network•Problematic application searches
Begins with: Customer receiving ticket # from info desk
Ends with: Customer call to cashier window
Process/Activities: • Customer waiting for cashier call (in lobby)•Cashier call
Outputs: • Check documents• Begin database search• Send to Print•Complete transaction
Customers: •General public (Residents of Texas state)
Measures: Average Customer wait timeCashier feedbackCustomer feedback
Inputs: • # of Customers• # of Cashiers•Supervisor triggers/alerts• Previously completed application (at home, office etc)•Availability of all needed documents
Suppliers: • Texas State database• Network
Call # Assigned
NY
Cashier Call
Complete SearchFinancial Transaction
Sent to Printer
Obtain Correct Information
Customer Wait TimeAvg.: 28 min
Is application information correct?
Pick up Certificate at window #10
Print Window CallCustomer Wait Time, includes SOD certificates Avg.: 7 min
Customer enters Vital Statistics Lobby
Info Desk
NY
Complete correct section
Leave if cannot
complete form or
missing docs
Is a correct application section complete and required documentation available?
Customer Wait Time: UnknownFlow Chart
Fishbone – Cause and Effect
Wait time of 28 minutes for vital statistic customers
•Database•Equipment•Network, server•Software
•Training, skill set•Communication
•“problem” certificates•Printing process•Signage/layout
PROCESS
MechanicalWo-Man Power
•Staffing Adjustments# of windows openSupervisor moderates flow
•Distribution of tasks, responsibilities↓ customer flow – additional tasks↑customer flow - ↑# of windows open
Staffing level
Staffing adjustments
Dist of tasks, responsibilities
•Staffing levelTriggersSupervisor calling for back up
Pilot TestIdea – transfer 1 person from correspondence
to window #6; add lunch coverage 4 windows open at all times
Results – June 4th – 8th
Plan
1. Identify / Prioritize Opportunities:Customer average wait time
more than 28 minutes
2. AIM: Reduce customerwait time to 15 minutes
3. Current Process: Limited number of cashiers
to process transactions
4. Collect Data On: Number of cashiers and the wait time
per customer
5. Identify Possible Causes: No. of cashier windows open,
Printer/network issues, Incomplete documentation etc.
6. Identify Potential Improvements:Increase the number of cashier
windows open(especially at rush hour)
7. Develop Improvement Theory: Create trigger system for supervisor to
improve customer flow. Maintain wait time to 15mins.
8. Develop Action Plan: Pilot Program – One additional cashier added from
Correspondence and additional cashier/swhen wait time exceeds 15 minutes
1. Implement the Improvement:Implementation of Pilot
Program for a week
Do
2. Collect and Document the data:Wait time reduced by 50%
3. Problems, Observations, Lessons LearnedPilot Program ImplementationDay 1: Ran a snag – 4 staff out
Day 2: Successfully implemented Pilot Program (5 cashier windows open)
Day 2-5: Pilot Successfully implemented
Check/Study
1. Reflect on the Analysis:Data obtained for wait time - 1 Week
pilot program. Cashier Survey data
Act:
2. Document Problems: Unavailability of Staff and Communication issues.
Observation: Smooth running of pilotLessons learned: Customer Wait time
directly proportional to # of cashier window open
Adopt
Adapt
Abandon
Standardize
Do
Plan
Vital Statistics
Priorities: Enhance the
ability to serve customers in timely
fashion and reduce long
wait times
Develop:MOU’s, SOP’s
Execute:Project
implemented after studying the pros and cons of
and fine-tuning theprogram , maintain
any progress.
Feedback:Cashier feedback
(Pilot project)Customer Survey
Incentive:Satisfied customers
reflect job well done by HDHHSVital Statistics.
Demonstrate:Measurable
improvementin HDHHS
Vital Statisticscustomer
wait time.
Overcome:Language barriersand geographical(satellite location)
barriers.
Encourage: Staff
and partnersto maintain
usage of available resources / manpower.
Develop:Agreements
between HDHHS
Vital Statisticsfor implementation
of pilot program
Prepare: Roadmap to
implement pilot program
and overcome any foreseen
barriers
Document:Pros and Cons
of Pilot program
Develop: Avenues and
trigger modules for Vital Statistics
Supervisor/s to access other
resources/manpower
Prepare: Pilot program
Instruct:Supervisor/s,
Cashiers
Identify:Supervisor, Cashier
and staff roles / responsibilities
Implement: Pilot program for 1 week
Evaluate: Data
Participants:Supervisor/s,
Cashiers,and Staff of
HDHHS Vital Statistics
Agencies:Satellite location
partners and otherAffiliated partners
Staff: HDHHS
QI STAR Trak TeamVital Statistics
Materials: Office supplies
Cash boxes(Vital Statistics)
Equipment:Printers
Xerox machinesComputers
Inputs OutputsActivities Participation
Outcomes- ImpactShort term Medium Term Long Term
SituationHDHHS Vital Statistics currently experiencing average customer wait time of 28minutes. Among the reasons for these difficulties is few cashier windows open to serve customers.
AssumptionsVital Statistics will work collaboratively
to implement the project
External factorsStaff feels alienated, incentives not good
enough to motivate and organizational bureaucracies.
EvaluationDemonstrate measureable improvement in Vital Statistics customer wait time. Customer Feedback Survey
And Cashier Feedback. Increase in customer satisfaction to access HDHHS Vital Statistics resources.
Goal: Build avenues to instruct supervisor/s on available resources that can be implemented to reduce customer wait time and assist them to adopt multiple trigger modules to use the available resources. Avenues created are flexible to accommodate all barriers.
Houston Department of Health and Human Services (HDDHS) aims to reduce Vital Statistics customer wait time.
Cashier Survey
Bureau of Vital Statistics - Cashier Feedback
STAR Trak (Blue Team) Pilot program initiative
(To be completed by Cashier)
Cashier Initials (optional): _________________________________________________
Cashier Work Days and Hours: _____________________________________________
Did you like the STAR Pilot Program Initiative? Yes/No: _______________
Why? (please provide details): ___________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Please provide any suggestion/comments to improve the program:
____________________________________________________________
____________________________________________________________
Thank you for your participation!
Customers waiting in lobby with 4 Cashier Windows Open Pilot program - Friday 06/08/12 at 2 pm
Cashier Feedback (N = 6)
Q. Did you like the Star TRaK Pilot Program? A. Yes = 5 No = 0
Cashier Comments:“Were able to assist customers faster, continue with more windows open.” “Compliments from customers really made me feel good.”“One [extra] window does make a difference.”“Need to keep more windows open.”“Enjoyed all windows being open, made everything flow smoothly and faster.”“Need more bilingual staff.”
Update on improvement effortsUpdate Cashier Standard Operating Procedures
(SOP)Brought on board temporary staff for Vital
StatisticsStreamlining tasks Workload analysis, resultsPerformance expectations – improved Bureau &
staff functionality New vacation/ sick time policyStaffing levels to improve efficiency &
effectiveness
Lessons LearnedBlack box / Ripple effectCashiers
Great customer service skillsEfficient and FASTExcellent troubleshooting
Control what you can control… Customer Cashier
???
Lessons learned from Vital Open to change, constructive criticismGoal improved customer servicesListen to othersSuggestions are a way to improve
Improvements ≠ failure it is an opportunity to make it even better