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Lean Six Sigma Process Improvement Results:
Increased audit processing throughput by over 100%

“Physician heal thyself” was the operative phrase for this nonprofit healthcare organization. The Quality Management Team tackled their own overwhelming workload with Lean Six Sigma with amazing results. Lynne Emmons of Valle del Sol has a great story to tell!


Project Summary

Quality Management Revamp: Improving the audit processing throughput.

Due to the rapid growth of their organization, Lynne and her process improvement team sought to increase the work done in the amount of another person without being to be able to hire for said person.

…we were growing rapidly as an organization and we had to find a way to basically get enough work done for a whole [extra] position without being able to hire [the employee].


Define Phase: Identify the Problem

After initial research, Emmons found:

  • The team was currently doing about 283 different deliverables– ranging from audits, licensing, meeting, attendance, and trainings.
  • The processes that were taking the most amount of time were audits.
  • With the low threshold of staff, the team ran into situations where the deliverables went beyond the deadline

And so, if you look at the number [283 deliverables], that’s about 30% increase there to 345, that’s why we shop for that number. And we need to do that sooner rather than later.

Lean Six Sigma Tools Used: Project Charter, SIPOC, Gemba Walk, Voice of the Customer,


Measure Phase: Quantify the Problem

To collect the data, the team measured cycle times, generated surveys and looked into information from the various processes needing to be delivered.

  • The team found that the average time in audit processing was taking about 12.5 hours, and in order to increase through put by 30%, they need to improve the processing time to under 8 hours.
  • By creating a Pareto Chart, the team was able to see that manual audits accounted for 80% of the deliverables.
  • After creating a Value Stream Map, the team found a multitude of non-value-adding steps, including redundancies and unnecessary steps.
  • Key Take Away: Approximately 90% of the current manual audit process included waste in the form of: Redundancies, Inspections, Wait Time and Corrections.

This was actually the tool [Value Stream Map] that launched me into the Green Belt training because I was like, OK, I kind of got an idea what this means but I need more education to be able to use this one. So that’s the one that actually triggered me into getting the Green Belt training.

Lean Six Sigma Tools Used: Data Collection Plan, Process Walk, Pareto Chart, Value Stream Map


Analyze Phase: Identify the Cause of the Problem

It was time to identify the root causes, so Lynne and team went to work.

  • By using the Fishbone Diagram, the team found that their most common observation was that there was a large opportunity for spending time improving their own department, rather other departmental issues.
  • By utilizing an Impact Effort Matrix, the team identified issues that were out-of-scope, which included things that required money to address, or as simple as the problem occurring in other departments.
  • After conducting a Value-Added Flow Analysis, the team realized that 38% of the 37 steps were of waste, and that 50% of the steps were required.

We’re so busy trying to help others improve their processes that we’re not even looking at our own department. So we have been doing things the same way for years and we’re not being very structured about it. We’re not doing any additional improvements to it to try to make it a better process. And so, that was kind of our first like aha moment like we need to use our own skills to help ourselves so we can help others better.

Lean Six Sigma Tools Used: 5 Why’s, Fishbone Diagram, Value-Added Flow Analysis, Root Cause Hypothesis. Impact Effort Matrix


Improve Phase: Implement and Verify the Solution

After conducting the necessary research, the team verified their hypothesis and the began the implementation of process improvements:

  • By taking advantage of their Impact Effort Matrix, the team identified numerous potential improvements ranging from:
    • Consolidating redundant standards
    • Retraining supervisors on documentation requirements so everyone is on the same page.
    • Re-ordering steps of an audit to minimize waiting/delays
    • Creating templates for each audit tool
  • The team voted for 30% of the solutions by targeting QM Department Workflows, Customer Services, and Quality Improvements.

The Improvement Results:

  • QM Audits on average decreased from 12.4 hours to 4 hours to complete
  • With savings of 17 hrs/wk, QM implemented 7 new audits, increased the frequency of 7 audits and produced 8 Customer Improvements
  • These improvements led to a total savings of $30,768 in paid wages and increased employee satisfaction on reports by 25% and QI by 14%

There was not one cure. There were many smoking guns here.

Lean Six Sigma Tools Used: Implementing Improvements, Reducing Process Steps, Templates Created, Increase in Customer Surveys.


Lynne Emmons

I remember when I first got approval from my boss to pay for the Lean Six Sigma training, he said, “That’s manufacturing. How is that going to apply here?” And I said, “I can think of tons of ways that it could apply them. I mean I just finished the Yellow Belt and I had a long laundry list of things that I could improve or just quick changes.”

Lynne Emmons
Director of Quality Management and Compliance, Valle del Sol

Control Phase: Maintain the Solution

To aid in controlling the results, Lynne shares that they have since implemented a Monitor & Response Plan by continuing to collect the data and consolidate the information into an Excel workbook so that they could track every audit. In doing so, they could pull pivot tables to track key metrics, like defects and touch time.

We are able to track how we’re doing and moving forward. We’re able to diagnose any challenges or issues that we might have in the future. We are able to drill down that level of detail that we would need.

Lean Six Sigma Tools Used: Monitor & Response Plan, Executive Summary


A Sneak Peak Into the Full Success Story Webinar:

Elisabeth Swan: So based on the world you’re in, do you have advice for someone looking to apply process improvement in the nonprofit industry?

Lynne Emmons: Yeah. My first piece of advice would be to challenge anybody who says that it’s not possible. I remember when I first got approval from my boss to pay for the Lean Six Sigma training, he said, “That’s manufacturing. How does that going to apply here?” And I said, “I can think of tons of ways that it could apply them. I mean I just finished the Yellow Belt and I had a long laundry list of things that I could improve or just quick changes.”

…challenge anybody who says that it’s not possible.

And so that was probably my first one is it applies. It definitely applies. It applies to any process that you’re working on. Heck! I used it at home too. So it applies everywhere. That’s probably my number one.

And then my number two is to be patient. I’ve come to notice as we’ve done more projects that a lot of times, you have to involve people from other department and they are still – I’m doing 50 hours’ worth of work and a 40-hour workweek. So fitting in additional time to go to these meetings, we had to be super patient. Still happily and lovingly pushing them along to get to the completion of the project but being very understanding when action items may not always get completed because they are taking this on in addition to, they are already very busy and full workload. A nonprofit, right? We’re always going to be fewer in numbers than what we need. So just being patient with that and understanding with that.

A nonprofit, right? We’re always going to be fewer in numbers than what we need. So just being patient with that and understanding with that.

Elisabeth Swan: That’s nice. You’re definitely this world doing what would last. And we’re working with a lot of nonprofits so I appreciate your willingness to be – give us this much information and just share your experience. That’s going to be helpful to other groups trying to apply process improvement in the nonprofit world and any world really. I mean a lot of what you’re talking about applies to every office sort of process that people are involved with.



View Slides

Success Story Transcript

Elisabeth Swan: Hello! And welcome to our Success Story series hosted by GoLeanSixSigma.com. My name is Elisabeth Swan and I’m the Managing Partner and Executive Advisor at GoLeanSixSigma.com.

And we are very excited to have this offering for our audience because this is where the rubber meets the road. This is when we highlight someone who has actually completed a real project that has been implemented with real impact and we get to share those stories with you.

About Our Presenter

And today, we are highlighting a project success story from Valle Del Sol and our presenter today is Lynne Emmons and I’m going to tell you a little bit about Lynne before we start. So Lynne is an Arizona native and she caught her big break in health care by selling golf balls and lemonade, I like this, to raise money for her community’s first health.

And years later, she paid her way through college by working with youth diagnosed with autism and she graduated with a Master’s Degree in Marriage and Family Therapy. When she was looking for an opportunity to be of service in her community, Lynne started her career as a therapist and she worked her way up the ranks at Valle Del Sol to her current position as Director of Quality Management and Corporate Compliance and Privacy Officer.

And Lynne is also the new Chair of the Arizona FQHC, the quality improvement committee. And in this capacity, Lynne is going to be able to drive change initiatives that impact health care for over 5,000 Arizona and New Mexico residents. So that’s huge. I’m sure we’re going to hear more from Lynne about that.

When not navigating health care systems and ensuring quality service delivery, she loves time with her family and chasing her 6, 3, and 1-year-old children. Nothing minor.

Well, thanks for joining us today, Lynne, and thanks for sharing your success story. So, why don’t you tell us a little bit about your project?

QM Revamp Project Storyboard

Lynne Emmons: I would love to. So for our project, we – I oversee the Quality Management Department and we were growing rapidly as an organization and we had to find a way to basically get enough work done for a whole another position without being able to hire for a whole another position. So that was what prompted this project.

…we were growing rapidly as an organization and we had to find a way to basically get enough work done for a whole another position without being able to hire for a whole another position.

I took the Yellow Belt Training with GoLeanSixSigma.com and I used that to launch this project and probably about midway through or towards the end of this project, I got my Green Belt so I was able to continue to build upon those improvements that we identified. So that’s a little bit of the history of what started this project and what my background was with Lean Six Sigma.

Elisabeth Swan: So you have to make this happen because you didn’t have the position you needed to get the work done that you already done.

Lynne Emmons: Correct. I went to my boss and said, “Hey, we’re adding all these programs. We’re adding all these patients. I need more people for that.” And he said, “Well, we don’t have the budget for that so you’re going to figure it out.” So this was our solution. How do we make it better, faster, more efficient? Turn that back. So that was it.

“Well, we don’t have the budget for that so you’re going to figure it out.”

Project Charter

So you’ll see here, the goal statement was to increase – we were doing about 283 different deliverables. And deliverables could be audits, licensing, meeting, attendance, trainings. We had about 283 that we were doing throughout the course of the year. And so, if you look at the number, that’s about 30% increase there to 345, that’s why we shop for that number. And we need to do that sooner rather than later.

Elisabeth Swan: And you said that most of deliverables were audits but there were some other pieces involved there.

Lynne Emmons: Yeah. The ones that usually take a largest amount of time are the ones that were audits. The licensing, the meetings, those are ones that were usually pretty quick. Get it done within an hour or two.

The ones that usually take a largest amount of time are the ones that were audits.

So that’s kind of what we were looking for. With the low threshold of staff, we were running into situations where our deliverables were now becoming late which was making them outdated and not very helpful.

8 Wastes Check Sheet

And so we started off by doing the 8 wastes checklist and really the key takeaway from this was that we needed to identify ways to cut out some of those high impact areas. So we saw a lot of waiting occurring not only outside the department but inside. We tried to really focus just inside our department as much as possible.

And so, the team would be waiting for me to assign deliverables to them or we would transition deliverables from one person to another which required a lot of free training or the deliverables moving around to a lot of different people so there would be more opportunities for the ball to get dropped.

Elisabeth Swan: Nice. I like the way you used it as focusing device.

Lynne Emmons: Yeah. And with each of these slides, there’s a lot of detail and a lot of information. I’m not going to touch on all of it. It’s just there so that if anybody who wants to freeze the webinar or look at the slides after, they can see some more the details they want to.

SIPOC: QM Deliverables

So for a SIPOC, we really identified that there’s a lot of different suppliers of our process and customers of our process. Again, we didn’t want to make any changes to our supplies or customers. We want to try to focus on the process from where we controlled it. So we did look at that to think about if there were ways to improve that process. And we definitely checked in with our customers which you’ll see in the bottom right hand side there.

And really, our big takeaway from this when we were doing it was that we’re sending out these reports. We’re giving them all this information in data on how they are doing. Well, we weren’t doing any quality improvement with it. We weren’t telling them how to fix it. We were I guess just assuming that their supervisors and their leadership knew how to and they would help them to address it.

So they get this report and they’re like, “OK, now what? What do I do with this?” And it just wasn’t making it easy for them to take that information and run with it.

…it just wasn’t making it easy for them to take that information and run with it.

Another big kind of takeaway in here is we weren’t including the right information. They are like, “There’s too much. It was a wrong information and not enough of the right information.” So we really looked at that as well.

Elisabeth Swan: Yeah. I heard the expression, “We are data-rich and information-poor.”

Lynne Emmons: Yes. DRIIP. Data-Rich Information-Poor. That was exactly what was going on.

DRIIP. Data-Rich Information-Poor. That was exactly what was going on.

Voice of the Customer Translation Matrix

All right. So what the customers were saying we hypothesized what we thought they were going to say so it kind of gear our satisfaction survey to get an idea of what their feedback was going to be. And so, the ones that made it to the grid are the ones that we have the greatest findings on. And so, you’ll see there they want to know what their mistakes are specifically and how to go in and fix it. So we needed to give them this specific information and also, they’re able to make it possible to correct.

And then this industry has so much changed. And so they need to have the information before the changes happened. So there are a lot of times where we might change things as a department or as an organization. And so, we need to be better about communicating that.

Elisabeth Swan: So do you want to describe a little bit who your customers are?

Lynne Emmons: Yeah. Our customers are our employees because our reports are meant for their purposes. So it could be leadership. It could be our direct care staff. Ultimately, we anticipated or we perceived that the only people that were looking at this was leadership. And even that if we were lucky.

Our customers are our employees because our reports are meant for their purposes.

So we wanted to make sure that these were going to be useful not only at that level but at our entry level staff as well. So the ones that have their goods on the ground and are providing the services and doing the actual work trying to cut out some of that middlemen as much as possible.

As you see down at the bottom there, the two hypotheses we thought that they were going to say that they weren’t reviewing their report, it turns out only 17% said that they never seen one. So they are seeing the reports. They just weren’t understanding them or they weren’t the right information or there wasn’t enough there to help them work through it. So that was kind of a neat thing to see because we just anticipated, “All right. We’re sending this out.” But does anybody actually looking at them?

Elisabeth Swan: Does anybody listen? You’re doing a lot of work.

Lynne Emmons: Yes. So it was really neat to see. All right. So, we have several different – as we said we focused on our audits, we have several different types of audits. And we thought it might be helpful to kind of look at not only where they fall on the touch time here but also what type of audit and where they fall on here.

Deliverable Touch Times

So the baseline weight on average in audit was taking about 12 to 12 and a half hours for audits. And when we figured out that we had to increase our deliverables by about 30 to 33% that basically means that we have to get that time down to under 8. So that was the target that we needed to set for ourselves is just a little bit under 8. And you can see a lot of these deliverables were taking longer than that. And majority of them are the manual audits or the ones that were hybrid which means that they are sometimes manual and some parts of are automated.

Touch Time by Audit Type

So we took that information and that leads into the next slide which speaks about the different types of audit and the amount of touch time it requires. So when we did this Pareto Chart, we were able to see that the manual audits and then the hybrid which has part of them including manual audit were taking up 80%. So that’s where we really needed to focus our efforts and we kind of gleaned from that that peer reviews and automated reviews were maybe the way to go as far as improving this process and trying to get some of those times down.

Elisabeth Swan: That’s interesting. So the Pareto gave you where the worst of it was but also a potential better practice.

Lynne Emmons: Yes. All right. So you can see here right, we are putting out about 283. We needed to get to 345. There are some of the data there. Our process, we would be doing quality improvement almost every step of the process as we were trying to improve things or work with individuals.

VSM – Screenshot

So have challenges in each step of the process. When we were sampling, sometimes we would sample too early and so when we go to do the audit it was irrelevant. The staff were no longer with us and so recording on it was not going to be very helpful or the charts that we worked in the medical record. And so the charts would be closed and they didn’t need to be audited. We need to look active charts.

So those were some of the challenges of the sample. And then for the audit itself, we saw a lot of redundancies there. And you can see when you look at each section of this here that the audit and the Q1 review were the ones that were taking the longest amount of time. So about 43 hours is the high end and it could take as low as a quarter of an hour on an audit versus the Q1 review and staff wait time.

So we had a built-in inspection in the process where we would send out our report internally in our department and see if there were any errors because we had so many errors that would come up those reports before we actually publish it and send it out to staff. So we noticed that there is a lot happening there.

And then the other one is our SOLAR. So the SOLAR is a Shared Operational Leadership Analysis and Recommendation. It’s an acronym. And it’s the name of our report. So when we would do the analysis and the report, it was a lot of moving from Excel and putting it into Word and getting the formatting just right. And it was something we were doing every time we were pushing out one of these reports.

And on average, our quality improvement efforts were taking about 10 to 11 months. So we would add these free generic recommendations on there and then it would take us 10 to 11 months to actually accomplish it because it was so generic and not very specific and measurable. So those are some of the things that we found when we looked through the data.

Elisabeth Swan: Yeah. And I can hear your description, the moving into Excel, there’s the motion, the formatting, that’s non-value-add like all kinds of wastes you guys were uncovering. It’s a great value stream map. Thank you.

Lynne Emmons: Absolutely. This was actually the tool that launched me into the Green Belt training because I was like, OK, I kind of got an idea what this means but I need more education to be able to use this one. So that’s the one that actually triggered me into getting the Green Belt training.

This was actually the tool that launched me into the Green Belt training because I was like, OK, I kind of got an idea what this means but I need more education to be able to use this one.

Elisabeth Swan: The value stream map one?

Lynne Emmons: Yes.

Elisabeth Swan: That’s how we got you.

Lynne Emmons: That’s how you got me. Well, you actually got me with the Yellow Belt training to be honest. I was sold the minute I took that training. I remember I went to my team and I said, “All right. I want to try something new. It’s going to be pretty interesting.” And they have learned that when I used the word “interesting” usually they’ll buy it because they know that it’s going to be something for the better.

Elisabeth Swan: I think you said in the beginning that you were doing this without – you were lacking a whole position. So really, the work fell to them. So all of this was in the interest of making their lives easier because they were all overloaded, right? Everyone was doing overtime.

So all of this was in the interest of making their lives easier because they were all overloaded, right? Everyone was doing overtime.

Lynne Emmons: Exactly. Their salary positions but they still have a life and being in the health industry, we believe in work-life balance. And so, they need to be able to have that too. And so we needed to get something that was going to fit.

Fishbone Diagram

So this was our fishbone. And we did stickies. So we started with just throwing up some observations and then kind of clustering them together. And after that, we voted on the ones that we felt were the most important to probably hone in on or look at a little bit deeper. Those are the ones that you’ll with the green dots.

And so the one that won out over all of them is at the top, it’s a little bit hard to read because the stickies were sticking up but it says, “QI-ing our own department. Probably improving our own department.” We’re so busy trying to help others improve their processes that we’re not even looking at our own department.

We’re so busy trying to help others improve their processes that we’re not even looking at our own department.

So we have been doing things the same way for years and we’re not being very structured about it. We’re not doing any additional improvements to it to try to make it a better process. And so, that was kind of our first like aha moment like we need to use our own skills to help ourselves so we can help others better.

Elisabeth Swan: The expression is, “The cobbler’s children have no shoes.”

Lynne Emmons: Yes. I haven’t heard that one before but that is completely the truth. We’re sitting there wondering like, “Why aren’t we helping ourselves?”

So we had a lot of ideas, a lot of resources to kind of tap into. We threw those all up in a list and then as they – as individuals, we threw up into different quadrants then voted. Some of them, we didn’t match so we ended up settling on these are the areas.

Impact Effort Matrix

And so, the ones that are in red, again if you remember at the beginning, I said that we’re going to try not to focus on other departments so the ones in red are the ones that either require money or it’s focusing on other departments, which was out of scope. We didn’t want to discount it completely but we just wanted to highlight like if we’re going to move forward with this, we need to be very mindful that we’re changing our scope of this project now. So that’s what we had there.

…we need to be very mindful that we’re changing our scope of this project now.

And so, really what we did is we took all of this information and we voted on the 30% of the solutions that we wanted for our department. So if we go to the next slide, you will see what we kept and what we tried and didn’t work. So of all those solutions, these were the ones that we voted on, that we want to give a shot.

The ones that have strikethrough on them are ones that we tried. We spent a little bit of time investing in them and it just seemed like it was more work than it was worth or it just didn’t seem to work with the workload didn’t work and practice the way we thought it would in theory. So that was a lot of those were. It was a hefty endeavor with all those solutions.

Elisabeth Swan: Yeah, and interesting because some of them as you say, you piloted them and it didn’t work so you had to chunk them.

Lynne Emmons: Yup, had to get them out of there.

Value-Added Flow Analysis

So this is what the process looks like before our improvements. You can see there’s a lot of red, so that would be our non-value-added, either work time or wait time that’s occurring in the process. And each of these are basically steps. They’re not actual times, more steps. But you can see there are 37 steps overall and about 38% of that is stuff that’s waste. And then another 50% is stuff that’s required either because of a step before or step after or because it’s something that we have to do for a regulatory reason.

And so, we needed to try to trim down that fast and get as close to that 10 and 11% as we could as the actual value-added work time.

…we needed to try to trim down that fast and get as close to that 10 and 11% as we could as the actual value-added work time.

Elisabeth Swan: Yeah.

Lynne Emmons: So we did that one of two ways. There were some deliverables, there were some audits that we still had to keep manual. So this slide shows the new process for the manual audits. We were able to cut down a lot of that waste. We cut out the inspections. We cut out moving the Excel graphs and charts into a Word document and instead, we built in templates into the Excel workbook and we used more pivot tables.

And so by doing all of that, it automatically updates on the document and then we can go ahead and just save that document as a PDF and send that out to our staff from Excel. So that was a big part of it.

We were able to eliminate some additional steps they have to take to close samples. So it was quicker. We released more reports for that. So we were able to get rid of a lot of that waste that was occurring. And so we were able – with this new process, this is still for the manual audit, we were able to get it down about 38%. We were able to eliminate some of that waste.

Elisabeth Swan: Wow!

Lynne Emmons: Yeah. It was a big deal. Anything that we could cut, we were chopping and hacking away.

Elisabeth Swan: Yeah. You went at this in many angles. There was not one cure. There were many smoking guns here.

Lynne Emmons: Yeah. And then this is the one that as if there is any smoking gun, it would be this one. It was moving a lot of our manual audits into an automated process. We work in an electronic health record. We have access to electronic tools. We were not taking advantage of them. We were still doing one chart of the time, manually looking at them, each one, each standard, one by one with a sample size of maybe 15 to 20 charts. We were doing it the way we used to do it when we had paper records. We have not been on paper records for over 15 years.

So, it was time to update that process. And so, this is the new process with the automated reports. So with these, we were able to do them more frequently so the staff could get the information sooner. So that was another challenge we had before is we would do an audit. We have to wait for the quarter to finish because they were mostly quarterly. We had to wait for the quarter to finish. We would do the audit in the next quarter and put it out before the end of that next quarter. So some of those data was at least 3 to 6 months old by the time they would get it. Not exactly helpful.

Elisabeth Swan: No.

Lynne Emmons: So this helped us to get that information out on a monthly basis for the previous month. And sometimes we even get it done by the 5th of the month for the previous month. So they’re able to get that feedback pretty quickly.

…sometimes we even get it done by the 5th of the month for the previous month. So they’re able to get that feedback pretty quickly.

Elisabeth Swan: Wow! Yeah, the lateness made it less usable.

Q:Drive (Before)

Lynne Emmons: Yes. It was – we were doing it because somebody externally was telling that we had to. So we eliminated a lot of wastes from that process.

We also found that we were spending a lot of time looking for things on our shared drive. And so, here are a couple of screenshots of the different folders or drives that we would work with then. So we apply 5S and we did some work in here and this is what it turned out to look like after it’s all said and done.

Q:Drive (After)

Elisabeth Swan: This is like digital dirty laundry. No one admits this. But whenever you talk about shared drive, everyone just groans and their shoulders slump. So this is great to see.

Lynne Emmons: It’s fantastic. And this drive is really typically only accessed by 3 to 4 people. So that big mess was just from the 3 to 4 of us, which made it pretty easy for us to correct too.

In the previous version, we have to go maybe like 5 or 6 clicks deep to get to the document that we needed to get to. The way that we reformatted it, we do a lot more archiving. And so usually, we only have to go 1 to 3 clicks deep to get to where we need to to get the information that we’re looking for.

Elisabeth Swan: Oh, that’s great.

Lynne Emmons: It’s a lot cleaner. It’s a lot easier to find the information we’re looking for.

Elisabeth Swan: Visually not chaotic. Easy to look at.

Monitoring Plan

Lynne Emmons: So after putting all of those efforts into place, we put together a monitoring plan. And one of the things that we decided to do was the data collection that we were doing at each different step of the phase, we decided to keep that, turn it into an actual form, and we would track that for every audit. And that really was going to help us put it into this Excel workbook. And with that, we’re able to identify where we need to improve. So we’re able to pull some pivot tables and see how were we doing, right? How are our defects? How are our touch time? Is it taking us a long time to get these reports out? We start it and it takes us over a hundred hours to get it out. So we’re able to look at that and drill maybe a little bit deeper to see where we need to go.

As you click once more, we can also make sure that when we’re assigning the deliverables that it’s more equitable. So that was one of the complaints that we had before as well that it just seems like some people might have a lighter workload than others. So with this, we’re able to do more data-driven assignments. We are able to track how we’re doing and moving forward. We’re able to diagnose any challenges or issues that we might have in the future. We are able to drill down that level of detail that we would need. And so, it really is kind of building for more in the future.

We are able to track how we’re doing and moving forward. We’re able to diagnose any challenges or issues that we might have in the future. We are able to drill down that level of detail that we would need.

Elisabeth Swan: Great. Impressive.

Outcome Metrics

Lynne Emmons: And it’s really nice. And as you can see here on this slide, you can see that we far surpassed our expectation. These numbers were from July of last year. And so, there are some – I have some additional numbers as well but we would track this in our monthly meetings every month. And our output increased too about almost 600 deliverables by the end of the year. So we went from 283 to almost 600. That’s more than double what we were doing before with some of these changes.

So we went from 283 to almost 600. That’s more than double what we were doing before with some of these changes.

Our touch time or our talk time was taking about 12 and a half hours. We wanted to get it down to about 7.25 so under 8. And as you can see month over month, we had it almost below 5. So we cut that time down by almost a third, a third or maybe even the fourth where we were originally. And that has continued to trend. For the entire calendar year last year, our average for all of our deliverables completed with a little 4 hours of touch time.

Elisabeth Swan: Wow!

Lynne Emmons: So we were able to maintain that over the entire year. And on the percent correct and accurate, we were basically only 11% of our audit for making it through the process without any defects or without any issues or errors. And so, we haven’t quite reached our 70% threshold yet. We hit it a couple of times throughout the year after this time period but it had definitely improved from where we were in the beginning. And we had a bit of catching up to do. The project put us a little behind so we put a hold on to some of our deliverables so that we could get this knocked out. And so, we were averaging about 71% so it dropped a little bit but we were seeing that increase month over month as we continued to capture this data.

Elisabeth Swan: Yeah. And that’s a good message for folks that sometimes you got – you’re going to suffer a little bit. You want to get this work done. You got to put some things on hold. But then as you see you catch up and you improved your throughput a 100%, not 33%.

Lynne Emmons: Yes. And guess what? We grew even more so we’re almost at capacity again. But we will have the data to be able to go to my boss and say, “All right. What do we cut or go to another position because we are past capacity.”

Elisabeth Swan: It’s a good story.

Executive Summary

Lynne Emmons: Yup. I think we’re almost but not quite. There’s always room for improvements. We’re almost as lean as we could be. So this is just your 1000-foot level view of the project. And really, the – of what we were trying to address here was that we didn’t have enough people and we still had more work coming in. And that can translate into a lot of risks that can translate into not having informed decision-making. So that was really the business case for this.

And so the root causes that we found is that the audits were organized. They took too long. We weren’t using the technology that we had available to us at that time. And our quality improvement was – it was – in a sad state of affair. We had more opportunity in that area than anywhere else when it came to the root causes.

We weren’t using the technology that we had available to us at that time.

Lots of solutions. We started an email trend that’s called “You Ask, QM Heard.” So anytime staff have requests or challenges, they will share that with us. And when we make a change or an implementation, we would say, “You ask. We heard. Here is what we’re doing about it and here’s the change that came out of it.” So, there were a couple of things that came out of that for our customers, our internal customers.

And to an extent, they also impacted our patients as well. The voice of the customer improvement survey results that you see in the bottom right hand there, the first couple of it that really appreciated the person with a consent bundle. This was the 5 to 6 forms that our patients had to sign and/or their guardians, if they had guardians for this. So we’re usually capturing probably anywhere from 12 to 15 signatures which would take up to 15 minutes. We were able to get that down to one form and as little as one to two signatures.

And so, staff really loves that and patients shared that it was a faster process as well. So those are really nice to see and you can see that a lot of the improvements, there wasn’t any negative feedback. They felt that it was very helpful and even some of the latter ones, the majority still thought that it was very helpful. So, really nice to see.

Elisabeth Swan: That must have been great.

Lynne Emmons: Oh yeah. It was really good feedback. And to be honest, there was self-reciprocating because these were things that we were doing that was cutting down the numbers, email requests to us their complaints, their grievances, their concerns that were coming through. So we didn’t have 20 people a month saying, “Where – how do I find those procedures again?” They all know that there’s a shortcut on their desktop to get them there now.

So we didn’t have 20 people a month saying, “Where – how do I find those procedures again?” They all know that there’s a shortcut on their desktop to get them there now.

Elisabeth Swan: So great.

Lynne Emmons: Yeah, it was really helpful. And we believe that we probably saved – this was a Yellow/Green Belt project so we probably saved you a little under $40,000, just the equivalent of a position is what we’re saying. Maybe even two considering that we doubled the number of deliverables. So I might even be so bold and say we saved two positions we’re needing to hire.

Looking Ahead

Elisabeth Swan: Yeah.

Lynne Emmons: So it’s pretty good to see.

Elisabeth Swan: That’s awesome.

Lynne Emmons: So these are kind of the areas either that we didn’t have the time to invest during the time of the project or that we said, “You know, we’re building the slate so that we can do some of these other things down the road.” So we’re doing more data-driven hiring. We’re doing a lot of the Just-In-Time training.

Eventually, we’d like to include control lines on our reports. That was more of a – we don’t want to shock our customers too. We already make quite a few changes to our reports. And so, letting them get acclamation of that and then we’ll start adding some of those other indicators in there.

And then we – with this project, we were able to launch a Lean Six Sigma initiative organization life. The leadership recognized some of the results that came out of it and the benefits from it. So we were able to start that process. That actually has already started. It’s pretty good.

Elisabeth Swan: Yeah. Lots happened there and you’re off to the races with – you said people who have been doing the training are starting to do their own projects. You don’t even have to – you haven’t even been sort of interfering. They’re just doing it.

Transfer Opportunities

Lynne Emmons: Yeah. It has been really neat to see. I’ll get emails on probably a weekly or a monthly basis which will say, “Hey, I just finished my Yellow Belt. Can’t wait to keep using it or to – I’ve got so many ideas that will walk past an office and I’ll see some swim lanes or some fishbones up on the wall or I’ve been seeing a lot more visual management around the building.” It’s kind of neat to see some of that stuff cropping out and popping out all over the place.

It’s kind of neat to see some of that stuff cropping out and popping out all over the place.

Elisabeth Swan: That’s really great.

Lynne Emmons: All right. So if there was anything really to take away from this webinar, these were the ones that we found to be the most valuable and transfer opportunities for others either in our organization or outside of our organization. So desktop shortcuts, don’t underutilize those or undervalue those. It’s something that you know you’re going to be getting into frequently. It’s very easy to add. And you can add icons to them. So for example, we change the color of our folders so they’re not just your standard Manila folder looking shortcut. You can change – so we have our green folder for our all of our procedures, an orange folder for all of our forms, and a pink one which has all of our reports in it. So staff always knows where they can go to get that information. It’s visually easy to see and to find on their desktops. That was pretty cool.

Hyperlinks and reports. So they said, “Hey, how do I fix this?” We already had job aids. We don’t want to recreate the wheel or make the reports any longer so we just added in some links. And the links would take them either to the procedure that explained this step by step or the job aid with a visual. Or if we have automate reports, some of our reports, staff can access on a daily basis and they can go there and they can double click on their name and they can find the information of what are they doing right or what do they need to improve on.

Kutools with a really awesome product is we were going to try to build a lot of macros; Kutools does a lot of them already.

We were able – for example, some of our audits are peer reviews. And so staff will complete these audits and they’ll send the reports back to us and we’d have to merge or consolidate and copy and paste all that information into one workbook. Kutools has a link or a tool on there that you just – were then like 3 or 4 clicks, it will merge all of that for you.

We record some of our trainings. So some of the staff was recalling the people and same thing over and over and over. And so every time we do that, it’s additional time when why can’t we use technology? So what we started doing is we will do a series of trainings. The first one will record and then the other ones will just have a link so people can go and watch it for themselves. And then we’ll be accessible now by phone, email or in-person right there. So it’s give them a little bit more freedom to do other things when there’s a recurring topic.

And the last one, probably my favorite, we used to actually call it “Crap You Should Know.” But we decided that wasn’t PC enough so we’re going to chase you to potty training. And it’s a one page document that we post inside the stall of the restrooms because we have a captive audience and it will be little tidbits of things that we want people to know that they can improve in their every day work.

Elisabeth Swan: That’s great.

Lynne Emmons: And in the Executive Summary it says that staff liked it for the most part. So it was a positive improvement.

Elisabeth Swan: Success!

Lynn Emmons: It’s very easy. We used to do like this whole newsletter and it would take weeks to get the staff hyped up and people weren’t reading it. And we did this and we know people aren’t reading it because they’ll stop in my office and was like, “I was just reading that and I have a question on this.” Oh, that’s too funny.

So those were the quick wins. Something that we could implement rather quick. As far as projects, just doing the work phase cleanup, using naming conventions, archiving and deleting. There are a lot of resources online that give you suggestions for shared online phases or shared drive.

And then if you’re in a QM department or even if you’re not, are you doing quality improvement on your own process? Are you looking at your own systems? I know you’re trying to use those tools.

The last one is, is there something that you got in Excel and you’re putting it into Word? See if you can create that Word document in Excel so that it will automatically updates and you don’t have to do all these copying and pasting over. That one alone has been a huge time favorite, at least one to two hours per audit that we saved just on that alone.

Questions?

Elisabeth Swan: Wow! That’s huge. That’s huge. So impressive, Lynne. So you really tackled this with sort of both guns and you really did it out of the box, right? You started on your own. You downloaded the Yellow Belt and then when you got – you were doing really good until you got to that Value Stream Map and then it took you to Green Belt.

But still, you did not have a tutor. You were doing this on your own. And it’s just incredibly impressive. And I know you’re now up against even more volume coming at you, which just means you guys are serving your population really well. But you’ve done your work. You’ve leaned out not just the position that was missing but then again another one. I mean 100% is hard to argue with.

So based on the world you’re in, do you have advice for someone looking to apply process improvement in the nonprofit industry?

Lynne Emmons: Yeah. My first piece of advice would be to challenge anybody who says that it’s not possible. I remember when I first got approval from my boss to pay for the Lean Six Sigma training, he said, “That’s manufacturing. How does that going to apply here?” And I said, “I can think of tons of ways that it could apply them. I mean I just finished the Yellow Belt and I had a long laundry list of things that I could improve or just quick changes.”

…challenge anybody who says that it’s not possible.

And so that was probably my first one is it applies. It definitely applies. It applies to any process that you’re working on. Heck! I used it at home too. So it applies everywhere. That’s probably my number one.

And then my number two is to be patient. I’ve come to notice as we’ve done more projects that a lot of times, you have to involve people from other department and they are still – I’m doing 50 hours’ worth of work and a 40-hour workweek. So fitting in additional time to go to these meetings, we had to be super patient. Still happily and lovingly pushing them along to get to the completion of the project but being very understanding when action items may not always get completed because they are taking this on in addition to, they are already very busy and full workload. A nonprofit, right? We’re always going to be fewer in numbers than what we need. So just being patient with that and understanding with that.

Elisabeth Swan: That’s nice. You’re definitely this world doing what would last. And we’re working with a lot of nonprofits so I appreciate your willingness to be – give us this much information and just share your experience. That’s going to be helpful to other groups trying to apply process improvement in the nonprofit world and any world really. I mean a lot of what you’re talking about applies to every office sort of process that people are involved with.

And tell me, what’s next for you in process improvement? What’s the result of – I know you were recently named chair of this committee.

Lynne Emmons: Yeah. So I’m actually probably in the midst of different phases of three different projects – four projects right now. First and foremost is getting Lean Six Sigma rolled out into the organization because the more people that I empower with these tools, the lighter my workload is going to be. And getting some of those improvements in place, people will be game changers all on their own. So that’s the first one.

…because the more people that I empower with these tools, the lighter my workload is going to be.

Another one that we’re working on is our intake process. So when new patients arrive into our organization, it can take anywhere from 3 to 6 hours of paperwork and interviews and everything else that goes with that before we’re done with them. We only get paid for about 90 minutes of it. So we’re working to cut that down. We’re very close to rolling that out. We’re hoping to get it down to about an hour. That’s our aim. We’ll see what the data shows after we put that into place.

And then this committee that I’m now chairing, we decided to go ahead and do a project for the state of Arizona. So – and FQHC is Federally Qualified Health Center and it’s basically a government overseen or granted organization that serves the underserved or the population that doesn’t have the income to afford. We have to be able to see everybody regardless of their ability to pay.

And so, one of the areas that we’ve been working on as a committee for two plus years is colorectal cancer screening, which is not a pleasant topic for a lot of people. And the CDC and the many initiatives are in place to try to get screening rates up to 80% by 2018. And I would say on average the FQHCs are probably closer to around – between 30 and 50%. So that basically means that half of our population that we’re seeing is not getting these screenings and 1 in 4 potentially has something there. If we don’t catch it early, it can be terminal. So the sooner it’s caught, the better.

So we’re working on this initiative to increase the state screening rate for these FQHCs by at least 15% in the next year.

Elisabeth Swan: And that’s going to impact a lot of lives, right?

Lynne Emmons: Yes, a lot of lives. If we can get the screening up to that level and the statistics holds true of 1 in 4 then that could be 5,000 preventable deaths within the next year.

Elisabeth Swan: Usually, you’re incredibly ambitious and a lot of people are going to be grateful and lucky for your intervention. So I’m looking forward to hearing about this project. We’ll come back and talk to you once you’ve gotten to the end of that.

I am Elisabeth Swan. You are listening to a GoLeanSixSigma.com’s success story highlighting Lynne Emmons from health care nonprofit Valle Del Sol. Thank you, Lynne, for joining us today and sharing your success story.

Lynn: My pleasure. I hope that I make an impact even for one person.

Elisabeth Swan: I know you have. You’re impacting me, Lynne. You’re impacting me. I also want to thank our listeners for joining us today. I hope you found this success story helpful and as inspirational as I did.

Thank You for Joining Us!

If you have a success story you’d like to share, send us a note at [email protected] Don’t forget to go to our website and view all of our other success stories and download free tools, templates, just like Lynne did, and lots of other resources from our website. We’ve got lots there for you.

So until next time, thank you for joining us.



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Elisabeth Swan

Elisabeth is a Managing Partner at GoLeanSixSigma.com. For over 25 years, she's helped leading organizations like Amazon, Charles Schwab and Starwood Hotels & Resorts build problem-solving muscles with Lean Six Sigma to achieve their goals.