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After using DMAIC to identify and eliminate waste in a process, Cape Cod Child Development reduced payment process rework from 25% to 5%.  

Nancy Sorbo is a Lean Six Sigma Green Belt and the Director of Enrollment and Family Child Development at Cape Cod Child Development, a non-profit organization dedicated to provide world-class child and family-focused programs that nurture each child’s full potential.

The Challenge

The cycle time for the payment process of their childcare providers was taking too long.

Nancy’s original intent was to learn more about the payment process, but with an average cycle time of almost ten days, she realized their system needed an update.

So she set out to improve it using DMAIC (Define, Measure, Analyze, Improve, Control).

Her goal? To reduce the amount of rework within the provider payment process from 25% to 5% in 6 months.

Once she had a clear goal, buy-in from her team, and the scope of her project in place, she was ready to continue to the next phase of her project.

The Discovery

To begin measuring the performance, Nancy needed a full understanding of the complete payment process from start-to-finish. To do this, she performed a Process Walk and created a Swimlane Map.

This helped her to outline the process and understand where waste and rework lived.

Then, by utilizing a Fishbone Diagram, she suspected to be causing the most rework was

  • the difficulty of reaching providers
  • the incorrect data received from the providers
  • and the number of people involved in the process

She found that the attendance sheet used by providers to record their hours was not formatting properly on providers’ devices. This left parts of the form empty that are necessary to continue the payment process—resulting in rework and time spent waiting for responses. Nancy was surprised by this discovery, and she realized, “that’s something fixable. That’s something we can improve.”

…that’s something fixable. That’s something we can improve.

The Improvements

From there, she began to implement solutions, which included:

  1. Providing education to providers regarding proper formatting
  2. Reducing providers’ workload by creating a sole email to receive the attendance sheets instead of the three separate emails they were using before
  3. Eliminating unnecessary printing by using two monitors and auto-populating the vouchers they needed to send to the Finance Department
  4. Discontinuing the use of paper checks – which required the CEO’s signature – by signing up providers for electronic payments
  5. Stopped using pink paper for attendance forms, which was part of a forgotten visual management system from the previous team–once again saving time and money!

All of this led to the improvement in rework within the process from 25% to 5%!

Nancy’s team is thrilled with their reduced workload and the ease of the process, plus the CEO is also happy to have her time back since she is no longer being tracked down to sign checks!

When we asked Nancy was her biggest takeaways were, she said:

 Communication… if you’re able to show your team or who is ever involved in the process how it will positively affect them… they’re more likely to [buy-in].

After the results they’ve achieved, we’re sure Nancy’s team is ready for her next big project: transportation!

If we’re able to change this process, get the buy-in, if you’re able to show your team or who is ever involved in the process how it will positively affect them, they’re more likely to say, “OK, this maybe work and maybe on top of my day-to-day responsibilities, but if I can see the benefit or the potential benefit,” they’re more likely to do it.

Nancy Sorbo
Director of Enrollment and Family Child Development, Cape Cod Child Development

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Elisabeth Swan: Hello and welcome to our Success Story series hosted by My name is Elisabeth Swan. I’m a Managing Partner and an Executive Advisor at

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

About Our Presenter

Today, we are highlighting a project success story from Nancy Sorbo and she is with Cape Cod Child Development. Cape Cod Child Development’s mission is to provide world-class child and family-focused programs that nurture each child’s full potential.

Nancy has been with this organization for two years. And prior to that, Nancy worked as a coordinator for hospice care.

Nancy also ran a licensed family care program.

Here’s a fun fact about Nancy. Nancy travelled recently, within the past two years, to Ireland with 40 members of her family in a bus and they still all love each other. So, I think Nancy is incredibly talented regardless of this project [Laughs].

Welcome, Nancy. Thanks for joining us today. Thanks for sharing your success story. So, tell us a little bit about your project.

Green Belt Storyboard Provider Payment Process

Nancy Sorbo: My project has to do with our Family Child Care providers who we need to pay for caring for our children. [Laughs] And they are licensed with our agency and they are certified with them. So what we do every week is we basically have to process their attendance and we have payment process that we go through to collect that attendance.

And the project I chose was their payment process because it had been unchanged for, if I had to guess, probably 20 years or so. It really and it was filled with rework. It was lengthy. It would – lots of handoffs. And I actually didn’t understand it enough. So that project helped me to really dive into it.

Elisabeth Swan: So what did you set out as a goal for the project?

Nancy Sorbo: Well, my goal was to decrease the amount of rework from 25% to 5% by November 1st.

Elisabeth Swan: And look at your Swimlane Map.

“As Is” Swimlane Map

Nancy Sorbo: Basically, I’ve just kind of walked through. We had to have the – all providers live in their separate homes so we require them to email their attendance to us. And that’s part of where the problem started. From there, we basically went ahead and printed individual attendance sheets and then we entered them into an Excel sheet.

And as you can see on this slide, basically, we sent it back to the providers to review and then they made some corrections and then we had to print out the forms. I had to review them and then I handed them off to Finance and then they went from Finance to being printed as paper checks, some of them, and then finally to our CEO to sign them.

And if all that was done, they got to got – they were uploaded to the bank.

Elisabeth Swan: I remember early on talking to you about this that doing that process walk, doing the gemba walk that you were like, “I had no idea.”

Nancy Sorbo: [Laughs] No. I knew it took a long time. I didn’t quite know all the reasons behind it.

Elisabeth Swan: So this was first window.

Baseline Data – Run Chart of Rework Per Day Period

Nancy Sorbo: Yes. So basically, when we collected the data, we were able to see that there was a minimum of five errors each time. Basically, an error meaning when our family visitor who collected all this data, she would have to reach back out to the provider because she either didn’t get it in the right format or she couldn’t read it or it was incomplete. And sometimes it would be multiple days before a provider would get back to her with the right information. And ultimately, that was significant because it could affect our billing. If we did not get our attendance in on time then we could not submit our Family Child Care billing to our larger agency and be the source of a delay to submit and get payment [Laughs].

Elisabeth Swan: So this impacted your cashflow.

Fishbone Diagram

Nancy Sorbo: Absolutely. And in my fishbone diagram when I looked at the different reasons, we could see that there’s lots of wasted motion and rework and that different sources were from the providers themselves. The data coming in couldn’t – we couldn’t get the information we needed and it was difficult to get. And the fact that we had so many hands in this process and so many handoffs and that all paint the picture of how much rework there was in the attendance sheets.

Elisabeth Swan: So just to think about the picture for folks out there, providers are independent. And as you say, they are operating – they are out there in the field. These are not people you can talk to in the office.

Nancy Sorbo: These are people who are busy taking care of children for ten hours a day, and that’s what we require of them that they have to be open. So us sending them a text or an email about their attendance when they are trying to feed children lunch, it’s not the most important thing sometimes. And then at the end of the day, they are tired and maybe they don’t get to it. So it’s easy to see why it could be as difficult as it was.

Elisabeth Swan: Yeah. And you had different technologies coming at you it sounds like.

Nancy Sorbo: Oh boy, did we? And the fact that a number of our providers have English as their second language, we are thankful we have a – ten of our providers are Portuguese-speaking. So that factored into this as well.

Elisabeth Swan: Yeah. There’s a big Portuguese community here on Cape Cod.

Nancy Sorbo: There is. Thriving.

Elisabeth Swan: Yeah.

Pareto Chart – Types of Rework

Nancy Sorbo: So, this was really kind of a highlight for me. When I looked at the sources of rework and we asked the person who collects the attendance, her name is Dee, to basically collect some data. And what it turned out to be, the main reason why we could not read the attendance was that the actual sheet was too big for the page and you could only see a portion of it.

So instead of seeing a whole week’s of attendance, you might see three days. The image was too large. And that all circled back to the different technologies being used, the user’s knowledge of use of technology, so I was surprised by that that. And to me that meant, that’s something fixable. That’s something we can improve. So, a little bit of an eye-opener there.

Elisabeth Swan: And I think, remind me if I got it right, but Dee would print each one of those attendance sheets out that she got from a provider, right? So then there was trying to format it or trying to get it to print and that whole too large issue meant you couldn’t get that to print on a page.

Nancy Sorbo: Correct. Right. And when she could see the image but when she went to print it, it would not fit on the page. So, that stopped her in her tracks. And then she would have to recontact the provider to send it in the appropriate format and then they wouldn’t understand sometimes what she needed.

Elisabeth Swan: What is that appropriate format?

Nancy Sorbo: It was kind of a circle.

Elisabeth Swan: I’m trying to feed some kid lunch here [Laughs].

Nancy Sorbo: That’s right. And I do have to mention my quick win pink paper …

Elisabeth Swan: Oh please tell.

Nancy Sorbo: … experience. Well, and this jumps back to our process walk. One of the things I realized and I had noticed this before that all the attendance sheets were on pink paper and I know I occasionally had to order, special order this pink paper because Dee asked me to, but I thought, “Well, OK, is there a reason we are using pink paper?” And when I asked Dee, she said, “I don’t why we’re using pink paper. It’s what we always used.”

And even worse than that was the fact that when she used the pink paper and put it in the copy machine, which is a shared copy machine for about ten people, she would have to yell down the hall, “Pink paper!” so that people wouldn’t send their documents to the printer and get their item on pink paper when only we wanted the attendance sheet.

So it’s a little comical. But we were able to eliminate the use of pink paper that day and we no longer order. We’ve reduced the cost because we can use the plain old white paper now.

Elisabeth Swan: And you said this that when you finally got down to the origin of this, it was that they wanted anything to do with payments to stand out.

Nancy Sorbo: Yes. So it goes even historically back in the older days when the Finance Department apparently color-coded the payments. So apparently, Family Child Care was pink. So that they visually were able to see the pink paper and know that was our attendance. I think that’s where the origin when I questioned more and more. That’s where it came from. But that was like eons ago.

Elisabeth Swan: So it was originally some form of visual management but people had even forgotten what that was for.

Nancy Sorbo: Oh yeah, all those people are gone [Laughs].

Elisabeth Swan: They are long gone but the pink paper remained.

Nancy Sorbo: It did.

Elisabeth Swan: So you kind of the buying of the pink paper, the yelling of pink paper, the mistakes on pink paper, the transfer, that was a hilarious quick win.

Solution Selection Matrix

Nancy Sorbo: It was. All right. Solutions. So when we looked at possible types of solutions we could introduce, the interesting part was and we weighted them, all of them were fairly easy and low cost and beneficial.

So one being, have a group distribution email. Our providers were having to send their attendance to three separate people and type in three different email addresses. We created one email address so they don’t have to type in one.

We also – oh, there’s the pink paper on there [Laughs]. And we also had some education around how to format the attendance before sending it in. So many of our providers don’t even – don’t have a desktop computer so they rely on their phones and they have to resize the image to send it appropriately. So, that helped a great deal when we did end up implementing that.

And two monitors. So as we got further down the line, we realized we don’t really even need to print out these attendance sheets. That in fact if we look at them on the monitor and had a second one, it could create the voucher from the viewing, they were already sent electronically and we were printing them out after they were sent.

So instead, we kept them in their format and completed the voucher. We do print out one sheet now instead but having two monitors has been great and we are not printing out all those individual sheets of attendance.

And then let’s see. We did ask some of our providers who wanted paper checks to join the electronic funds community with the rest. So that was another thing that we thought would be worthwhile to implement.

Elisabeth Swan: So just a few tugs into the modern age and everybody was online. That’s wild. These are great, great interventions. As you say, pretty low effort. I mean the only tech here was the two monitors.

Nancy Sorbo: And we already – I had one monitor and we had another one sitting around. So we had no expense.

Elisabeth Swan: No expense. I was wondering why that was a four because I thought, “That doesn’t look like it cost too much,” but it didn’t. It was sitting there.

Swimlane Map – Improved Process

Nancy Sorbo: Right. And now, our improved process as we can see, we now have removed 108 pages of paper each payment cycle.

And the other significant thing other than we’ve now don’t print any paper checks, we have also eliminated having to have our CEO sign anything [Laughs]. She is very busy. She didn’t need us tracking her down weekly to ask her to sign our checks. So we took that off. We took quite a few steps out of our whole process, which helped to reduce the cycle time overall.

Elisabeth Swan: I remember when you presented your project to the CEO and who is your sponsor and you got to that point and she did – hadn’t realized that she was now being relieved of all this check writing or check signing and you’re thinking not only is relieved with the check signing but you didn’t have to run around trying to find her to get the checks signed. So …

Nancy Sorbo: Absolutely. We had to know if she was in the building and all of that.

Elisabeth Swan: I’ve worked with her. I know how busy she is.

Nancy Sorbo: Yes.

Elisabeth Swan: So that’s incredible. This is great. I love seeing it right on the map there.

Verification of Improvement

Nancy Sorbo: We can see here from our collection of data after we implemented our solutions that the second monitor was effective. And also, the introduction of on August 8th the new email and the afterwards, as you can see, the second monitor. So there is the improvement and it feels really good to have had those be successful.

Elisabeth Swan: And so, you got that down this past November. How has it been since?

Nancy Sorbo: It has been steady. We’ve not seen any return to the errors of the past. We occasionally have a fluky week where some other factors are at work and they tend not to be the ones that we were measuring. So it sustained. We have sustained our improvement, which I’m really pleased to report.

Elisabeth Swan: And so – and this is you say there was 20 years of a process before you. Had Dee been in her role for a long time?

Nancy Sorbo: She has been in six years. So she knew this – she knew this older process quite well.

Elisabeth Swan: And so, she has completely shifted into this newer process.

Nancy Sorbo: She has. Not easy. I have to say for someone who is really – from her perspective although I think she is thrilled that she is not re-contacting providers over and over and over again.

Elisabeth Swan: Yeah.

Nancy Sorbo: That was frustrating and time-consuming for her.

Elisabeth Swan: That’s nice because I know that’s a hard thing where people have to – they’ve got to process down cold and it’s painful and, “What am I doing? What do you mean two monitors? This is all different. Can’t we just do this a little bit simpler?” And I knew both of you had to work that through.

Nancy Sorbo: We did. And she was a trooper and I’m very grateful for her and her efforts and she is on board.

Elisabeth Swan: And she really was part of this. I mean she collected the data. You really …

Nancy Sorbo: She is key. I relied on her because she is really the primary person and I’m the other person who does this, so between she and I.

Elisabeth Swan: And she taught you a lot of what really happens in this thing, what it’s all about. And you learned the process through going through this together.

Nancy Sorbo: And we did it forever and print it in my brain [Laughs].

Elisabeth Swan: Oh, that’s great.

Benefits and Lessons Learned

Nancy Sorbo: Benefits and lessons. So essentially, we reduced the amount of rework required, we’ve reduced errors, we’ve saved money by eliminating the need to print paper checks entirely in the overall payment cycle, it’s more efficient, and a fewer handoffs and people involved.

Lessons learned. This process was ready. Ready to be looked at, ready to be changed, and the climate was right. And thankfully for my Six Sigma tools, I think without it, it probably would have been hard to approach it and get it to where we needed. And final source, the data piece of what the error was, where, what was happening exactly.

So – and as I say, time dedicated to data collection is well worth the investment. It’s eye-opening. It’s time-consuming but it’s worth the time. And they are valuable. So thank you, Liz [Laughs].

Elisabeth Swan: It wasn’t me. It was you, you and Dee. You mentioned that this process because of all this rework took a long time and had a negative impact on cash flow. Do you remember where you started and how long it took and then kind of roughly what it is now?

Nancy Sorbo: Where we started in terms of …

Elisabeth Swan: How long this whole process took with all that rework? You had like from 5 to 8 times, you had to go back to providers so that sort of could go on for 9 days or more.

Nancy Sorbo: Right. So we have a 2-week cycle to get the payments done. We have to basically have it done the Wednesday before the Friday, so yeah, 8 or 9 days. And sometimes we were right up to that final day because we are waiting on someone or something to be accurate. And in that process, if you don’t do your piece, of course the next person can’t do theirs.

Elisabeth Swan: And now, what’s the timeframe? Now, how fast does it happen?

Nancy Sorbo: We are basically done – sometimes we’re done in 3 or 4 days. It’s really shortened. I’m surprised. Dee is so impressive that that window keeps getting smaller.

Elisabeth Swan: Tighter and tighter.

Nancy Sorbo: Yeah, it does. And I think part of that is you have a new process and in the beginning, it’s slower because it’s a new process. But as she has become more comfortable with it, that certainly helped too, the amount of time.

Elisabeth Swan: So you almost wiped out all the errors and you cut the time more than in half.

Nancy Sorbo: We did.


Elisabeth Swan: Nice work. So a couple of questions for you. What – do you have any advice for someone looking to apply process improvement in non-profit?

Nancy Sorbo: I think the – and I don’t want to make – you need to make – there might be a more of an education process for staff sometimes in terms of the need. Maybe not as focused on why it is necessary because maybe there’s a little bit more of a relaxed, can be, I would not say that across the board. But is this necessary? What we’re doing works. Granted it may not be working very well.

Elisabeth Swan: But it works.

Nancy Sorbo: But you might fight that a little bit more.

Elisabeth Swan: What did you find help you get passed that to sort of express the need?

Nancy Sorbo: Well, the communication. So I think as the owner of the project, you need to be clear about why – what the benefits are. If we’re able to change this process, get the buy-in, if you’re able to show your team or who is ever involved in the process how it will positively affect them, they’re more likely to say, “OK, this maybe work and maybe on top of my day-to-day responsibilities, but if I can see the benefit or the potential benefit,” they’re more likely to more to do it.

Elisabeth Swan: Yeah, it made her life easier.

Nancy Sorbo: It did ultimately.

Elisabeth Swan: And what’s next for you in process improvement, Nancy?

Nancy Sorbo: Well, how we – in my newer enrollment capacity, we have a transportation process that has a form and if that refused to kind of for a long time, it’s a paper form, so looking at that transportation process, so Family Child Care requires a bus and communication with another department in that process has …

Elisabeth Swan: Has some issues.

Nancy Sorbo: It does. It does [Laughs].

Elisabeth Swan: And you are going to tackle it.

Nancy Sorbo: I am.

Elisabeth Swan: That’s great. I’m looking forward to hear about that.

Getting Started

I’m Elisabeth Swan and you’re listening to a Success Story highlighting Nancy Sorbo of Cape Cod Child Development. I want to thank you, Nancy, for joining us today, for sharing your success story.

Nancy Sorbo: You’re welcome, Liz.

Thank You for Joining Us!

Elisabeth Swan: I also want to thank our listeners for joining us today. I hope you found this success story as helpful and as inspirational as I did. If you have a success story you’d like to share, send us a note and contact at Don’t forget to go to our website and view of all other success stories and download free tools, templates, and lots of other resources from our website. Until next time.

Get the inside scoop on many other successful Lean Six Sigma projects at our Super Stories of Success page. Do you have a story to tell? We’d love to hear about your own project success! Please contact us.

Elisabeth Swan

Elisabeth is a Managing Partner at, the co-author of The Problem-Solver’s Toolkit and co-host of the Just-in-Time Cafe. 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.