Our Quality Journey using Lean Six Sigma and other tools

1. Our Quality Journey using Lean Six Sigma and other tools

2. 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 Belttrainingprojects (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 Belttraining 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.

3. Title XX Service Utilization Project Yellow Belt– Aging Services • Synergism Thru Sigma Team • Define – What’s Important? - Charter • Measure – How are we doing? – Process Map • Analyze – What is wrong? – Cause & Effects Matrix • Improve – Fixing things – Failure Modes & Effect Analysis (FMEA) • Control – Assure performance – Control charts

5. Client Engagement ProjectYellow Belt • Marriage Counseling • Focus on improving 1st appointment rate. • Streamline intake method, • 6% increase in ‘show rate’. • Team may have been below critical mass. • Unsustainable solution.

6. Develop Agency-wide DashboardYellow Belt • Went from a low level of report compliance to nearly all. • Quality of outcome measures improved • Stronger commitment to use Dashboard/ Scoreboard tied to Strategic Plan

7. Appeal Deposit ProcessYellow Belt • Define – Difficulty reconciling deposits • Measure – Realization of complexity of process • Analyze – Leadership support for change • Improve – Currently down to days instead of months with zero discrepancies • Control – Have maintained performance, team achieved Yellow Belt status, new related project focused on cash receipts.

8. HR Dept – Recruitment Expense & Time Reduction – Yellow Belt • Goal is 20% reduction in recruitment costs and 40% in cycle time. • Using focus groups, surveys, flow charting, and alternative solutions • Gaining new insights

9. Green Belt Projects via a Community Health Foundation Grant • 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.

10. Insurance Utilization Project • Impacting on lost revenue and improving 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.

11. Better balancing of payer mix within Aging Services • 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.

12. Improving computer support to the 50+ offices • 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.

13. Improved 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

14. Substance Abuse Services; a Federal NIATx Project • 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

15. 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 a real champion & right people on team 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! Lessons Learned

16. Future Steps • Implement a New York State Department of Labor Worker Skills Upgrading grant • Broad training of over 50 staff at the White, Yellow and Green Belt levels as well as Lean Thinking. • Structured improvement approach coupled with a Balanced Scorecard method of continuous improvement!

17. For more information, contact Michael Venezia, LCSWR, ASQ-CQM, CLSSGB Director of Quality Improvement (716) 218-1450 ext 298 mike.venezia@ccwny.org